Each year half a million people in India and other tropical countries catch visceral leishmaniasis, also known as black fever. Infected by the bite of a sand fly, they rapidly weaken and lose weight before dying with painfully swollen livers and spleens.
A safe and effective treatment for black fever was found long ago: the antibiotic paromomycin (cure rate 95%). But the firm that developed it -- Pharmacia, a precursor of Pfizer – shelved it in the 1960s for lack of a "viable market." What that means is that the people who need it cannot afford to pay for it. It is simply not profitable for pharmaceutical companies to fight diseases that afflict the poor. Less than 1% of the new drugs developed in 1975–99 were for tropical diseases (Joel Bakan, The Corporation: The Pathological Pursuit of Profit and Power, Simon & Schuster 2005, p. 49).
Lack of effective demand is not the only thing that makes many useful drugs unprofitable. In general, a capitalist firm can only make big profits by selling drugs on which it has a patent – that is, an exclusive right to make, use, and sell a new product for a certain period (in Britain and the US it is 20 or even 25 years). Firms are not interested in making drugs that cannot be patented.
An interesting recent development is the emergence of a new kind of charity that raises money not just to distribute but to produce things that people need but can't afford. One such organization is the Institute for One World Health (IOWH), founded in San Francisco in 2000 by Dr. Victoria Hale. A pharmaceutical chemist, Dr. Hale had felt frustrated watching the industry abandon badly needed and promising but unprofitable drugs. At about the same time, James Fruchterman, an electrical engineer, set up Benetech, another "nonprofit company," in Palo Alto, California, to produce new types of equipment for the disabled.
The first program of IOWH aims to make paromomycin available to black fever sufferers in the north Indian state of Bihar. The program is being funded (to the tune of $4,700,000) mainly by Bill and Melinda Gates. The Indian government has given its approval and an Indian firm (Gland Pharma of Hyderabad) has agreed to manufacture the drug at cost. Other programs are planned to tackle Chagas disease, malaria, and diarrhea.
It is hard not to sympathize with well-meaning projects of this kind. But we also have to consider the problems faced by nonprofit organizations as they operate under the constraints of a profit-driven economy.
The first problem is how to raise enough money. IOWH is asking the Gates for another $30 million. They can't take out loans or raise funds on the capital market because that would force them to operate on a profit-oriented basis. But unfortunately only a few of the very wealthy are willing to give to charity on a really major scale and the demands made on those few are legion. And doesn't it seem perverse first to accumulate profit and then use it to ameliorate the ills constantly generated by that same profit-making process? Does the left hand know what the right hand is up to?
It also bears noting that the paromomycin is not going to be provided free of charge. The aim is only to make it as affordable as possible. Dr. Hale hopes to keep the cost down to $10 for a 21-day course of treatment, but the website of the World Health Organization merely says "below $50." We shall see. The point is that in the context of India – and especially in that of Bihar, India's poorest state – these are by no means paltry sums. The average per capita income in Bihar is $120 (5,500 rupees) a year. As the distribution of income is highly unequal, even $10 will be well beyond the means of many sufferers.
In his enthusiastic report in The Guardian Weekly (October 20-26, 2006, p. 29), Ken Burnett asks why nonprofit pharmaceutical companies should not be followed by nonprofit seed companies, water companies, travel companies, and so on. Why not, indeed? But if this is supposed to be a process that develops under capitalism, we can't avoid asking: "Where is the money coming from?" So far all we have is one small nonprofit pharmaceutical company and one small nonprofit engineering firm.
Nevertheless, it is encouraging to see people trying to move in this direction, people who crave meaningful work for the benefit of the community. The very existence of nonprofit companies is a protest against and challenge to the system of production for profit. We would only take the argument to the next logical step. Why not extend the principle of production for need to the world economy as a whole?