Merck is a global research-driven pharmaceutical company that, throughout its history, has devoted considerable effort to bringing its medicines, vaccines, expertise and experience to people in need around the world. Its primary responsibilities are: to discover, develop and deliver innovative medicines and vaccines that address major burdens of illness globally and/or address specific poor or vulnerable groups; to develop long-term business models that help its products reach as many people as possible; and to promote and participate in partnerships with governments, multilateral and non-governmental organizations, other private-sector organizations and communities, to build healthcare capacity and to address specific health and development challenges around the world. Merck believes that responding to global health challenges is a strategic and humanitarian necessity and that, through public-private partnerships, significant progress can be achieved. Twenty years ago, in October 1987, before collaboration between public and private sectors was common, Merck launched the Mectizan Donation Program (MDP) - a unique, multisectoral coalition involving Merck, the Mectizan Expert Committee (MEC), the Task Force for Child Survival and Development, the World Health Organization (WHO), the World Bank, the United Nations Children's Fund, national ministries of health, more than 35 non-governmental development organizations, and thousands of local community healthworkers - to treat a debilitating, disfiguring and often blinding disease called onchocerciasis (river blindness). Through this programme, Merck made the commitment to donate Mectizan (ivermectin) for as long as needed and wherever needed, to combat this disease. Since the MDP's inception in 1987, Merck has donated >1800 million tablets of Mectizan, with >530 million treatments for onchocerciasis administered since 1987. The programme currently reaches >68 million people in Africa, Latin American and Yemen annually, via community-based treatment programmes in 125,000 communities in 33 endemic countries. This 20-year-old effort has achieved a number of notable results, including positive health impacts, economic benefits, strengthened health systems, and the empowerment of communities where the delivery and administration of Mectizan are managed. The MDP serves as a model for similar health programmes in the developing world and has also laid the foundation for the current integration efforts around 'neglected' tropical diseases. It has also taught the world many valuable lessons - about how to mobilize resources to address significant health challenges - and has demonstrated that it is possible, through public-private partnerships, to deliver healthcare to long-neglected populations, despite seemingly insurmountable obstacles including inadequate financial and human resources, lack of social, economic and health infrastructures, civil unrest and political strife, and competing, high-priority health issues.
Established by MSD, also known as Merck & Co., Inc., Kenilworth, NJ USA in 1987, the Mectizan Donation Program (MDP) is the longest running disease-specific program of its kind. Initially aimed at control of onchocerciasis (river blindness), the company expanded its commitment through the MDP in 1998 to include lymphatic filariasis (LF). Both diseases are now candidates for elimination and the company is engaged in several global partnerships to help advance towards that goal. To support the steadily growing demand from country-led disease elimination programs, the company has put in place several administrative and operational improvements. In addition, the company is involved 'beyond the pill', including making financial and management contributions to partners such as the END Fund and the Expanded Special Project to Eliminate NTDs (ESPEN) to support the technical needs of elimination programs. While the time-bound elimination targets are challenging, clear progress is being made for both onchocerciasis and LF, with several national and subnational areas in Latin America and Africa having stopped transmission of one or both diseases. The company's donation of Mectizan and contributions of financial, management and technical resources reflect the company's long-standing commitment to pursue inventive ways to expand and enhance access to medicine. Continued support from MSD and other partners will enable countries to advance towards their elimination targets for LF and onchocerciasis.
and the Global Medical Program at Massachusetts General Hospital. Some of the issues within poorly directed STMEs include a lack of coordination with existing medical services and national and local public health offi cials; language and cultural understanding; medical skill sets (appropriate experience, training, and licensing) to perform procedures; familiarity with national and local laws; knowledge of unique challenges that may aff ect medication intake (e.g., the availability of food and water); and understanding of individual medical histories and continuity of care.More broadly, the sections below also illuminate the point that without necessary research and communication with the partner community, some interventions may not necessarily cause extensive harm to individuals, but rather, may be misaligned with the needs of the communities they seek to assist and so are either less eff ective or unwanted. These engagements represent a lost opportunity in terms of wasting resources that could have been applied to a quality STME or to meet other needs of the partner community and sometimes also waste preciously limited resources of the host community. These failed STMEs rarely become public knowledge. Moreover, the failure may not be recognized or acknowledged by the leaders and participants. Generally, there is little to no oversight, nor is there a requirement for a public record regarding STME activities. Without oversight, STMEs may not be self-correcting.At the same time, global health promotion and partnerships have been encouraged by the Sustainable Development Goals (SDGs)-specifi cally SDG-3, which seeks to "ensure healthy lives and promote well-being for all at all ages," and SDG-17, which seeks to "strengthen the means of implementation and revitalize the global partnership for sustainable development" [25]. As in the example of ReSurge, some eff ective STMEs have successfully contributed to these goals, especially those that focus on SDG-17's advocacy for targeted "capacity-building in developing countries to support national plans" [25].This paper also seeks to defi ne both challenges and opportunities that exist for STMEs and suggests co-ordinated actions to establish best practices for highquality STMEs.
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