The milestones keep coming in the global fight against trachoma. In May, the World Health Organization officially declared Nepal free of the progressive eye disease, which often begins with repeated childhood infections that turn the eyelids inward, leading the eyelashes to painfully scrap the surface of the eyes.
It was the sixth country to eliminate trachoma, and the first in Southeast Asia. One month later, Ghana, too, was confirmed to be trachoma free, the first sub-Saharan Africa country to eliminate the disease.
See the results of our exclusive Chronicle survey, along with analysis and strategies to help charities benefit from companies that increasingly want to be seen as good citizens of their community and the world.
During the last seven years, the number of people living in areas where they are at risk for trachoma — the leading infectious cause of blindness globally — has been slashed by more than half to about 158 million, according to the International Coalition for Trachoma Control.
“The real benefits are starting to show up around the world, which is pretty exciting, and that is going to continue,” says Emily Wainwright, senior operations adviser for the United States Agency for International Development’s program for neglected tropical diseases.
The strides made in reducing trachoma, as well as several other neglected tropical diseases such as lymphatic filariasis and schistosomiasis, is the result of a massive, decades-long multilateral undertaking by governments, the World Health Organization, and nonprofits including the Edna McConnell Clark, Gates, Hilton, and Lions Clubs International foundations, among others.
Still, global-health experts say that none of the work would exist on the scale that it does today without corporate philanthropy. Major pharmaceutical companies including Eisai, GlaxoSmithKline, Johnson & Johnson, Merck, and Pfizer have given billions of dollars’ worth of pharmaceutical products, as well as cash, to help eliminate global diseases, making those companies some of the biggest donors year after year, according to data collected by the Chronicle of Philanthropy.
In 2017, for example, pharmaceutical companies were three of the top 10 companies in terms of giving cash, according to the newly published Chronicle survey of corporate giving. In terms of product contributions alone, pharmaceutical companies were seven of the top 10, with Pfizer and Merck at No. 1 and No. 2, respectively.
Even though the pharmaceutical industry is much maligned in the United States for what critics decry as outrageously high drug prices — and for some drug makers’ part in the substance-use crisis — pharmaceutical companies’ seismic role in markedly improving the lives of hundreds of millions of people in developing countries is indisputable, say global health experts.
“I am not naïve about the complexities of the corporate world, but I do have to say, under their corporate social responsibility, the thing that is quite impressive is these haven’t been time-limited investments,” Wainwright says. “These companies have been making this available for decades now. They have systematically grown every year, particularly over the last 10 years.”
Overcoming Obstacles
Pharmaceutical companies began to offer up products to reduce global diseases in the 1980s. Among the first was a Merck drug called Mectizan, used to help eliminate the transmission of river blindness. Early donation efforts were undertapped, however, because international partnerships and local health infrastructure did not yet exist to distribute the drugs in high-need communities, which were often remote and destitute.
For trachoma, that began to change in the 1990s. For decades, the disease had been treated with an ointment applied twice a day for six weeks. Pfizer proved that its antibiotic Zithromax could treat trachoma with a single, once-a-year oral dose. The corporation and the Edna McConnell Clark Foundation field tested a multipronged approach to eliminating trachoma dubbed SAFE, which included surgery, antibiotics, facial cleanliness, and environmental improvement. WHO adopted the strategy, and in 1996 the United Nations agency launched its Alliance for the Global Elimination of Trachoma by 2020, known as GET2020, and set a deadline of 2020 for tackling the disease.
Pfizer and the Edna McConnell Clark Foundation subsequently created the International Trachoma Initiative to start working with governments to implement the strategy and get larger quantities of Zithromax to high-risk populations around the world.
Others in philanthropy began to step up, too. The Hilton Foundation, for example, committed $20 million over 10 years for ending trachoma, money that got the Carter Center Trachoma Control program up and operating.
Kelly Callahan, director of the program, says the Carter Center made its first request for Zithromax in 2001 for use in the highlands of Amhara, Ethiopia, which harbored the highest rates of blinding trachoma in the world.
Since then, the Carter Center has distributed 174 million doses of Pfizer-donated antibiotics, with a market value of $3.1 billion. The nonprofit’s operational costs for its trachoma work in six countries are about $16 million a year.
“That gives you a perspective of the order of magnitude of the value of that contribution,” says Madelle Hatch, a senior associate director of development at the Carter Center. “The drug donation, without support for distribution, is irrelevant and meaningless. But having funds for distribution and program implementation without the drug donation would be nonexistent and impossible.”
Those working to eliminate neglected tropical diseases around the globe say that the billions of dollars in donated drugs helps draw donations from private philanthropy. It’s also spurred government investment.
In 2006, Congress authorized $15 million in spending on its efforts to curb neglected tropical diseases, including trachoma. In the inaugural year, Wainwright says, USAID helped distribute 36 million treatments to 16 million people — what amounted to about $400 million in donated drugs. In 2017, with $100 million in funding, USAID helped get out $3.3 billion in drugs, or about 317 million treatments to 172 million people.
“For the U.S. government, our conservative estimate is that for every dollar we spend in country to distribute that product, get it to people, make sure they get it, we’re leveraging at a minimum $26 in donated drugs,” Wainwright says. “It is really good return on the investment.”
Staying Flexible
Caroline Roan, head of the Pfizer Foundation, says the company recently committed to providing Zithromax through 2025 to global efforts to eliminate trachoma. The company still plans to hit the original 2020 goal, she says, but noted that global realities could push the date back.
“We recognize some of the challenges we are facing are in countries where there is conflict, and it has been difficult to get the medicine and the full SAFE strategy into those countries,” Roan says. “So if we can’t make it work by 2020, we don’t want those countries that are partners to stop working toward that goal of elimination and want them to know they will have the medicine if they need it.”
She describes the work as an extraordinary example of public-private partnership and evidence of a scale of impact that many governments would never be able to achieve without help from corporate donors.
“If we don’t do our part to address the issues from a public-health perspective that are affecting communities, then we are not doing our part to deliver for patients or shareholders,” Roan says. “We believe we can do both. We think we can deliver for shareholders when we deliver for patients.”
Peter Olsen-Phillips, Brian O’Leary, and Alex Daniels compiled the data for this article.
