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Commentary

The Life and Times of Ivermectin - A Success Story
Andy Crump, Satoshi Õmura, Nature, 1-4-05

This article chronicles a successful model of how public-private partnerships can work hand-in-glove to greatly lessen the impact of infectious diseases in developing nations. Ivermectin, an anti-parasitic drug developed jointly by the Kitasato Institute in Japan and the Merck, Sharpe and Dhome laboratory in the U.S. has “improved the lives of hundreds of millions of the world’s poorest” citizens afflicted with the debilitating parasite that causes “river blindness” (onchocerciasis). Thanks to this groundbreaking partnership, the disease may be eradicated as a global public health problem by 2010.

Ivermectin began its career as a successful veterinary antiparasitic drug in 1981, and has remained a market leader ever since with sales of about $1 billion annually. From animal studies researchers suspected the drug might be effective against the parasite that causes river blindness and moved quickly to test their thesis.

After 4 years of large scale human clinical trials it was found that “a single annual dose of 200 micrograms per kg of body weight eradicated microfilarial worms from the eye and skin after one month, and patients remained worm-free for up to 12 months after treatment.” By 2007, 59 million people in African countries where the disease is prevalent will have been treated with ivermectin.

As the humanitarian value of the drug crystallized during late stage clinical trials, “discussions took place between the public and private sectors to determine a suitable price for the drug, bearing in mind that the end-users of the product would be poor and marginalized communities. In 1987 . . . the Kitasato Institute . . . agreed to forgo royalties” and Merck agreed that ivermectin “would be provided free of charge for the treatment of river blindness ‘for as long as it is needed’, a pledge that has been honored ever since.”

Besides giving away the drug gratis to eradicate river blindness, Merck also pays “the production costs [of ivermectin], the costs of transport from the manufacturing facility in France to the recipient countries and the related customs and other handling costs.” To date, Merck has donated over 250 million doses; in one year, 2001, “the value of the ivermectin contributed by Merck & Co. [was] estimated to be US$143.6 million.” To put that sum in perspective, the total fifteen year program costs to eliminate river blindness are estimated to be only $182.5 million.

In other words, even for a “free” drug Merck bears very substantial costs year in and year out.

All in all, “The discovery, development, and deployment of ivermectin through the efforts of Merck & Co. and the Kitasato Institute, aided by a group of international partners…has been hailed by some commentators as one of the greatest medical achievements of the twentieth century.”



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