Special Session with Mr. Raymond V. Gilmartin, Chairman, President and Chief Executive Officer of Merck & Co., Inc.,

October 2003, Merck Headquarters, Whitehouse Station, New Jersey, USA

At the beginning of the second day of the MEC/AC meeting, the participants had the pleasure of a visit by Mr. Raymond Gilmartin, Chairman, President and Chief Executive Officer of Merck & Co., Inc.

The session began with a presentation by Dr. Björn Thylefors, Director of the Mectizan Donation Program, describing the successes and challenges of using Mectizan for the control of onchocerciasis as a public health problem in Africa, possible elimination of transmission of onchocerciasis in Latin America, and the elimination of LF.  Following Dr. Thylefors' presentation, program partners gave brief comments regarding their activities and their gratitude for Merck's donation of Mectizan.  Below are excerpts from the presentations and comments made during this special session. 

Mectizan Donation Program

Onchocerciasis

Achievements of the program:

Good public health control of onchocerciasis in many countries with elimination of transmission possible in the Americas 
Effective Mectizan delivery through community participation 
Impact evaluations are ongoing

Challenges for the program:

Reaching the ultimate treatment goal worldwide of 70-90 million Mectizan treatments per year 
Defining the endpoint of treatment with Mectizan: how long do we treat?
Treating in areas of low endemicity (<20% onchocercal nodule prevalence) 
Sustaining national onchocerciasis control programs

Research issues:

What is the optimal frequency of Mectizan treatment to obtain the greatest impact? Is the goal control as a public health problem or elimination of transmission?
Serious Adverse Experiences associated with L. loa 
Monitoring Mectizan's continuing effectiveness 
Integration of Mectizan delivery into PHC

Global control of onchocerciasis:  

Expansion of treatment coverage for complete control as a public health problem in Africa and Yemen should be continued
Focus on elimination of transmission in the Americas 
Continue with operational research to maintain effective treatment programs

Lymphatic Filariasis

Achievements of the program:

National elimination programs using Mectizan and albendazole have been established in 7 African countries plus Yemen; since 2000, a cumulative total of 43 million treatments using these two drugs have been approved.

Strategic issues:
 
Achieving effective mass drug administration in both rural and urban areas 
Integration and sustainability of national elimination programs 
Mobilization of needed resources

The Future: 

By 2010, LF elimination programs using Mectizan and albendazole will be underway in 28 African countries plus Yemen with a total at-risk population of 400 million people.

Research issues: 

Improvement of diagnostic tools for mapping of LF
Integration of LF disability management 
Treatment strategy in L. loa endemic areas 
Sustainability of community-based support

Dr. Thylefors concluded by stating that without the help of a well-established partnership, the successes achieved and the possibility for future successes would not be possible.  

Partner Presentations:

African Program for Onchocerciasis Control (APOC)
On behalf of APOC, Dr. Azodoga Sékétéli, spoke about the past and future of onchocerciasis control in Africa.  By 2010, APOC predicts that eligible people in all areas indicated for mass treatment in the APOC region will be taking annual doses of Mectizan for onchocerciasis.  An issue currently facing APOC is the long-term sustainability of mass treatment programs. 

The World Bank and Committee for Sponsoring Agencies (CSA)
Mr. Bruce Benton commented, on behalf of the World Bank and the CSA, that securing additional donor support for APOC will be essential in the near future. The Bank currently projects a financing gap of  $26 million through 2004, but the gap, unless narrowed, will begin to impact APOC operations in 2005.  Hence, the World Bank is proposing to convene a Donors Conference in Washington, DC USA in the spring of 2004 in an effort to substantially reduce this projected shortfall.

NGDO Coordination Group for Onchocerciasis Control
Mr. Paul Derstine, chairman of the NGDO Coordination Group, recalled the success and positive impact of Mr. Gilmartin's visit to Bombani, Tanga Region, Tanzania in 2002 for the delivery of the 250 millionth treatment with Mectizan for onchocerciasis. He praised the model for public-private partnerships that has resulted from Merck's donation of Mectizan and expressed the commitment of the NGDOs to onchocerciasis control for the long term. 

World Health Organization (WHO)
Dr. Gautam Biswas commented, for the WHO, that progress of the LF program has been satisfactory and that 15-20 million people will be treated in 2003. He indicated that the commitment on behalf of the countries has made this success possible and hopes that scaling up to reach entire populations at risk will progress rapidly.

GlaxoSmithKline (GSK)
Representing GSK, Dr. Brian Bagnall commented on the remarkable partnership that has developed between Merck and GSK -- two research-based pharmaceutical companies working together towards a humanitarian goal.  He applauded the partnership's success in collaborating and coordinating activities for LF elimination in 28 African countries and Yemen.

Tanzania LF Elimination Program
Dr. Mwele Malecela, National Coordinator for Tanzania's LF elimination program, commented on the partnerships and political will needed at the national level to ensure the success of LF elimination. She discussed the challenges faced by her country including securing funding to expand treatment to cover 54 districts with 15 million people and integrating LF elimination with other disease control programs. 

Comments by Mr. Gilmartin
Mr. Gilmartin thanked the participants for the briefing and recounted his fond memories of delivering the 250 millionth treatment with Mectizan in Tanzania.  Mr. Gilmartin felt his visit to Tanzania was extraordinary in its demonstration of the partners' commitment to the success of onchocerciasis control. He also commented that the most difficult part of drug donations is getting the drugs to the people in need. Partnerships are crucial, and the dedication shown by the people involved has created a positive impact on the programs. Mr. Gilmartin noted his awareness that people risk their lives to deliver these drugs.

He spoke about Merck's approach to HIV/AIDS in Botswana and its focus on capacity building as well as getting medicine to infected people. Mr. Gilmartin observed that the positive experiences and successes of the Mectizan Donation Program encouraged Merck to become involved in other disease control initiatives.  He ended by saying that Merck looks forward to the ongoing success of the Mectizan Donation Program and to the opportunities for progress with lymphatic filariasis elimination.

The celebration to commemorate the 15th anniversary of the Mectizan Donation Program and the 250 millionth treatment with Mectizan was held in Tanzania on 5 September 2002. Mr. Raymond Gilmartin, CEO of Merck & Co., Inc., and other dignitaries traveled to Tanzania for the event. More than 1,000 citizens of Tanzania attended the event.

The 250 millionth treatment was administered in the onchocerciasis-endemic village of Bombani located in the Tanga region in the district of Muheza in Tanzania.  Accompanying Mr. Gilmartin to the village were:

• His Excellency Dr. Ali Mohamed Shein, Vice President of Tanzania
• The Honorable Anna M. Abdallah, MP, Tanzania’s Minister of Health
• Mr. Robert Venning Royall, the U.S. Ambassador to Tanzania
• Dr. L. Sambo, Director of Programme Management, World Health Organization African Region
• Dr. Frannie Léautier, Vice President, The World Bank Institute
• Dr. Allen Foster, chairman of the Mectizan Expert Committee
• Dr. Björn Thylefors, Director of the Mectizan Donation Program
• Mr. Kenneth C. Frazier, senior vice president and general counsel, Merck & Co., Inc.; and,
• Senior officials from several non-governmental development organizations. 

During the celebration and symbolic administration of the 250 millionth dose of Mectizan to commemorate the success of the program, residents of Bombani shared personal stories of the program's impact in Tanzania where more than 800,000 people are treated with Mectizan each year for onchocerciasis and to date, more than 1.5 million have been treated with Mectizan for lymphatic filariasis.

Mr. Gilmartin spoke of the Mectizan Donation Program stating: "At Merck, we measure success not only by how well we execute our core commitment to research and develop innovative medicines, but also by how well we help ensure that patients throughout the world have access to the medicines they need. Fifteen years ago, Merck decided to donate Mectizan because we felt an especially strong obligation to make it available to the people who needed it, but also were the least able to pay for it.”

Mr. Gilmartin also discussed the additional benefits of the program, “We are proud of the accomplishments of the Merck Mectizan Donation Program and are especially pleased to see that it has served as a model for other global health initiatives. Merck also continues to apply lessons learned from this extraordinary program," he said. “For example, in Botswana, Merck is now partnering with the government and the Bill & Melinda Gates Foundation on a comprehensive program to address the full spectrum of HIV education, prevention, treatment and care.”