Roy Vagelos

Since it's used as a case study in a Wharton School business-ethics course, you could say that the story of how Merck & Co. decided to just give away a valuable new drug is a textbook example of routine corporate social responsibility.

In fact, though, it isn't. As far as Roy Vagelos (C'50) knows, no other pharmaceutical manufacturer has even attempted to duplicate what Merck did with Mectizan, a drug that proved effective in killing the parasite that causes river blindness, a chronic illness in much of sub-Saharan Africa.

But Vagelos, chairman of the University Trustees and Merck CEO at the time the decision was made, remains convinced his company did the right thing in giving away Mectizan to those who needed it. And his successor as Merck CEO, who continued the program, is not the only one who agrees. The Mectizan program formed the basis of a friendship between Vagelos and former President Jimmy Carter, who spoke at Penn's 1998 Commencement, and the Franklin Institute this spring honored Vagelos with the Bower Award for Business Leadership in recognition of the importance of the gesture.

Vagelos is justifiably proud of Merck's Mectizan program, and though it's been a decade since his company made the decision, he still enjoys telling the tale of how it came to pass.

As CEO of Merck, the chairman of Penn's Trustees decided to do the right thing to eliminate a chronic disease. The decision proved right in more ways than one.

Photo by Candace diCarlo

Q. How is river blindness spread?
The disease is caused by a parasite, and it's transmitted by the bite of a fly, and the flies breed along the streams on the edge of the Sahara. And so these are the fertile areas of the sub-Saharan area, so people tend to live near the river. A fly bites the person and picks up a microphyllaria, which is the microscopic form of this parasite, and within the fly, the parasite matures so that when the fly bites another person, the injected parasite is now capable of becoming an adult worm.
   At the site of the injection, you will get males that get to be about eight to 10 inches and females that get to be 18 inches. And they live together under the skin, and they mate, propagating millions of microphyllaria. And these crawl all through the skin and ... they also get into the eyes....and they become totally blind.
   So, because of the biology of the parasite, one can treat people once a year, with a tablet, and completely prevent progression of the disease.
   The discovery of the drug was done by a guy by the name of William Campbell, but the development into a product for humans was done by a man by the name of Mohammed Aziz. He was a very interesting Pakistani-trained physician who worked in the World Health Organization and had seen river blindness while working in eastern Africa.

Q. But this was originally a general-purpose drug, right? It wasn't specifically targeted for river blindness.
That's correct. We were looking for a general-purpose parasite-killing drug. And the product that was found was called ivermectin. And ivermectin was then examined to see whether it would be a good product for humans, and the answer was no, because it doesn't kill hookworms and tapeworms, and those are important parasites in humans.
   But our scientists never forgot the potential of trying to do something in humans, so it was Mohammed Aziz who had the idea that we should take it to Africa and try it on this unusual parasitic disease.

Q. And it worked on the parasite that causes river blindness.
Exactly. I spent about a year traveling the globe looking for ways to get the thing to the people. First, our marketing people reported that there was no way they could afford it, even if we charged only five cents a tablet.
   So then we went to governments. Most of them didn't care about river blindness, because [their citizens] were dying of other things as well. There are lots of ways to die, and with river blindness, you just got blind, you didn't die.
   So then I made the rounds of the U.S. government, where I met with [President Reagan's] chief of staff, who, at one time, was the chairman of the board of trustees at Penn; his name was Donald Regan. And I presented the notion that the U.S. government could buy the drug from us at cost and then distribute it in the places where it's needed and thereby plant the American flag in all parts of Africa in a very positive way. And he thought it was a great idea, and he asked his aide to look after it, but when we stepped out of the office, the aide told me they didn't have any money.
   And then it got to the point where we had all the studies finished, and it was going to be ready to make available to patients, and we didn't have a way to do it. ... And in 1987 we decided as a company that we would contribute this drug to anyone in the world who had this parasite, so long as they were willing to comply with certain basic accounting - we needed to know their names, and their weights, and we had to have a report from them as to whether they would have a side effect, because that's the usual way you follow up drugs that you put on the market.

Q. What's the approximate value of the product that's been donated so far?
What is the value of preventing 18 million people from going blind? I don't know what the cost of the program is, but in the case of these sophisticated drugs, mostly the research and development part. The provision of the chemical is a minor side, so it's not a significant cost. I can imagine that this program has cost Merck hundreds of millions of dollars over the years.
   I've been asked why we did it. Because the company is so dedicated to health, our philosophy is that we do research and development to help people's health. And to have such a dynamite product that could never reach the people, that would be a very, very bad thing for that company, for scientists in general. So we thought we couldn't do that, and therefore we took this decision, and it had an incredibly positive effect on the scientists, who felt that this was exactly what Merck should be like. And it helped our recruiting forever. So it was worth whatever the cost is to raise morale and to help the recruiting of the scientists of the future. It sort of set a standard for the world.

Q. This is sort of an open-ended project if I understand your explanation of how the disease is communicated, because people can get reinfected.
You're right. Except for one thing. If you cover an area and give the tablet to everyone in that area, the flies no longer have a source for microphyllaria.

Q. So after a period of years it dies out?
So you can absolutely eradicate the disease.

Q. Has that happened anywhere yet?
No, because it's too early. It's going to take, I would guess, another 10 years to have a broad enough population covered so the flies can't find a target. And the beauty of this disease is that there are no other carriers. So it's going to take a little time, but it's going far better than anyone could have dreamed at the time it started.

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Originally published on May 27, 1999