Sometimes, though their implacable foes would refuse to acknowledge it, big corporations do the right thing even without a metaphorical gun at their heads. This week’s Economist magazine relates an amazing example that the public needs to know about, especially since it challenges popular stereotypes about Big Pharma.

The Economist begins by horrifying us with a deadly aspect of life in third world countries that are hot and wet: “neglected tropical diseases,” or NTDs. These are neglected because the populations that suffer from them are poor and far away, but they affect more than a billion people. Among the scourges, all parasitic, are Buruli ulcer, Chagas disease, guinea-worm disease, leishmaniasis, river blindness, trachoma and yaws. There are 18 pernicious maladies currently listed as NTSs.

In the 1970s, mega-pharmaceutical firm Merck developed the drug ivermectin after tests on animals with parasitic infections. William Campbell, one of the firm’s parasitologists,told company executives that the new drug might be effective against the parasite that caused onchocerciasis, or river blindness, which  afflicts populations in in parts of Africa, Latin America, and  Yemen.  He was given the green light to find out.

The first human trial of ivermectin as treatment for river blindness took place in Senegal in 1981, on patients who had the early stages of the disease—itching, rashes— but no damage to their eyes yet. The results were encouraging,  indicating that ivermectin was safe for humans and highly effective at stopping the disease before it blinded its victims.  Merck, however, now faced the problem that has impeded cures for all the neglected tropical diseases: those who needed ivermectin were too poor to buy it, and so were the nations where they lived. Big corporations are not charities; they have investors, stockholders and a bottom line. They are not accustomed or programmed to give away their products.

Yet Merck made a corporate decision that Bernie Sanders and Elizabeth Warren say is impossible. Starting in 1987, it made an open-ended commitment to distribute as much ivermectin as was needed to eradicate the river blindness worldwide. In the next ten years, it swallowed the cost of 100 million doses. The biggest hurdle, however, was not finding a cure but getting it to the afflicted.  The treatments had to be sent to remote areas.  Health care workers  had to be trained in regions where medical personnel were scarce. Victims of the disease had to be found and persuaded to accept treatment, and protocols for surveillance and follow-up had to be developed and followed, or the disease would come back.

To accomplish all this, Merck developed partnerships with charities, foundations and international health groups. Meanwhile, its example spurred other drug companies, such as GSK, Pfizer and Novartis,  to donate their medicines on a large scale for other  NTDs.

In 1999 the Gates Foundation began funding efforts to eliminate  lymphatic filariasis (elephantiasis) and schistosomiasis, another horrible disease caused by a parasitic worm transmitted by freshwater snails. Efforts to eradicate guinea worm were led by the Carter Centre, the foundation set up by Jimmy Carter in 1982. A public-information campaign about the need to filter drinking water and keep sufferers away from water sources, where they might pass on the infection, brought new cases guinea worm down from an estimated 3.5 million a year in  1986 to just twenty five in 2016.

The Economist makes it clear that the battle against NTDs will be a long one, and that the proposed cuts to the Trump State Department budget would be serious setback. Read the whole article, which is about a a lot more than Merck. Still, it was Merck that cut the Gordian Knot of economic reality blocking any chance of successfully fighting these 18 dread diseases.

The article emphasizes that Merck’s 1987 decision to donate ivermectin for river blindness was pure altruism. The firm’s scientists  felt it was the right thing to do, and management agreed. I am obligated to point out that there was probably some ulterior economic motive in the executive suites: the vilification of drug companies is a serious problem for companies like Merck, so stories like this can be extremely useful. Then again, if the idea was to get Merck good publicity and provide PR magic bullet to counter the accusations of critics, why don’t I know about the river blindness saga? Why don’t you?

Whatever the answer, Merck earned its Ethics Hero status.

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Pointer: Tom Fuller