Big Pharma, the World Health Organization, and the co-constitution of international policies against river blindness
For seven consecutive years from 1987 to 1993, the US-based pharmaceuti-cal company Merck earned the title of ‘most admired business’ awarded by Fortune magazine – a highly recognized distinction in the business world. It rewarded the company for its rising profits (from 1985 to 1989 sales almost doubled1), but also for setting up the Mectizan Donation Program (MDP) in 1987, a drug donation program against river blindness.2 Also known under its scientific name onchocerciasis, it was until then a neglected tropical disease without adequate treatment. Caused by a parasite, it provokes dermatological and ocular infections that can lead to complete blindness. It affects mainly people in sub-Saharan Africa (90% of cases), Yemen and Latin America. In the late 1970s, it was estimated that 18 million people were infected with the parasite and that 100 million were at risk of infection.However, Merck is not the only organization claiming a key role in the fight against river blindness. In front of the World Health Organization (WHO) headquarters in Geneva stands a statue depicting an African child guiding a blind man.3 As explained on the accompanying plaque, it symbol-izes the ‘success’ of the fight against river blindness, a ‘unique public health action’ conducted thanks to several WHO-led programs, ‘which also fostered socio-economic development’.4 A close look at the plaque reveals that the statue was built, thanks to the donations of several philanthropic organiza-tions and NGOs,5 the World Bank, but also Merck and the MDP.Although it is not obvious from the above-mentioned awards and symbols, which put emphasis only on one actor’s role, the fight against onchocerciasis/river blindness is actually a cooperative one, and there is a rich and long his-tory of interactions among different actors to study.The international fight against the disease started during the later years of first half of the twentieth century. Onchocerciasis, caused by the parasite onchocerca volvulus, which is transmitted to humans through the bite of an intermediate host (or vector), a simulium black f ly, was one of the last tropical diseases to be discovered, its symptoms being first attributed to other causes (trachoma, infection, nutrition deficiencies...).