An amazing tale of three men and a miracle drug changing lives of millions

By Maria Saporta

Three amazing men sat on the same stage to tell an amazing tale of how they led the fight to get rid of one of the most debilitating human diseases — river blindness.

The occasion was the 25th anniversary of the Mectizan Donation Project, and the location was the Carter Center — the site where it all came together in 1987.

On the stage were three men most responsible for this extraordinary tale of corporate philanthropy, public health and global leadership.

First to speak was P. Roy Vagelos, who served as the CEO of Merck from 1984 to 1994. It was under his leadership that Merck pledged to donate the miraculous drug — Mectizan — to all who needed for as long as it was needed.

Although Merck had discovered that the drug could prevent river blindness and treat the symptoms of the disease, Vagelos said the company had no idea how to distribute the drug to the people who needed it.

That’s when he zeroed in on Bill Foege, who had become internationally known for his leadership in the eradication of smallpox. At the time, Foege was both the executive director of the Carter Center and head of the Task Force for Childhood Survival (now the Task Force for Global Health).

Foege brought in former President Jimmy Carter who became the “top marketeer” for Mectizan in the countries that needed it most. As a former U.S president, Carter was able to open doors in a host of countries and get their top officials to sign off on the Mectizan Distribution Project.

Today, 25 years later, the partnership between these three men and their respective organizations has let to more than one billion treatments of Mectizan in more than 117,000 communities. River blindness, known in scientific circles as Onchocerciasis, now is in retreat.

The world has gone from having 100 million people at risk, 37 million people infected and 200,000 people who have gone blind from the disease to having river blindness become a disease that could disappear within a decade.

“I think we will demonstrate in the next few years that river blindness can be eradicated every where on earth,” President Carter said during the panel discussion.

The story of Mectizan Donation Project is one that needs to be told and retold, and it has become a model for “pharma philanthropy” — the charitable side of major pharmaceutical companies.

The tale begins at Merck when scientists discovered that a drug to treat parasites in animals could possibly treat humans who had been infected with the parasites that caused river blindness. People were infected with parasites after being bitten black flies living on river banks. Worms would grow underneath the skin, causing horrible itching and eventually would lead to blindness.

When Merck realized it had a drug that could help prevent the disease in millions of people, it went to the World Health Organization. But WHO didn’t really take the matter seriously and “walked away” from the possibility.

“Merck researches were not going to be left high and dry by WHO,” Valegos said, adding that the company continued to do clinical trials on the drug. “The word started to creep out that Merck had this remarkable drug.”

But when Merck officials went to the U.S. government with an offer to sell it at cost — about $2 million, they were told there was no money.

Merck then filed its clinical studies with the French government, and the company later heard that the drug was going to be approved in three days.

“We decided the company would do it at that point at no charge. We announced that Merck would contribute the drug free of charge for as long as it was needed,” Valegos said. “It happened so fast that I never checked with the board of directors.”

Valegos said the reaction to Merck’s pledge was “incredible” with employees and shareholders endorsing the idea. The company’s reputation soared.

But although Merck was willing to donate the drug, Valegos said it still did not know how best to distribute it.

That’s when he reached out to Foege, who agreed to take on the effort in 1987.

“In those days, there was no daylight between the Task Force and the Carter Center. Our offices were here,” Foege said, adding that President Carter began meeting with heads of states and became the top marketeer.

“When (Merck officials) approved the money for a study in Africa, they already realized they couldn’t make money on it, but they went through with it,” said Foege, who admitted that he wondered whether Merck would stick with its pledge.

Foege also encountered resistance from some in the public health field when he told them about Merck’s pledge.

“There was a small but vocal public health group that believed it was wrong to work for a company making a profit,” Foege said. “We underestimate the amount of altruism in corporations.”

When it was his turn to talk, Carter looked at Valegos and Foege and said: “I’m sitting here with giants.”

Carter confirmed that when Foege recommended that the Center and the Task Force take on river blindness, he accepted it “without hesitation.”

But Carter did have concerns about how they were going to get the drug to the people who needed it and whether they would be willing to take it.

“We quickly found out that people who were infected looked at this as a miraculous pill,” Carter said. “Once you got into a village and gave everybody the pill, they became so excited that it was overwhelming. This pill was so valuable to them” that if they had been given a choice of the pill and a diamond of the same size, they would have chosen the pill.

Merck’s contribution also had a profound impact on communities. To get away from the flies, people had moved from the fertile areas next to the river in favor of the more sterile mountains where there were no flies. After they had been treated with Mectizan, people were able to return to their homes next to the river banks.

“What Merck has done is serve as a wonderful example,” Carter said.

Valegos said it was a serendipitous turn of events.

“The company had the ability to produce a drug like this, and there was the availability of Bill Foege and Jimmy Carter,” Valegos said. “What are the chances of getting three characters like us working together? It did set an example for other companies.”

Foege said that the prevention of river blindness has become a symbol for Merck. In front of the company’s headquarters, there’s a sculpture of a young boy leading an old blind man.

“It has been a tremendously satisfying program,” Foege said. “This has changed how public health works.”

Mark Rosenberg, who followed Foege as president and CEO of the Task Force for Global Health, moderated the conversations.

In closing, he observed that “it is unusual in history that 25 years later you have the three principals who are still sharp, still committed and willing to share their story.”

The story of the Mectizan Donation Program also demonstrates the tremendous role Atlanta has played in the evolution of global health and for working toward the eradication of river blindness.

It is not the only global health success story to have sprouted from Atlanta, and if our leaders are wise and well-intentioned, it will not be the last.