River blindness (onchocerciasis) is a parasitic disease, a worm affecting millions of people, mostly in Africa. Until the late 1980s, there was no magic bullet against the worm, Onchocerca volvulus. The available drugs had serious side effects and the sick, mostly poor villagers, couldn’t afford drugs anyway. River blindness control usually involved spraying insecticides to kill the blackflies that spread the infection, but the insects developed resistance to the poisons. A dreadful human parasite raged on.
Ivermectin discovered
In 1975, a soil sample from a golf course in Japan yielded a fungus that produced a chemical toxic to parasitic worms. From this chemical, scientists developed avermectins, a family of drugs effective against parasitic worms. Ivermectin, one of these drugs, was soon available to treat animal parasites, particularly worms in horses and heartworm in dogs. The potential for treating certain human parasites was intuitive to researchers, but there was a problem.
Medical treatment versus corporate profit
Millions of people would benefit from a drug that would treat and possibly cure river blindness, but most of these were poor people in undeveloped countries. An African infected with onchocerca could not afford even a few dollars, and countries lacked the money and the infrastructure to provide the drug. Thus, there was little incentive to develop drugs to treat human parasites that afflict the poor—any drug company that spent millions producing such a drug would have no one to buy their product. It was an ethical dilemma.
Merck and Co. Inc. steps up
The management of the pharmaceutical company Merck and Co. Ltd., under chairman Dr. Roy Vagalos, wrestled with the enormous potential benefits of Ivermectin to humanity versus the likelihood of financial loss. They came to an unprecedented conclusion—the probable benefits outweighed the probable losses. Merck and Co. Inc. spent millions developing and testing Mectizan, a human formulation of Ivermectin. In 1987, having no buyer, the company pledged to provide it free of charge to anyone who needed it, anywhere, in perpetuity. Eventually, Merck and Co. Inc. cooperated with the World Health Organization, the World Bank, non-governmental organizations, and local people in many countries to distribute Mectizan to those infected or at risk.
Treating river blindness
By 2001, drug treatment combined with insect control had alleviated onchocerciasis and risk in over 200 million people, mostly in Africa. It is estimated that 16 million children have been spared infection and that 600 thousand cases of blindness have been prevented. In addition, 25 million hectares of land, formerly infested with blackflies that transmit onchocerciasis are now habitable by humans. The current goal is to eliminate this human parasite entirely by 2020.
Other drug companies follow suit
Merck and Co. Inc. took a huge financial risk. In the end it paid off for the company—today they are still enjoying the benefits of the positive public image it generated. And they set a precedent for others:
- In 1996, Glaxo Wellcome donated Malarone, used to prevent and treat malaria.
- In 1998, SmithKline Beecham donated albendazole for another filarial parasitic disease.
- In 1998 Pfizer Inc. donated zithromax for trachoma, a bacterial eye infection.
These drugs have profitable markets in countries where governments and individuals have the resources to pay for them, but are a precious gift when donated to the poor in countries where the diseases they treat are common and devastating.
Read about onchocerciasis and treatment choices.
Related content:
Sources
Business Ethics. Velasquez, Manuel G. Upper Saddle River: Prentice Hall, 2002.
“Pharmacophilanthropy.” Wehrwein, Peter. Harvard Public Health Review.
"Stemming the Tide of River Blindness." Taylor, Hugh R. eMJA: The Medical Journal of Australia 2003;179 (11/12):617-619
Rosemary Drisdelle - Rosemary Drisdelle has been published many times as a nonfiction writer and several times as a poet. Her first book, Parasites: Tales of ...
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