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Friday, May 26, 2017

When pharmaceutical giants deserve thanks

Twenty-five years ago last month, something big started, a collaborative venture that changed the lives of hundreds of millions of people. For me the story began two decades earlier, when I was living in a Nigerian village, learning the language to help run a local health program. I can't forget the constant scratching of people in that village. Women spent their days carrying water, preparing meals, collecting firewood and working in the field, always with constant itching as the background. For men, too, itching ruled their days. And then men and women in the village would go blind. Their bodies were the battleground for parasites. Microfilaria were coursing through these people, the result of a female black fly sucking blood while depositing tiny larval forms of microfilaria that would mature as adult Onchocerca worms. As the microfilaria died, proteins released from a parasite they carried, Wolbachia, caused itching and inflammation that led to various ailments, blindness being the worst. But help was on the way. It would not reverse the early eye symptoms, but it would stop the process and the itching. The help was the positive side of globalization, when the benefits of science and transportation came to their village.
Help started as a soil sample from a golf course in Japan. It yielded an anti-parasitic compound produced in soil by bacteria. Merck initially developed the substance to protect dogs against heartworms. But the company did not stop there. It developed and tested a human version of the drug. Then it faced a dilemma. Merck had a drug so good it could inhibit the microfilaria of onchocerciasis for a year with a single dose. But the target population included some of the poorest people in the world. This was not a promising commercial endeavor. In October 1987, Roy Vagelos, then the chief executive of Merck, launched the largest pharmaco-philanthropic venture ever. He approached me, as the head of the Task Force for Child Survival in Atlanta, and offered the drug — now copyrighted as Mectizan — for free if the task force could devise a distribution system. All requests had to be approved by a destination country's ministry of health so that consistency with national priorities was assured. There were concerns. How long would Merck give the drug for free? What if side effects were not noticed until millions had been treated? How could people be motivated to take the drug if freedom from blindness would not be realized for decades? There was good news in the answers: Merck said that it would supply the drug as long as it was needed. Extended surveillance has shown this to be one of the safest drugs ever developed. And because the drug ended the itching suffered by so many, it was accepted much more easily than had been anticipated. The original target of treating 6 million people in six years was achieved in four years. Only 15 years after the program started, 250 million treatments had been given. Last year, the Mectizan Donation Program provided 140 million treatments for onchocerciasis in Africa, Latin America and Yemen. A quarter-century after the program began, 1 billion treatments have been provided free by Merck. The disease, also known as river blindness, is diminishing. Today, we can even contemplate its elimination, first in Latin America and eventually in even the most infected regions of Africa. Merck provided the science, product and inspiration. The Task Force for Child Survival provided a mechanism, the World Health Organization provided technical expertise, and the World Bank developed a program to secure funds for distribution. Former President Jimmy Carter personally enlisted the interest and help of heads of state in Africa. Dozens of nongovernmental organizations (NGOs) and ministries of health became active participants, and this union of a corporation, an ex-president and an NGO provided a power previously unknown in global health. This example has been replicated by programs that utilize mass distribution of drugs to treat what are called the "neglected tropical diseases," diseases that affect 1 billion of the poorest people on Earth. In some of the least recognized but most important global health efforts of this century, pharmaceutical companies are teaming up with more than 50 ministries of health in Africa, Asia and Latin America, as well as with the World Health Organization, the World Bank, UNICEF and NGOs to treat intestinal parasites of children (Johnson & Johnson and GlaxoSmithKline), to treat blinding trachoma (Pfizer), to treat lymphatic filariasis or elephantiasis (Merck, GlaxoSmithKline and Eisai), and to treat schistosomiasis (Merck KGaA). Each year these programs reach more than half a billion people at risk for neglected tropical diseases. Some regard it as politically incorrect to thank pharmaceutical companies, but in this case saying thanks seems insufficient. For millions spared the loss of sight and even more spared the burden of itching, there is no adequate way to thank Merck.

William Foege was director of the U.S. Centers for Disease Control and Prevention from 1977 to 1983. An epidemiologist, he received the Presidential Medal of Freedom in 2012 for his contributions to the eradication of smallpox.
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