Rx for Humanitarian Relief - Pacific Standard

Rx for Humanitarian Relief

U.S. drug firms donate $6 billion yearly overseas.
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Two years ago, in the wake of Hurricane Katrina, Direct Relief International began stockpiling medical supplies annually at hospitals in the cyclone-prone countries of the Caribbean, including Haiti.

“We made an educated guess and thought, ‘Let’s boost inventories.’ … It avoids the fog of disasters, which is like the fog of war,” said Thomas Tighe, president and CEO of Direct Relief, a nonprofit group that provides medical assistance in the United States and around the world. (Tighe is also a member of the editorial advisory board of Miller-McCune.)

Chaos engulfed Haiti anyway, not in a hurricane, but in January’s catastrophic earthquake. And in those first tumultuous days, the Direct Relief caches provided enough antibiotics, sterile gauze, disinfectant, pain medications and prescription drugs — courtesy of Abbott Laboratories — to treat 3,000 people.

Direct Relief and most of its top corporate donors belong to the Partnership for Quality Medical Donations, an alliance of 14 manufacturers of drugs and medical equipment, and 16 nonprofit humanitarian groups working in developing countries.

In 2007, the latest year for which figures are available, the corporate partnership members gave $6.1 billion in aid to the developing world, according to The Index of Global Philanthropy and Remittances. That was out of a total $6.8 billion from U.S. corporations overall.

This year to date, the partnership members (including four European companies doing business in the U.S.) have shipped $55 million in drugs, medical devices and supplies to Haiti’s quake victims. Steel pins and rods, and sterile packs for surgeries have been in high demand, along with syringes, antibiotics and pediatric fluids.

“I don’t think people realize how generous the pharmaceutical and medical device and equipment industries are in a time of disaster,” said Pat Bacuros, a director of gifts in kind for Project HOPE (Health Opportunities for People Everywhere), a founding partnership member. “If we have specific needs, these companies always step up to the plate, always.”

The partnership incorporated in 1999, after a rash of bad publicity about unusable drug shipments to the victims of the Balkan wars. It remains the only alliance of its kind in the United States. In Europe, Pharmaciens Sans Frontières Comité International (Pharmacists Without Borders International Committee), a humanitarian association with 500 partners worldwide, relies heavily on government donations.

Bill Lin, director of corporate contributions for Johnson & Johnson, a founding member of PQMD, said corporate donors sought to create an organization that would “provide guidance for standards and speak with one industrial voice in response to criticism.”

“We’d been practicing what we preached for many years,” he said, “but this allowed us to have a forum for an open dialogue with nongovernment organizations and across the Fortune 500 pharmaceutical companies.”

Unfortunately, Lin said, the public persists in viewing corporate drug donations as “dumping” for purposes of tax deductions. Yet the World Health Organization, a United Nations agency, has recognized the partnership as a leading authority on medical donations. Every October, the group holds an education forum for the public on medical aid to poor countries.

“We’ve always been very, very careful about what we do,” Lin said. “I’m not saying that with 30 members of PQMD we are changing the world, but we want to change the world’s perception of how we have handled our donations.”

When aid goes awry
All drug donors in the world must adhere to a set of tight guidelines written in 1996 and revised in 1999 by World Health, Pharmaciens Sans Frontières, the International Red Cross and other aid organizations.

The “first and paramount principle” is that drug donations should benefit the recipients “to the maximum extent possible.” Unsolicited donations are discouraged. Drugs must be relevant to local disease patterns, packaged and labeled properly, and, on arrival, have a shelf life of at least one year. Nothing should be shipped unless it is absolutely needed.

Despite the rules, however, a lot can and does go wrong. Local pharmacies ship their overstock to disaster areas without knowing the rules. Doctors show up, only to find they lack the skills most in demand. Well-meaning but clueless churches, neighborhood groups or individuals ignorant of the established protocols will send off boxes in the mail, full of used clothes and leftover medicines.

“I was at church two weeks ago, and I heard my priest say that the community was collecting clothes and medicines to ship to Haiti,” said Bacuros of Project HOPE. “I thought, ‘Oh, my gosh, you can’t just ship to Haiti.’”

Bacuros told church volunteers that, for starters, they would have to dry clean, fumigate and pack the clothes, and contact someone to receive them in Port-au-Prince. Hearing that, the church gave them to Goodwill instead.

At Project HOPE, Bacuros gets a lot of calls from people wanting to donate the contents of their medicine cabinets for Haiti, including the prescription drugs that belonged to their late spouses. She patiently explains that the drugs prescribed for one person cannot safely be given to another. Yet the callers, undeterred, ask her, “Is there another organization?”

“We find that everybody wants to do the right thing,” Bacuros said. “They just don’t understand the difficulties involved.”

Attached to the World Health guidelines is a list of medical relief efforts that backfired, starting in 1988, when 5,000 tons of drugs and supplies were sent to Armenia after an earthquake, far exceeding what was needed.

“It took 50 people six months to gain a clear picture of the drugs that had been received,” the account said. “Eight percent of the drugs had expired on arrival, and 4 percent were destroyed by frost.” Of the remaining supply, “only 30 percent were easy to identify, and only 42 percent were relevant for an emergency situation.”

Other bad examples included Eritrea in 1989, when donors sent “seven truckloads of expired aspirin tablets that took six months to burn”; Sudan in 1990, when only 12 of 50 boxes “contained drugs of some use”; Lithuania in 1993, when 11 women “temporarily lost their eyesight after using a donated drug”; and Bosnia and Herzegovina between 1992 and 1996, when 17,000 tons of unneeded, unwanted and expired drugs had to be burned at a cost of $34 million.

Yet in 2004, nearly 10 years after World Health first issued its guidelines, Indonesia was flooded with an ocean of excess drugs after the tsunami. A report by Pharmaciens Sans Frontières stated that “extremely large quantities” of cough medicine and tetracycline, an antibiotic, would surely expire before they could be used up. Sixty percent of the donations were not on Indonesia’s list of essential drugs, and 70 percent were labeled in a foreign language.

“It is wrong to claim that any drug is useful in an emergency situation,” the report said, adding that in Indonesia as in Bosnia, drug donations “seem to cause more problems to the authorities than they help the population.” In conclusion, the report said, “the quality of humanitarian aid with respect to drug donations in acute emergency situations has not improved.”

A corporate member of the Partnership for Quality Medical Donations was falsely accused of shipping expired drugs to Indonesia, said Myron Aldrink, chairman of the group and executive director of Medical Teams International, a Christian global health organization. The company looked into it, he said, and traced the lot number of the drugs to an Indonesian drugstore.

“Donations are not for amateurs,” Aldrink said. “It’s got to be the right product at the right time, in the right quantity and the right quality. If you match all of those, it works.”

And even the pros make mistakes. A 2006 report, based on a survey of partnership members who responded to Hurricane Katrina and the Indonesian tsunami, quotes a frustrated aid worker as saying, “Sometimes, disasters make people forget what their mission is.

“I observed several big pharmaceutical companies, some of whom are in PQMD, violating all the principles that they so carefully wrote down and live by, and just packing up containers of product and sending it to the tsunami, for example,” the worker said. “Most, if not all, of that product ended up rotting on the docks somewhere in a foreign port where they had no forklifts to take the product off. People just didn’t know what to do. Pharmaceutical company X, which shall be nameless, they thought, ‘Well we’re just going to send something; we need to respond.’ So rather than calling one of their trusted partners, they just panicked and filled up a sea container and took it down to the port for some carrier here to get it to Indonesia. It’s weird, like everybody gets stupid for a day or two.”

Going the distance
In the category “U.S. private philanthropy” for 2007, the Index shows total corporate giving to poor nations, at $6.8 billion, ranked below that of private and voluntary organizations, which gave $10.8 billion, and U.S. religious organizations, which gave $8.6 billion.

Of the $6.1 billion from partnership members, $4.2 billion was in-kind donations and $1.9 billion was spent on shipping, insurance, tariffs, storage and in-country transportation.

Drugs and medical supplies donated by the corporations are typically surplus goods, or they are purchased internally from “active” stock. Sometimes, as in the case of Johnson & Johnson’s “disaster modules” for Direct Relief in Haiti, they are manufactured expressly to give away. The donations are tax deductible for the companies.

For more than 20 years, Merck & Co. has manufactured Mectizan for the mass treatment of two disfiguring and disabling tropical diseases: onchocerciasis, or “river blindness,” and lymphatic filariasis, or elephantiasis. It is the longest-running such program in the world.

To date, 1 billion people have been treated with Mectizan in Africa, Latin America and Yemen. Working with such nonprofit groups on the ground as World Vision, a Christian humanitarian organization and partnership member, Merck has pledged to continue making and donating the drug until river blindness and lymphatic filariasis are no longer a public health problem.

In 2009, partnership members sent 10,000 shipments of medical aid, primarily to developing countries. Most of it was for ongoing health projects for the poor — not disaster relief.

“We’re in a marathon; we’re not in a sprint,” said Samuel Smith, CEO of Mercy Ships, a Christian charity that operates hospital ships in developing countries. They are supplied, in part, by corporate partnership members.

“We’re a standard-setter,” said Lori Warren, the partnership’s executive director. “Our members are experts in this work. They have done a lot in Haiti, and they’ve helped other organizations that are less experienced. They are first responders when disaster strikes a country, but they were there before, and they will be there afterwards.”

Johnson & Johnson, like Direct Relief, Project HOPE and other members, had been involved in Haiti long before the quake and expect to stay involved long after.

“Once CNN and the media leave Haiti, so do a lot of other funders,” Lin said. “We don’t ever want to be accused of that.”

Elsewhere, Eli Lilly & Company partners with the Catholic Medical Mission Board, the leading U.S. Catholic charity for global health care, to provide insulin, Prozac and cancer medicine to a teaching hospital in Kenya.

Abbott pairs up with AmeriCares, a nonprofit medical aid group, to donate nutritional products and multivitamins to malnourished children in the remote countryside of Vietnam. Johnson & Johnson collaborates with Medical Teams International, a Christian global health organization, at a surgical training center in Ghana that serves all of West Africa.

“We couldn’t do it without the corporations, and they couldn’t do it without us,” said Myron Aldrink, executive director of Medical Teams and chairman of the partnership.

In Egypt, Genzyme Corp. supplies an enzyme treatment therapy for patients with a debilitating genetic disorder through Project HOPE.

“When I first started in PQMD, many of the nonprofits did not communicate amongst each other,” Bacuros said. “Now we’re complementing each other versus working against each other, which is something we did not see 10 years ago. We have all become extremely close.”

Similarly, corporate members say they can set aside rivalries with their competitors, pool their knowledge, avoid redundancies and ensure that their products are delivered to the people who need them. One firm may commit to antibiotics, while another pledges vaccines, and still another sends medical kits.

“In this space, we’re allowed to talk to each other, which is unusual and very gratifying,” said Tamara Russell, Lilly’s global product donations coordinator.

Since the quake in Haiti, Russell has been co-chairing regular conference calls so that members can get beyond media reports to learn what’s happening on the ground. There’s a roll call to find out who needs what and who can supply it.

Thus, Russell said, when Lilly needed a plane to ship insulin after the quake, Direct Relief stepped up and planned the logistics with the company. The cold packs protecting the insulin would melt in five days, so Direct Relief had to ensure that the drug would arrive in time on the trip from Lilly’s warehouse in Indianapolis to a refrigerator at a Haitian clinic, with a Direct Relief staff member on hand to receive it.

“The information-sharing during disasters is just priceless,” Russell said. “It’s incredibly helpful.”

Said Lin: “We may be competitors on a commercial scale, but not when things like Haiti happen.”

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