The industry of medical research and product development is an expensive and risky business in which the rate of failure far outweighs the likelihood of success (Glaxo). Only the largest companies can afford to invest large amounts of time and capital in projects that seem to have little chance of striking research gold--a drug that is effective, safe, and marketable for a profit. This creates an obvious problem: what incentives exist that would encourage companies to make a commitment to the development and distribution of products that are not likely to produce great returns, namely medicines that would be used mainly in third world countries? Are these companies morally obligated to earmark at least some of their profits to pursue such projects? What responsibilities do the governments of developing nations have to their citizens in providing and improving health care?
Some of the most urgent current health issues in developing countries are the threats posed by drug-resistant TB and malaria, Hepatitis A and B, yellow fever, meningococcal meningitis, and typhoid fever (Alameda). Vaccines are available for all of the above infections except TB and malaria, but separate injections are required for each, some require follow-ups, and each injection costs as much as $75 (Alameda). This is an expense that is obviously not practical for most rural citizens in Africa and Southeast Asia, some of the areas where these diseases are most prevalent (Glaxo). No relief effort to date has the resources to make widespread distribution of these vaccines possible or practical. The very beginning of the battle is making products that will greatly increase the health of a general population available to countries that cannot afford to pay for them at "retail" price. Possibly more daunting is encouraging investment in the development of even better new products which are obviously not likely to be profitable, even on a large scale.
Of all the diseases mentioned above, malaria presents a threat to the greatest number of people. It is a health problem today in more that 90 countries, with total populations of more than 2,400 million people--about 40% of the world's population. It is estimated that there are up to 500 million cases a year worldwide (Glaxo). A British pharmaceutical company called Glaxo Wellcome recently developed the first new industrially researched malaria remedy since World War II. It is a combination drug containing 2 substances, atovaquone and proguanil, given the commercial name Malarone. While this product has proven to be extremely effective in cases involving drug-resistant strains of malaria, the atovaquone component is very expensive to produce, and each recipient requires a full round of therapy lest a Malarone-resistant strain of malaria develop (Glaxo). Most of the people who need Malarone have no access to consistent health care, and cannot afford to pay for the medicine. With this in mind, Glaxo Wellcome founded a donation program to make up to one million courses of Malarone per year available under carefully controlled conditions to the countries that need it most. Pilot areas selected by the World Health Organization include Kenya and Southeast Asia (Glaxo).
A similar project is being executed by Merck Corporation. While investigating a heartworm treatment for animals, company researchers discovered a drug that prevents tropical river blindness. Over 51 million treatments have been distributed so far. The Merck project is managed in cooperation with UN agencies, the WHO, and the Task Force for Child Survival and Development. Organizations involved in the Glaxo donation program include the WHO (Division of Control of Tropical Diseases), British government agencies, and the Carter Center in Atlanta, Georgia (Glaxo).
These efforts could certainly serve as models for other agencies to reach people in the greatest need of basic health care. However, they do not address the issues of who is responsible for developing new technologies that will aid developing countries, and who will be able to assume the expense.
I believe that there is an obvious moral obligation, even of the poorest countries, to do whatever they can to improve the health of their citizens. Whether through research and development or simply ensuring that schoolchildren receive basic vaccinations, it seems to me that basic health care is a right of every person in a modern world. However, there are obviously many demands competing for the limited funds of poor governments. While research may be seem important to me, I realize that providing clean water would probably take priority.
What about the duty of the US and other wealthy and developed nations? I believe that we have a very great responsibility to the third world, especially in our role as the single most important world leader. The US already provides millions of dollars in foreign aid to other countries every year, and much of it is earmarked for health care (Belden). However, there are clear political advantages to this kind of philanthropy on a grand scale. From a purely selfish perspective, it does not serve American interests to ignore the existence of poor countries overrun by disease all over the globe. This makes other continents rather unpleasant places to visit, and while threatening American tourists also presents the possibility of epidemics spreading to our cities. It is also evident throughout history that starving and disease-ridden populations are generally not content. They emigrate in mass quantities, riot, and revolt, none of which contributes to furthering the reality of the peaceful and prosperous world envisioned by the US. A final effect of poor health care abroad is the proliferation of illegal immigrants to the US. While there are many more complex reasons for illegal immigration, it is quite possible that people with better health care at home would not try to enter the US illegally (Belden).
Thus it is greatly to the advantage of the US to aid in improving the health care in poor countries in whatever ways are practical. The more immediate issue, however, is who will be responsible for improving the drugs and technology currently available. The drug Malarone will certainly help millions of people, but even more useful would be a malaria vaccine that could be given to children, and provide a lifetime of protection. Other developments that would be welcomed by foreign aid foundations would be better birth control, particularly methods that are long-lasting, low-maintenance, and could be used by men. Any better product to prevent the spread of HIV would be extremely useful, as well as abortion techniques that could be performed at low cost in remote locations. Illegal abortion is the leading cause of death of pregnant women in some developing countries (Belden). This is a wish list of products that would be of great use in poor countries, with domestic applications obvious as well. Better birth control and HIV protection would be welcomed in the US and Europe, and travelers and relief workers could be more confident if a wider range of vaccinations were available. The task now falls to research companies to develop and produce marketable and safe solutions. I have already explained how this benefits the US from an international (and possibly domestic) perspective, but there are also many purely business reasons for companies to support such research.
Pretend a company develops a malaria vaccine: obviously it will
be expensive to develop and produce, but will not have a large
market unless it is priced realistically. The company will be
forced to sell it for a low price, and therefore sales will be
enormous. Even if nations still cannot afford it, the World Health
Organization can. They paid to wipe out smallpox in this century
(Encyclopedia Britannica). Conceivably, the profit for the company will still be very low.
However, there are still many tangible benefits for the company
which developed the vaccine. If they are able to patent their
product, they will be able to squeeze competitors out of the market
for years to come. The large number of sales will give any company
a presence in third-world economies, some of which will inevitably
take off in the future. Spin-offs from research may be useful
in treating other diseases (Ryan). The public relations value
is also obvious: picture a company executive standing in front
of photographs of dying Saharan babies in 1997 and the same communities
thriving in 2007: "Certainly the research was expensive, and we
knew the product would be unprofitable, but we saved the lives
of x number of people. Our company is one with a social conscience!"
Management can't argue with that.
Another option would allow US government to bear the brunt of the expense, which seems reasonable considering the manifold benefits that exist if research is successful. This is assigning relevant projects to military research laboratories. The US military would certainly benefit from progress made in treating any tropical disease, since its members may be called at any time to all corners of the globe. It would not be ideal to send US troops to malaria-ridden islands in the eastern Pacific or to the òmeningitis beltó in central Africa without any sort of inoculation against such diseases. Certainly modern antibiotics are very useful in treating these infections when they are diagnosed early, but it is still not to our military advantage to have large percentages of American troops in hospitals receiving treatment while on active duty abroad. It is imperative that the military be prepared for such situations, and funding from the US government would seem very appropriate. Once the necessary technology has been developed, the patent could be handed over to private companies who could manufacture the product in large quantities and ensure its widespread distribution.
In short, I believe that there already exist many incentives for both corporations and the US government to conduct this kind of research. It is most practical for the very large companies, because they can absorb the day-to-day costs of doing the research until it pans out in a marketable product. It follows that the US government should also pursue some research of this type or at least bankroll some of the smaller companies through research grants. Perhaps the government could offer tax breaks for companies contingent upon their level of sales to developing nations, thus encouraging them to develop products for use in such markets. Ideally, developing nations should contribute whatever they can financially to these efforts as well, but in reality this would probably be impractical.
However, I want to emphasize that my research has made me conclude that it is already to the advantage of corporations to conduct medical research that will impact developing nations. Given that the company is large and has a reasonable profit margin, it is fairly practical as well. There are many corporations that are large enough to do so, such as Hoffman LaRouche, Ciba Geigy, Chiron, Schering, Eli Lilly, and Bristol-Meyers, to name a few (Ryan). There is certainly no dearth of companies with the resources who would enjoy the benefits. In addition, it is obvious that the US on an international scale benefits from such efforts, and thus our government should be willing to support or conduct such research when necessary.
Encyclopedia Britannica. vol. 10, 1994 ed. p. 887-8.