When drug donations succeed
In 2007, pharmaceutical companies and medical supply manufacturers donated more than $2.6 billion of in-kind contributions (not including taxes, transport, storage and in-country distribution costs). Although we could spend hours debating which of those costs should be included - not to mention whether it is appropriate to value the products at wholesale prices- it's inarguably a lot of drugs - almost all of which comprise ongoing development programs (unlike in previous years, where up to 13% of contributions were for tsunami recovery and other humanitarian relief efforts).
In fact, the widely heralded success of trachoma control and the prevention of river blindness can be directly attributed to partnerships with pharmaceutical manufacturers, who contributed both products and managerial expertise. Since 1988, Merck has participated in the Onchocerciasis Control Program to control river blindness in Africa. Through donations from Merck, OCP has distributed Mectizan (ivermectin) to more than 45 million people to prevent and treat the disease with just one annual dose - a total of 472 millions treatments since the program's introduction, valued in excess of $1.5 billion. This was made feasible in part by the financial offsets from the drug's wide use to treat parasitic infections among agricultural livestock in the US and other wealthy nations. Merck has committed to donate the drug indefinitely, and since 1998 has also contributed Mectizan to treat lymphatic filariasis (in combination with albendazole from GlaxoSmithKline) - and in doing so, has paved the way for other successful large-scale drug donation programs.
Trachoma is another one of the leading causes of global blindness, and has been the target of a global partnership with Pfizer, which contributes antibioitics to treat the disease in addition to supporting a broader program of santiation, face-washing and education to address the disease. In Morocco alone, Pfizer has donated 4.3 million treatments of the antibiotic azithromycin since 1999, valued at more than $72 million. Unlike the predecessor treatments requiring 4-6 week regimen, Zithromax was a topical eye ointment that only required one dose to treat active trachoma infections and prevent scarring (and thus also reducing transmission within the community). By simplifying the treatment process and eliminating side effects like stinging and blurred vision, compliance increased and access was vastly improved. Morocco is now on track to eliminate trachoma entirely, and the International Trachoma Initiative has built on this initial success by expanding to fifteen countries.
But as Alanna pointed out, there are inherent limitations to relying on donated drugs and medical equipment to solve the much deeper health systems issues that impede the development of a functioning market for pharmaceutical and other health products - from the obvious challenges of affordability and delivery infrastructure to the more insidious incentive misalignments facing health donors, national governments and pharmaceutical manufacturers. (See CGD's work on demand forecasting for a more in-depth discussion of these issues.) Donation programs are just a bandaid: in the long run, we need pharmaceutical companies to incorporate developing country markets into their actual business practices, and for the international community to support government efforts to build rationale systems for drug approval, procurement, distribution and financing.
This is just one of many bandaids in global health, though, and I think our treatment of the subject requires more careful consideration. While we don't want to delude ourselves into mistaking a bandaid for a cure, there is also a very real risk of making the best the enemy of the good. It is relatively easy to point out all of the problems with the current development programs (just ask Bill Easterly), and much, much harder to propose better alternatives. Drug donation programs may not do much, but not only are they better than nothing, they also helped buy pharmaceutical companies an initial seat at the global health table back before it was fashionable. And that does have the potential to revolutionize global health. So now let's build on those partnerships to find a way for companies to sell their products - cheaply, affordably, but also rationally distributed and for appropriate indications - and happily accept the donated products as a stop-gap measure in the meantime.
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