Empty Cities, Outstretched Hands

...Si lunga tratta

di gente, ch'io non avrei mai creduto

che morte tanta n'avesse disfatta.

...So long a train

of people, that I should never have believed

death had undone so many.

Dante Alighieri, The Inferno, Canto 3.

Ninety million people live in California, Texas, New York, and Florida. Imagine that, sometime tonight, an unnameable catastrophe carries off everyone in those states over the age of 14. When the sun comes up tomorrow, only the children remain. Eighteen million children, left to care for one another or fend for themselves.

Douglas McCormick

Eighteen million orphans: That's Africa today.

Last month, BD Medical (a division of Becton, Dickinson and Company, Franklin Lakes, NJ, www.bd.com) hosted a two-day conference in Lyon, France, on product life-cycle management. The keynote, presented by executive vice-president Gary M. Cohen to an audience of some 200 customers and prospective customers, was not about the company's products, however.

Design for the developing world

Instead, he talked about his company's mission to provide appropriate healthcare to the world's most disadvantaged populations, taking as his text three of the eight United Nations Millennium Goals for improving the health of the world's poorest nations by 2015:

• reduce child mortality by two-thirds;

• reduce maternal mortality rates by three-quarters;

• halt and begin to reverse the spread of HIV, malaria, tuberculosis, and other pandemic infectious diseases (1).

Vanished cities

Here are the dimensions of the problem: In southern Africa, HIV infects 40 million people and AIDS kills three million each year (the population of Chicago—gone). Malaria kills another three million (Philadelphia and Phoenix—gone). Tuberculosis kills two million (Houston—gone). In 2000, measles killed 850,000 (the children of San Jose, Detroit, Indianapolis, Jacksonville, and San Francisco—all gone). Maternal and neonatal tetanus, contracted by the infant or mother during childbirth on bare ground, killed 200,000 babies and 30,000 women (the children of Dallas—gone).

The litany of suffering recalled former president Bill Clinton's address at the 2006 BIO Annual Meeting in Chicago. Though we've reported it before, it bears repeating:

Keep in mind half the world's people live on less than $2.00 a day; a billion people live on less than $1.00 a day; a billion people go to bed hungry every night; a billion people never get a clean glass of water in their entire lives; . . . [each year] ten million kids die of completely preventable childhood illnesses that claim no lives in America...; and one in four of all the deaths on earth this year, all the deaths including from natural disasters, wars, accidents, crime, heart attacks, stroke, cancer, everything else in the whole world, one in four deaths will come from AIDS, TB, Malaria and infections related to dirty water, principally cholera and diarrhea-related illnesses (2).

Second-hand woes

Our industry is doing much to help, and must do more. In 2003, industry delivered more than $2 billion in aid to fight AIDS, malaria, and tuberculosis in Africa—more than the World Health Organization or UNICEF (3, 4).

Much of this aid, though, comes in the form of Western hand-me-downs: products designed and manufactured for developed-world needs and healthcare delivery systems. They are a start, but they don't precisely fit the real needs. The challenge, Cohen pointed out, is to design and provide products that are tailored to this market, however unprofitable they might be: drugs, devices, and supplies that are robust, easy to use, and inexpensive. And in this direction, we have very far to go.

Douglas McCormick is editor in chief of Pharmaceutical Technology, dmccormick@advanstar.com

References

1. World Health Organization (WHO), Health in the Millennium Development Goals (WHO, Geneva, Switzerland, 2005), www.who.int/mdg/publications/mdg_report/en/index.html, accessed Dec. 20, 2006.

2. D. McCormick, "Motion and Tranquility," Pharm. Technol. 30 (5), 14 (2006).

3. J. Breitstein, "AIDS in Africa: The Road Forward," Pharm. Exec. 25 (3), (2005).

4. Pharmaceutical Research and Manufacturers Association (PhRMA), Millennium Development Goals: The Industry's Contributions (PhRMA, Washington, DC, 2005), www.phrma.org/files/2005-01-18.1120.pdf, accessed Dec. 20, 2006.