International Journal of Academic Research and Development

International Journal of Academic Research and Development

ISSN: 2455-4197
Impact Factor: RJIF 5.22
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Volume 3; Issue 1; January 2018; Page No. 218-220

Merck and river blindness: A case study in ethical dilemma

Dr. Pushpinder Kaur
Associate Professor, Department of History, B.Z.S.F.S. Khalsa Girls, College, Morinda, Ropar, Punjab, India

Abstract
Ethics is that greyish zone of human behaviour that lies between the law on the one hand and the common courtesy on the other. It
is not mandated by law. You do not have to be ethical. It is a moral obligation.

Keywords: ethics, onchocerciasis, mectizan, ethical leadership, sustainability

Introduction million tablets of Mectizan at no charge. The company’s

Merck & Co Inc is one of the world’s largest pharmaceutical decision was grounded in its core values:
products and Services Company. Headquartered in 1. Our business is preserving and improving human life.
Whitehouse station, New Jersey, Merck has over 70,000 2. We are committed to the highest standards of ethics and
employees and sells products and services in approximately integrity.
150 countries. Merck had revenues of $47,715,700,000 in 3. We are dedicated to the highest level of scientific
2001, ranked 24thon the 2002 Fortune 500 list of America’s excellence and commit our research to improving human
largest companies and 82th on the Fortune 100 list of the Best and animal health and the quality of life.
companies to Work for. 4. We expect profits but only from work that satisfies
In the late seventies, Merck research scientists discovered a customer needs and benefits humanity.
potential cure for a severely debilitating human disease known 5. We recognize that the ability to excel—to most
as river blindness (Onchocerciasis).The disease is caused by a competitively meet society’s and customers’ needs and
parasite that enters the body through the bite of black flies that aspirations—depends on the integrity, knowledge,
breed on the rivers of Africa and Latin America. imagination, skill, diversity and team work of employees,
and we value these qualities most highly.
Disease spectrum
The parasite causes severe itching, disfiguring skin infections Merck’s dilemma
and finally total and permanent blindness. This is known as Because of the devastation the disease causes, Merck decided
AMBLYOPIA. to produce the drug even though it would not financially profit
In order to demonstrate that it was safe and effective, the drug from doing so. When no government or aid organization
needed to undergo expensive clinical trials. Executives were stepped forward to buy the drug, Merck pledged to supply the
concerned that because they knew that those who would drug free forever. When Merck recognized that no effective
benefit from using it could not afford to pay for it even if it mechanism existed to distribute the drug, they went far
was sold at a cost. Merck research scientists argued that was beyond industry practice and organized a committee to
not too promising from a medical standpoint to abandon. oversee the distribution. Hailed as one of the best managed US
Executives relented and a seven year clinical trial proved the companies, Merck believes that such decisions serve its own
drug both safe as well as efficacious. A single annual dose of long run interests.
Mectizan, the name Merck gave to the drug kills the parasites It took $200 million in research and 12 years to bring the drug
inside the body as well as the flies that carry the parasites. into the market; the decision to pursue research is a complex
Once Mectizan was approved for human use, Merck one. Since resources are finite, dollars and time have to go to
executives explored third party payment options with the projects that hold the most promise, in terms of both making
WHO, the US Agency for International Development, and the money so that a company can continue to exist and alleviating
US Department of State without success. Four United states human suffering. This is an especially delicate issue when it
Senators went so far as to introduce legislation to provide US comes to rare diseases, when drug companies’ investments
funding for the worldwide distribution of Mectizan. However, could probably never be recouped because the number of
their efforts were unsuccessful. No legislation was passed and people who could buy the drug is so small. The problem with
no US government funding was made available. Finally developing a drug to combat river blindness was a flipside of
Merck executives decided to manufacture and distribute the the “orphan” drug dilemma. There were certainly enough
drug for free. people suffering from the disease to justify the research, but
Since 1987, Merck has manufactured and distributed over 700 since it was a disease afflicting people in some of the poorest

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parts of the world, those suffering from the malady could not Merck voluntarily recalled Vioxx a few years ago, after
pay for the medication. In 1978, Merck was testing learning that it caused cardiovascular problems in patients
Ivermectin, a drug for animals, to see if it could effectively who took it for 18 months or more. The recall created uproar
kill parasites and worms. During this clinical testing, Merck and lot of lawsuit. Merck fought them, because of its claim
discovered that the drug killed parasite in horses that was very that it had done no wrong. But after winning more cases that it
similar to the worms that caused river blindness in humans. lost, it finally settled the remaining cases and it moved on its
This, therefore, was Merck’ s dilemma, the Company trajectory of ethical excellence.
scientists were encouraging the firm to invest in further
research to determine if the drug could be adapted for safe use Lessons learnt from Merck
with humans, but Merck knew it would likely never be a On October 21st 1987, Merck &Co decided to donate newly
profitable product. discovered drug molecule to combat River Blindness. Merck
took this decision collaborating with international experts in
Merck’s ethical leadership parasitology and WHO. This decision came twelve years after
Although the decision by Merck to develop this drug for no the discovery of Mectizan and seven years after its clinical
profits is an old one, it is still a great example of corporate trials in Dakar, Senegal.
social responsibility and ethical leadership. Merck did this Merck chairman Raymond V Gilmartin has reaffirmed
long before the CSR was fashionable. company’s commitment to donate as much Mectizan as
necessary for as long as necessary to treat river blindness and
Reputational utility of Merck to help bring the disease burden down and under control as a
The outcomes for the patients are tremendous and with the public health problem.
growing media attention, Merck was on the verge of Mectizan has taught us about how to mobilize resources in
catapulting into ethereal fame in an overriding manner. Hence successful public/private partnerships to address significant
reputational utility far surpassed its personal utility. That was health problems so as to significantly reduce disease burden
the beauty of selfless philanthropy. over long term.
At the same time scientists who are the main human resourse Effective treatment requires only one annual dose, easily
of Merck feel good while innovating some new drug administered with no major side effects. Some of the critical
molecule. Yet some opportunity cost is also there in the form success factors for this achievement are as below:
of drugs not discovered because the scientists were working 1. The need to focus scientific and clinical research resources
passionately on this project of Mectizan. Merck took the on feasible targets for clearly important health priorities.
decision in terms of the question of philanthropy. 2. The importance of partnerships among public and private
sector organizations including Non Governmental
Merck’s value system organizations to control a dreadful disease.
Merck says that it values people over profits. And it has acted 3. The essential role of distribution mechanisms and
like this indeed. Otherwise, there is no use of creating a lot of healthcare infrastructure in ensuring that medicines like
cynical employees who do not respect their organization’s Mectizan reach those who need them.
culture.
Health impact and capacity building for future
If you do not mean it, please do not say it! And it goes programmes
pretty well for individuals too. Since the inception of MDP, around sixteen million children
Extra mile mentality of Merck around the world have been spared the risk of infection due to
It is pertinent to note that Merck wanted to pursue research. spraying programme combined with Mectizan treatment. The
And it did succeed after many millions of dollars and a decade World Bank report says that 25 million hectares of arable land
of pain and privation. But that was worth it. They came up have been recovered enough to feed 17 million people. More
with a wonder drug for river blindness but alas! no one was than 60,000 cases of blindness have been prevented.
ready to take this. Not even the government. The cooperative nature of programme has helped to strengthes
The company took an extraordinary decision- to distribute the the primary care system in many countries where Mectizan
drug for free to all who needed it forever or till the time river has been delivered: in fact the delivery strategy and treatment
blindness was eradicated! And that was not the end of the guidelines have resulted in the delivery of other health
show for the company. The biggest challenge was to transport services e.g. Vitamin A in the Central African Republic and
the drug to the remotest possible areas where it was needed diagnosis of `other conditions such as cataracts.
the most. They designed their own network and logistic Donation programmes offer a mechanism for providing access
support. to care and treatment which should be evaluated on a case by
Their philanthropy programme is being emulated by other case basis.
companies as well. Merck remains one of the most The Merck Mectizan Donation Programme which has helped
philanthropic companies of US. There was another outcome- millions of people in the developing world is an instructive
when AIDS became a world health problem, the company’s case, reminding us that even when medicines are free,
experience with the distribution of Mectizan in Africa helped. questions of infrastructure, transparency, distribution,
Although AIDS drugs were more complicated, the company logistics, partnership and sustainability structure the prospects
could call on its experience to direct these new efforts. for long term health benefits.

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Sustainability Responsibility: Multinational Managers and Developing

Mectizan also shows that for a donation programme to Country concerns Notredame, Indiana: University of
succeed in a significant way, commitments to ensure fNotredame Press, 1997, 244-275.
sustainability are as critical as promises to supply product. 8. Michael Useem. Roy Vagelos Attacks River Blindness:
The MDP case also suggests that donation programme should, ‘The drug was needed Only by People who could not
where possible, be integrated into the country’s health system. afford it, in The Leadership Moment: Nine True Srories of
For example, onchocerciasis control efforts in endemic Triumph and Disaster and Their Lessons for Us All (New
countries have been supported by training of local(country and York: Times Business, 1998, 10-42.
community level) health workers in the distribution,
administration and monitoring of Mectizan treatment.
Similarly, treatment strategies of lymphatic filariasis can
benefit from the existing delivery structure for river blindness
where the two diseases co-exist. The involvement of the local
political leadership and opinion leaders is of paramount
significance for long term programme sustainability and
overall success in diminishing disease burden in developing
countries.

The height of magnanimity-the Merck way to Processual

affordances
George W Merck, the company’s president from 1925 to
1950, summarized the core values of Merck thus:
“Medicine is for the people. It is not for the profit. The profits
follow, and if we have remembered that, they have never
failed to appear. The better we have remembered that, the
larger they have been.”
In total, approximately 30 million people in 32 countries are
now treated annually with Mectizan. Merck reports that it has
no idea how much the entire programme has cost but
estimates that each pill is worth $ 1.50. The United Nations
reports that River Blindness May Soon Be Eradicated.

References
1. David Bollier. Merck and Company: Quandaries in
Developing a wonder drug for the Third World, in Aiming
Higher: 25 stories of how companies prosper by combinig
sound management and social vision New York American
Management Association 1997, 280-293.
2. Jane E Dutton, Michael G Pratt. Merck & Company: From
Core Competence to Global Community Involvement, in
Noel M Tichy, Andrew R. McGill, and Lynda St. Clair,
Eds., Corporate Global Citizenship: Doing Business In
The Public Eye San Francisco: New Lexington Press,
1997, 150-167.
3. Mectizan, Onchocerciasis. A Decade of Accomplishment
and Prospects for the Future; the Evolution of a Drug into
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phones/santé. 1998; 1(8):3-90.
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Merck &Co., Inc., 1998.
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Historical Background. Rahway, New Jersey: Merck &
Co., Inc., 1992.
7. Lee A Tavis. River Blindness: The Merck Decision to
Develop and Donate MECTIZAN, in Power and

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