Merck researchers believed that ivermectin, a drug already used to treat parasites in livestock, could also cure human river blindness (onchocerciasis), a disease that was blinding hundreds of thousands of poor people across tropical Africa and Latin America. Proving it — development, human trials, mass manufacture and distribution — would take years and cost enormous sums, and every patient who needed the drug was too poor to pay anything for it.
The textbook business response was to leave the drug on the shelf: R&D poured into a medicine with zero paying market is money down the drain, and Merck already had a healthy market selling the same molecule to farmers. Any competent board would have asked why a profit-making company should spend a fortune to give medicine free to the poorest people on earth.
In 1987 Merck committed to donate Mectizan (ivermectin) completely free of charge, as much as needed and for as long as needed, to eliminate river blindness as a public health problem everywhere — then institutionalised the give-away by building the Mectizan Donation Program, a delivery partnership that shipped over 1.3 billion treatments in its first quarter-century.
Set the price to zero unconditionally, making the drug a reliable public asset that partners build delivery on, scaling to billions of doses and compounding into trust.
Zero price removes the payment wall, letting the drug flow to those who need it.
Unconditional commitment lets WHO and governments build delivery infrastructure on reliable supply.
Reliable supply scales distribution, reaching over a billion treatments.
The gift builds institutional trust and reputation, becoming durable advantage.
When your market can't pay, price at zero and make the gift unconditional; partners build on reliable supply, turning a loss into durable reputation and scale.
Over 1.3 billion treatments donated; WHO verified five countries free of river blindness; 171 million people treated in 2024. The Mectizan Donation Program became the institutional blueprint for corporate drug donation, copied by later large-scale giving for lymphatic filariasis and other neglected diseases, and the 1987 'free forever' commitment is now the standard mechanism for reaching markets that cannot pay.
FOLLOW THE EVIDENCE
The sources
- Onchocerciasis — WHO fact sheet World Health Organization · who.int
- Growth, Challenges, and Solutions over 25 Years of Mectizan and the Onchocerciasis Control Program — PLOS NTDs PLOS Neglected Tropical Diseases · journals.plos.org
- Merck & Co., Inc.: Addressing Third-World Needs — HBS case Harvard Business School · hbsp.harvard.edu