Kicking the habit
Life without multinationals. Still a dream, but can it come true? Advocates of big business domination in the global market place argue that 'life as we know it' depends on aggressive marketing by multinational corporations. Thanks only to their constant efforts in research and development can our ever-changing appetites be satisfied. In the Third World 'development' means a rising demand for goods and services. And with indigenous industry slow to adapt, multinationals alone can provide what the people want.
So runs the old argument. But in one area after another multinationals are being exposed as greedy and irresponsible: placing profits before people sometimes with deadly consequences. The babyfoods scandal is one example. And pharmaceuticals is fast becoming another. Marketing costly, inappropriate and even dangerous drugs in Third World countries is a major factor in putting decent health care beyond the reach of the poor.
But what can be done about it? A fine example comes from Savar in Bangladesh where Gonoshastama Kendra - the People's Health Centre - has just begun making its own drugs. Already wellknown as a success story in community health care, GSK has come face-to-face with the power of multinational drug companies.
Pioneer of the project, Dr. Zafrullah Chowdhury, explained the problem in a recent interview with Multinational Monitor. He makes the following points:
- Eight multinationals control 74 per cent of Bangladesh's pharmaceutical market.
- Multinationals can't repatriate profits so they rely on 'transfer pricing' - paying the parent company inflated prices for goods and services. One anaesthetic sold by May & Becker costs three cents for the drug, six for overheads, but 50 for the bottle - imported from Britain.
- Companies rely on familiar brand names to dominate the market. BristolMyers puts its own label on locally made pencillin and sells it at twice the price.
- Doctors buy known brands, either because they aren't taught about the economics of drugs and multinationals 'trade on their ignorance'. Or because they have a 'direct financial interest in the status quo'. Of Pfizer's 45 local shareholders 44 are doctors or doctors' wives.
- People think if a drug is expensive it must be good - even if they have to sell their land to pay for it. 'This is a human weakness', says Chowdhury, 'and the drug companies are playing on it.' The consequence is that no more than 20 per cent of Bangladeshis can afford available medicines.
So much for the problem. The solution is designed to build on GSK's existing success in primary health care. Given the right information and training, says Chowdhury, people can take charge of up to three-quarters of their own health needs. GSK uses 'barefoot' doctors for preventive health care, routine treatment, and even simple operations - relying on a referral system for more specialised facilities and treatment. It also links health with development as a whole, bringing the struggle for self-sufficiency into the front-line of the fight against malnutrition and disease. 'We've proved that knowledge can be transferred to the people', argues Chowdhury, 'but they are without ammunition. In the health field drugs are ammunition.'
After three years wrangling with the government and with the aid of a $3 million grant from the Dutch agency NOVIB, the People's Health Centre is now opening its own pharmaceutical factory. The factory is designed to produse 30 basic drugs for sale under generic names - at half the price charged by multinationals. Linked to the manufacturing is a campaign to increase consumer awareness and set up a retail network. Meanwhile GSK's biggest customers will be the government and UNICEF.
To begin with the impact on multinationals will be small. But, says, Chowdhury, 'we have to show how Third World countries can survive with limited resources. If in five years we can show we no longer need help with pharmaceuticals, people will see we don't have to, and certainly don't want to, live on charity.'