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Globalisation and health

In this age of globalisation and growing insecurity, health is everybody’s business. The world faces continuing threats of war, poverty, environmental degradation and disease. And with the impact of global transportation and communications networks, a SARS outbreak in China can reverberate rapidly from Bangkok to Berlin. As Gro Harlem Brundtland, former Director-General of the World Health Organisation, has observed, “in an interconnected and inter-dependent world, bacteria and viruses travel almost as fast as e-mail messages and money flows.” [Gro Harlem Brundtland, “Public health challenges in a globalising world,” European Journal of Public Health 15, no. 1 (2005): 3-5, at p. 3. ] So public health, like economics and defense before it, has now become an area of foreign policy focus.

This is not just a concern for social scientists and politicians. Whether and how the world’s poor gain access to the benefits of globalisation will be a key factor in defining the political, business and economic climate for societies and for companies such as Merck in coming years. Just as transnational challenges affect private citizens and governments in a variety of ways — some obvious, others less so — corporations too must wrestle with the uncertainties of this new world, with new challenges, new actors, new governance mechanisms, and new institutions. Businesses need to engage with other stakeholders to play a role in addressing these challenges, contributing where they have unique expertise and resources.

Merck’s global engagement as a research-based pharmaceutical company logically has health at its core. The private sector – multinationals as well as local companies working in developing countries and emerging markets – has a vital role to play in helping to scale up and strengthen the provision of health care products and services. We discover and develop new medicines and vaccines —and these medicines must also benefit the people of poor nations.

The role of public/private partnerships

As with any other multinational enterprise, we can also make contributions to health and development by building robust public/private partnerships to address the challenges that face developing countries. Working together, we can achieve more than any single organisation or country can do on its own. Yet all too often public officials and others in civil society have neglected the resources and expertise that private sector companies can bring to bear in helping to find sustainable solutions to health care crises like HIV/AIDS.

Public/private partnerships are a cultural innovation that offer an important mechanism that really works to harness the complementary resources and expertise of the public and private sectors to achieve health goals. [A good introduction is Michael Reich, ed., Public-Private Partnerships for Public Health (Cambridge, Massachusetts: Harvard Center for Population and Development Studies, 2002). ] This mechanism can also help to ensure that we can contribute to collective learning in addressing global health challenges more effectively. And because good health leads to wealth, which in turn leads to growth and economic productivity, communities are then better equipped to deal with other challenges like poverty and social inequality.

Let me give two examples of partnerships that work and some of their implications: the MECTIZAN Donation Programme and the African Comprehensive HIV/AIDS Partnerships (ACHAP) in Botswana.

The MECTIZAN Donation Programme

Since 1987, Merck has donated MECTIZAN, a medicine that helps to prevent river blindness, to millions in some of the poorest countries in the world where this disease is endemic. Through a global network including the affected communities themselves, the World Bank, the WHO, dozens of national health ministries and dozens of NGOs who help to deliver the drug to the remote areas where it is most needed, last year alone more than 40 million people in 34 countries received free treatments through community-directed programmes. Another 20 million people received donated MECTIZAN to treat lymphatic filariasis in 8 countries where the two diseases are co-endemic.

The economic and social consequences of these programmes have been impressive – in addition to helping to eliminate one of the major causes of preventable blindness in the world, there have been significant and sustained benefits in terms of economic productivity (by improving the ability of people to work and of villages to return land near rivers to productive use) and community revitalization. [Brenda Colatrella and Jeffrey L. Sturchio, “Successful public-private partnerships in global health: lessons from the MECTIZAN Donation Programme,” in B. Granville, ed., The Economics of Essential Medicines (London: Royal Institute of International Affairs, 2002), 25-274]

The African Comprehensive HIV/AIDS Partnerships (ACHAP) in Botswana

Kofi Annan once observed that the world faces an increasing number of “problems without passports,” which will require all of our efforts to solve. Given these challenges, it is important to find common ground in defining and working together on sustainable solutions. Even if Merck develops great products for the developing world, without the right health system infrastructure or trained doctors and nurses to deliver care and treatment, those medicines and vaccines can’t do their job. With our knowledge base as a profit-making organisation, there are ways in which we can apply our skills within public/private partnerships to help developing countries achieve tangible results themselves.

The most ambitious public/private partnership in which Merck participates is the collaboration among the Government of Botswana, the Bill & Melinda Gates Foundation and Merck, designed to help Botswana transform their approach to the HIV epidemic across the spectrum of prevention, care, treatment and support. [Patricia A. Watson, ed. The Front Line in the War Against HIV/AIDS in Botswana: Case Studies from the African Comprehensive HIV/IADS Partnership (Gaborone, Botswana: ACHAP, 2004).] Merck and the Gates Foundation have each committed $50 million over five years to help Botswana implement its comprehensive national HIV/AIDS strategy. This project, begun in mid-2000, is making remarkable progress, in a country that has one of the highest adult HIV prevalence rates in the world (with more than one in three adults HIV+). As President Festus Mogae has pointed out, Botswana’s very survival depends on its ability to successfully meet its AIDS crisis.

As Merck, we decided to run this collaboration just as we would run a subsidiary – a business model — with clearly defined objectives and performance plans. (In fact, the first Project Leader had been the head of the Merck subsidiary in South Africa.) The results have been impressive to date. To give just one example, the government’s treatment programme already reaches more than 40,000 patients, roughly half of those in need of treatment according to the WHO – and close to 2000 patients are enrolling every month. This makes it the largest treatment programme in Africa. And, by the summer of 2006, if we can keep going at this pace, all of those who should be treated will be treated.

The power of partnerships

Let me close by coming back to the theme of partnership. In another context, Secretary-General Annan has said, “No company and no government can take on the challenge of AIDS alone. What is needed is a new approach to public health – combining all available resources, public and private, and using all opportunities, local and global.” [Kofi Annan, “The Global Challenges of AIDS,” Diana, Princess of Wales Memorial Lecture, London, England, 25 June 1999, available at www.un.org in Press Release SG/SM/7045.]

By working in this spirit – finding new approaches that work, building trust through cooperative action, embracing cultural differences and community values to find common ground, and harnessing the expertise and commitment of the private sector and other constituencies in civil society – together we can create innovative solutions to such global challenges as HIV/AIDS, environmental crisis, poverty and social inequality.

Dr. Jeffrey L. Sturchio, Vice President, External Affairs, Human Health – Europe, Middle East & Africa, Merck & Co., Inc.