The day a drug company boss saw the light

It was a defining moment of Roy Vagelos’ career as a scientist and businessman.

In the early 1980s, researchers at Merck the pharmaceuticals group, discovered that a drug called ivermectin, which the company had initially developed for veterinary use, could – with a little tweaking of the dosage – be used to tackle river blindness, a parasitical disease afflicting millions of people across Africa, Latin America and parts of the Arabian peninsula.

“It was very exciting,” says Dr Vagelos, from New Jersey, a biochemist and surgeon by training who was Merck’s chief executive from 1985 to 1994. A disease that robbed communities of their vitality while entrenching people in poverty could now be treated with a pill.

The problem was getting it to those who needed it – the vast majority of whom lived in poor remote places. No matter how hard Merck’s marketing people chiseled away at the price, they would not get it down to a realistically affordable level. There was little or no support from international agencies or developed world governments.  

So Dr Vagelos decided to try something different. At a press conference in late 1987, he announced that the drug, also known by its brand name Mectizan, was to be available free of charge for as long as necessary. Only later did he explain to his board the decision to commit to an open-ended programme which, a quarter of a century later, continues to run, with an estimated 100m people treated each year.

“One director challenged me [over] why I had not told them,” recalls Dr Vagelos, now 82. “I asked if anyone would have made a different decision, and the answer was no.”

It was a pioneering step. Under the Mectizan Donation Programme (MDP), an intermediate body set up to manage the operation, local health organisations or development agencies apply to access the drug. Following approval, Merck ships supplies without charge. The costs of getting the tablets to the point of distribution are covered locally.

The programme’s biggest consumer is Sightsavers, the international development organisation which the Financial Times is supporting in its seasonal appeal this year.

“It’s the wonder drug,” says Sunday Isiyaku, Sightsavers’ country director in Nigeria where, over the past 20 years, Mectizan has contributed to huge advances in the battle against river blindness. 

Before Mectizan, the principal means of treatment was spraying insecticide along the riverside habits of the black fly that transmits the disease to humans. This required helicopters and crop-spraying planes.

“It was incredibly expensive,” says Adrian Hopkins, director of the MDP.

Today, he reckons it costs somewhere between the equivalent of 10 to 20 US cents per person per year to distribute the drug. The tablet itself has a guide price of $1.50, with users taking on average three tablets, or one treatment, per year.

For Merck, the programme has been a huge commitment. In a statement, the company said that since 1987 it has donated 4bn tablets. In  2010, Sightsavers received tablets with a value of £140m from Merck.

For Dr Vagelos, it remains money well spent. The veterinary side made profits and there were added benefits, such as increasing Merck’s allure for budding talent.

“It allowed us to recruit almost any scientist we went after,” he says. The Mectizan programme is, he adds, in keeping with the belief of Merck’s founder that “drugs are for people not profits”.

Since Dr Vagelos took that bold step, other pharmaceutical companies have followed. GlaxoSmithKline, for instance, donates albendazole. Combined with Mectizan, this is a treatment for lymphatic filariasis, another disabling tropical disease, commonly known as elephantiasis.

The largesse of pharmaceutical groups is still greeted with suspicion by some local communities, who fear ulterior motives. Some critics, meanwhile, argue that drug companies could do more.

Looking back, Dr Vagelos concedes that it was “a mistake” not to tell his board of a decision that would commit a large pharmaceutical company to a programme costing hundreds of millions of dollars. Otherwise, there are no regrets.

He adds: “It was one of the happiest things I was associated with at Merck.”