Annual Report 2014 Annual Report 2014

Trend/4 → Access to Health

for everyone

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An estimated 1.3 billion people have no access to effective and affordable health care. With its Group-wide Access to Health initiative, Merck is pursuing multiple approaches in order to overcome access barriers, for instance through a program to fight schistosomiasis.

The hazard lurks in water in which people swim, fish or wash clothes. In stagnant freshwater, the larvae of the schistoma worm penetrate the skin and enter the blood vessels of their victims, infecting them. This infectious tropical disease affects no fewer than 240 million people worldwide, mainly in Africa but also in parts of South America and Asia. The acute symptoms range from a rash to life-threatening fever. The long-term consequences include chronic inflammation of various organs, which can also lead to death. Up to 200,000 of those infected die each year from the effects of the disease. It is a vicious cycle. The female’s eggs infest inner organs such as the colon, spleen or liver, where the larvae develop into worms, the eggs of which are then excreted via the urine or feces of those infected. Freshwater snails then act as a host in which the eggs develop into larvae, which in turn penetrate the human body. This cycle can be broken by the active ingredient praziquantel, which Merck developed as part of a research collaboration in the 1970s. It was a milestone in the treatment of the worm disease that has made it possible to cure schistosomiasis in many millions of people.

Frank Gotthardt → Head of Public Affairs & Corporate Responsibility

“we want to work with multiple constituencies In a strong alliance to help fight schistosomiasis worldwide.”

With its broad-based Praziquantel Donation Program, Merck has been actively supporting the World Health Organization (WHO) in the fight against the dangerous disease in Africa since 2007. To date, Merck has donated around 200 million tablets to WHO. Altogether, more than 54 million patients, primarily children, have been treated. “However, millions of children worldwide still suffer from schistosomiasis. The disease prevents them from learning and weakens development potential in the affected countries. We want to give children new opportunities while at the same time promoting economic growth and making a brighter future possible,”says Stefan Oschmann, Vice Chairman of the Executive Board, whose responsibilities include the topic of Corporate Responsibility. Meeting this ambitious goal calls for sophisticated logistics. Merck produces the medicine in Mexico and transports it in coordination with WHO and the respective health ministries to the affected countries thousands of kilometers away. “We want to work with multiple constituencies in a strong alliance to help fight schistosomiasis worldwide,” explains Frank Gotthardt, Head of Public Affairs & Corporate Responsibility, who is responsible for the program. The infection rate is especially high among children and the symptoms that result are particularly serious; schistosomiasis stunts growth, causes learning disabilities and leads to anemia. The problem is that in its current form, the medication is not suitable for children under the age of six. “Together with international partners, we are therefore developing a new pediatric formulation of praziquantel for young children, which is now being investigated in initial clinical trials,” says Jutta Reinhard-Rupp, Head of the Global Health Translational Innovation Platform at Merck.

Transmission of schistosomiasis → via people and intermediate hosts

Worms of the genus schistosoma, the cause of schistosomiasis,
live in stagnant bodies of water.

Access to Health: A four-pillar strategy

The Merck Praziquantel Donation Program is one of the many activities within the scope of the Access to Health initiative. Merck leverages core competencies across the company to provide health solutions to underserved populations and patients in developing countries. Improving access to health involves a complex and broad range of tasks, e. g. researching, developing and refining health solutions, creating efficient health systems and distribution channels, offering products at affordable prices, as well as educating health workers and patients. Merck’s strategy focuses on four areas, the so-called “4As”: Availability, Affordability, Awareness, and Accessibility. Availability includes refining health solutions that address unmet needs and are tailored to local environments; affordability is about helping patients who are unable to pay for the health solutions they need; awareness focuses on empowering people to make informed decisions through education and training. For example, the Merck Capacity Advancement Program (CAP) seeks to improve access to and the quality of diabetes treatment in Africa and India. Accessibility aims at strengthening supply chains in order to deliver and reach out efficiently at the point of care.

Putting patients first

The Access to Medicine Foundation has recognized Merck’s strategic approach in its Access to Medicine Index. Every two years, the index compiled by the non-profit international foundation assesses the initiatives by the world’s leading pharmaceutical companies to promote access to medicine in developing countries. In 2014, Merck ranked sixth, moving up two places compared with 2012 (→ see Corporate Responsibility).


“Patients are at the core of all our efforts. we will do everything we can to better help them while working to further lower the barriers to access.”

“The repeated improvement in our ranking proves that our diverse activities have become an integral part of how we conduct business. Patients are at the core of all our efforts. We will do everything we can to better help them while working to further lower the barriers to access,” says Stefan Oschmann. Apart from Merck’s commitment to the fight against schistosomiasis, the foundation praised a new business model in India. The Suswastha pilot program is aimed at increasing access to health care products at an affordable price in rural India.


Ensuring access to safe medicines

The numerous Merck projects based on the Access to Health strategy are bearing fruit around the world, with a clear focus on the rural regions of developing countries. For instance, Merck has developed a rural pharmacy, a pharmacy specifically designed for Africa that is being piloted in Ghana. The pharmacy is inside a 30 m2 container that can be transported by truck to remote communities, pre-equipped and with minimal assembly required. “We are providing rural populations with direct and safe access to medicines and professional advice,” says Ronke Ampiah, Head of the Rural Pharmacy project at Merck.

Safe provision also means that the medicines are neither substandard nor counterfeit. That’s because these could be lethal if, for instance, patients take entirely ineffective medications for malaria. The packaging is largely identical; the international police organization Interpol estimates that up to 30% of all medicines in developing countries are either counterfeit or substandard. The Global Pharma Health Fund (GPHF), a non-profit initiative funded by Merck, is dedicated to fighting counterfeit medicines. The most effective tool is a mobile, compact laboratory that can be used to identify counterfeit medicines quickly and easily. Reference samples are used to test the identity and concentration of 75 active ingredients in total, ranging from anti-malarial drugs and antibiotics to analgesics and antipyretics. This is another initiative through which Merck is helping to improve access to health in developing countries.


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