Raymond V. Gilmartin Chairman, President and Chief Executive Officer Merck & Co., Inc.

In May, together with four other pharmaceutical companies and five UN agencies, Merck endorsed a joint statement of intent on accelerating access to HIV care and treatment in the developing world. As part of the UN/industry initiative, Merck agreed to make our HIV drugs available at more affordable prices in developing countries. But the framework goes beyond a focus on simply supplying less expensive medicines. It seeks to address the broader issues of sustainable solutions and comprehensive approaches to HIV care and treatment.            At the International AIDS Conference in Durban in July, in the spirit of that framework, Merck, the Republic of Botswana and the Bill & Melinda Gates Foundation announced the Botswana Comprehensive HIV/AIDS Partnership. This initiative is designed to demonstrate the feasibility of a comprehensive, targeted approach to improving the entire spectrum of HIV care and treatment in one of the African countries hardest hit by the epidemic. Working together, we hope to transform Botswana's response to HIV/AIDS.

            The partnership will be conducted with the participation of other national governments; the Harvard AIDS Institute and other academic centers; global health and development agencies, such as the Joint United Nations Programme on HIV/AIDS; non-governmental organizations; HIV community organizations, and people living with HIV.

           The Gates Foundation will dedicate $50 million over five years to help Botswana fundamentally strengthen its primary health care system. Merck and The Merck Company Foundation will match the Gates Foundation funding through two major components: the development and management of the program and the contribution of antiretroviral medicines.

           Two other companies, Boehringer-Ingelheim and Unilever, have already agreed to join in this partnership. Boehringer-Ingelheim has pledged to donate medication for the prevention of mother-to-child transmission of HIV infection. Unilever PLC will contribute expertise in setting up distribution systems and public communications and awareness programs.

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           That's a brief description of what our partnership is about. Now, let me move on to the question I was asked: "Why is Merck working with the Republic of Botswana and the Gates Foundation to address HIV/AIDS?" I'll begin by borrowing the eloquence of Henry James, who once wrote, "our passion is our task."

           At Merck, our passion is to translate cutting-edge science into breakthrough medicines.

           On December 27th of last year, clinical investigators vaccinated the first human subject in Merck's Phase I safety trials for an HIV/AIDS vaccine - an event possible because of that passion for cutting-edge research.

           Of course, the likelihood of failure at this stage remains high - and if we fail, we'll still keep going. But that day - fourteen years in the making - symbolizes our passion, our commitment, and the most important long-term role that we play in improving global health: pushing the boundaries of science and technology to conduct breakthrough research.

           Yet if we are fortunate enough to make a vaccine for HIV available, will it be accessible? For millions of people, our finest achievement could very well be beyond reach.

           So, at Merck we are equally passionate about our other major role: to help bring our achievement to patients throughout the world.

           In Botswana - a country with 1.5 million people - and with one-third of adults infected with HIV - we see our task as working with the government, the Gates Foundation, and other partners, including Boehringer-Ingelheim and Unilever, to dramatically improve prevention, care, and treatment for HIV - including training, education, testing, counseling, and medical care.

           We are all working together, looking for long-term solutions - not a quick fix. Such solutions can come only from comprehensive approaches that draw on the complementary expertise of all stakeholders - so we are working with groups global and local, governmental and non-governmental, public and private.

           Working together, we can also help to strengthen national capacity to address unmet needs in malaria and TB. And we hope that the lessons learned from this project over the next few years will catalyze similar efforts in other countries and thus help strengthen the global response to HIV/AIDS.

           So, to answer the question I was asked, we're involved because we want to make our medicines not only available but accessible.

           That's a long-time tradition in our company. Fifty years ago, George W. had something to say on this topic. Not that George W., but George W. Merck, the son of our founder, a former chairman, and the architect of the modern-day Merck. "Medicine is for the people," he said. "It is not for the profits."

           That may sound surprising for the chief executive of a private-sector company to say - and cynics may be skeptical.

           But I'll tell you what he said next: "The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been." He went on to say that "we cannot rest till the way has been found, with our help, to bring our finest achievement to everyone."

           His vision helped firmly establish Merck tradition and values - a commitment to making medicines available without immediate concern for profits. From the manufacture and supply of penicillin during World War II - to our transfer to China of recombinant DNA technology for the manufacture of our hepatitis B vaccine - to our Mectizan Donation Program that treats millions of people in the world's poorest nations - our passion is our task.

           So Merck is involved in the Botswana partnership because it is part of our tradition, our values, who we are as a company.

           Of course, we are a company. We're publicly owned. That means we also have a responsibility to our shareholders. That brings us to the second part of George Merck's quote: the better we remembered that medicine is for patients, the larger our profits have been.

           I can't tell you if he had read Adam Smith - but his views coincide with the economic theory that "by pursuing its own interest [the corporation] frequently promotes that of society more effectually than when it really intends to promote it."

           When, as a company, we remember that we're trying to get our medicines to the widest number of people, we do well for our shareholders and manage to do some good in society. How? The first, and easy answer, is that our passion attracts passionate and talented people.

           BusinessWeek said it best a couple of years ago. Its cover story read: "When the partially constructed Virginia plant for Merck's new AIDS drug, Crixivan, got buried under four feet of snow, everyone from managers to lab workers rushed in with snow shovels. That helped Merck get the lifesaving drug off the production line just 15 months after breaking ground, nine months ahead of schedule. You won't find a column measuring that kind of dedication and resourcefulness on any kind of balance sheet."

           But that's just the first part. We also recognize that the extraordinary medical breakthroughs of this century have created medicines and vaccines for many life-threatening diseases. Many therapies are off-patent and inexpensive. Yet millions still suffer from illnesses that are preventable or treatable - because of lack of access.

           So, secondly, the partnerships that we have been creating are helping to create a health care infrastructure that will allow medicines to be delivered in the future. They can create markets for our medicines, even if they are at lower prices that reflect the needs of developing nations.

           They can pre-empt other approaches that are destructive to innovation, such as the weakening of intellectual property rights through compulsory licensing. Doing away with patents will not provide patients with medicines. But creating a health care infrastructure and delivery system and educating health care professionals can help.

           In fact, by improving the health care delivery system, it may be possible to stimulate further medical research and development, especially for diseases endemic in developing countries. And we would hope that intellectual property protection would be seen not as a barrier to access, but as a powerful incentive for badly-needed innovation and research.

           I mentioned earlier that Merck may be on the verge of developing an HIV vaccine. Creating collaborations and infrastructure - and building both sustainable resources and the political will to address public health - would help get a vaccine to patients.

           Our experience with the medicine Mectizan, which treats and prevents river blindness and lymphatic filariasis, has taught us that even the simplest pharmaceutical intervention faces tremendous challenges in delivery. This medicine has no special storage requirements, requires minimal medical supervision, and is taken as one tablet just once a year.

           Recognizing that the hundreds of millions of people at risk for these devastating diseases could not afford this medicine - no matter how little we charged for it, our company decided to donate it - for as long as necessary - to help eliminate the diseases as public health problems.

           Yet even with the cost of the medicine removed as a barrier to access, it still took the collaborative efforts of the World Health Organization, the World Bank, the Carter Center, international aid agencies, non-governmental development organizations, national ministries of health, community health care workers, and Merck - three years to develop a protocol, an infrastructure, and a delivery system for Mectizan.

           The effort was worth it: the system reaches tens of millions each year with an effective therapy, and in so doing, has helped to improve primary health care in some of the poorest regions of Africa.

           We're replicating the success of that collaboration in our Botswana partnership, particularly the focus on partnership itself, on health care infrastructure, and on coordination, communication, and commitment from all stakeholders.

           But let me repeat: It took three years to get a free one-dose-a-year tablet of Mectizan to those in need.

           We simply would not tolerate having people wait three years after final development to get an HIV vaccine. As a Greek philosopher once said, "There is no medicine for a life that has fled."

           Cutting-edge HIV treatments, including those that scientists at our company discovered and developed, are costly and require complex medical oversight. We view a vaccine as potential future solution - but people need care today. Collaborations like the Botswana partnership can help both address current needs and prepare for future breakthroughs.

           For the future, we're confident in continuing medical breakthroughs. Our only barrier in research is science itself: we don't keep discoveries on the shelf simply because the market today may be limited. But for the present, building infrastructure, delivery systems, political will, and sustained commitment and financing can have a tremendous impact on public health in the developing world.

           In the past year, some have become vocal, expressing fears of the consequences of globalization. In the Botswana partnership and other such collaborations, I see the tremendous potential of the world becoming more integrated: we can work more closely together in ways that were never before possible.

           A private foundation and private company entering into an agreement with a nation-state - to build a shared future rather than assigning blame for what has passed: this is an extraordinary demonstration of the kind of collaboration that is possible.

           With the collaboration of the Gates Foundation, the leadership of the Government of Botswana, the research and expertise we seek to provide, the involvement of key players on the world health stage, and the commitment of governments prepared to be serious about the fight for better health, we believe this kind of collaboration can serve as both a model and a catalyst for countless more, to improve the lives of millions.

           For only our collective knowledge, resources, and experience can bring the best of medicines to the widest possible number of people.

           In that spirit, allow me to conclude with a remark made by a giant in the field of vaccines, Dr. Albert B. Sabin, during a visit by American scientists to Soviet scientists in the 1950s - a time not noted for cooperation between these nations. Dr. Sabin said: "A toast to biological warfare - against all disease."

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