Author Archives: scj278

Marketing ORT

In 1980, diarrhea and dehydration were killing 4.6 million children worldwide. You would probably guess that when a simple, inexpensive solution came along, it would be quickly and widely adopted. Unfortunately, eight years after introduction, Oral Rehydration Therapy was only being used in 35% of diarrhea episodes. While there are numerous reasons for the slow adoption for ORT, I want to discuss the case in the context of the ORT marketing strategy. I acknowledge that businesses have the luxury of knowing that the financial benefits of marketing will far outweigh the upfront costs. While the same is true in healthcare, justifying the short-term marketing costs can be far more difficult than in business.

A central pillar of marketing is that you must “meet your customers where they are.” Meaning, your product must be distributed through the channels your customers want to use, not necessary those that are the easiest or cheapest for the distributor. To put this in context: Amazon is opening brick and mortar stores because some customers do not want to shop via the internet, and would prefer to visit a store location. Arguably, BRAC succeeded because its oral rehydration workers were visiting millions of houses, meeting care providers in their preferred locations, which removed hurdles to adoption for ORT. Admittedly, this door-to-door strategy is time intensive, expensive and difficult to coordinate. Nevertheless, it was working, and intensifying the strategy could have eliminated some of the confusion that hindered the use of ORT.

The question of bundling zinc and ORT together, or distributing them separately, is easy to answer from a branding and marketing perspective: together. Setting aside all the other challenges with zinc, customers are more willing to buy complimentary products when offered together. Moreover, not bundling products is simply a missed opportunity for a second sale, or in this case, an improved health outcome. While a costly and logistically difficult, clean water should also have been part of the bundle. How many times have you bought a toy, couldn’t use it because you didn’t have batteries? In this scenario, water is the batteries.

Finally, officials expected a viral marketing campaign based on the quality of ORT alone. Unfortunately, viral marketing requires identifying influencers and targeting them for early adoption, and dissemination. Given this, pharmacists should have been a key target in the early stages of ORT outreach. The same workers conducting in home trainings should also have been training pharmacists, religious leaders, community heads and schoolteachers.

Despite common lure, even great products do not sell themselves. ORT adoption could have been significantly improved with a more traditional approach to marketing.

Is Disease Eradication Possible In The Age Of Patents?

After reading about attempts to eradicate Polio in Uttar Pradesh, followed by several articles addressing the Trade-Related Aspects of Intellectual Property Rights (TRIPS), I was curious: Did the United States use a patented vaccine in its polio elimination campaign? The short answer is no.

This question was prompted by (what I guessed to be) an analogues situation in economic development. In the late 1990s and early 2000s, many economists promoted market liberalization as a pathway for economic development. Many rationalized this practice by pointing to the current economic policies of the United States, and its economic growth. Essentially, the prescription to developing countries was – make your economic policy reflect that of the United States, and economic growth will follow. However, this overlooked, or intentionally ignored, the fact that the United States utilized intense protectionist policies in its infancy, incubating domestic industries and enterprises before ever exposing them to intense international competition. There was no empirical evidence that market liberalization could promote economic development.

While disease reduction is a noble cause, I question if we are asking middle and low-income countries to execute an impossible task. To some extent, the current dialogue highlights the United States and says to developing countries, “if they could do it, so can you” – despite the fact that the rules of the game have changed drastically.

The March of Dimes “committed to give the formulation and production processes for the vaccine to several pharmaceutical companies for free,” ensuring that the polio vaccine could be produced cheaply, and in mass. Interestingly, patent law existed, but lawyers did not believe they could patent the Salk vaccine. Today, most vaccines are patented and expensive. ” In this context, one could argue that the recent decisions and threats by India and Brazil, respectively, are only attempts to recreate the same environment in which vaccination campaigns have been financially and operationally feasible in the past.

With patent law intensifying since the American polio eradication campaign, the United States Government has adapted. “The U.S. government is now the primary applicant for vaccine-related patents, followed by GlaxoSmithKline and a number of other corporations.” With the government as a competitor in drug development, it is possible that the public sector will develop new remedies funded by taxpayer dollars, enabling inexpensive distribution. However, this still leaves low and moderate-income countries out of the loop. Low-income countries have small tax and limited bandwidth to support such research – leaving them tied to patented drugs, and the support of NGOs.

To date, the only globally eradicated disease is smallpox. The original vaccine for smallpox did not have a patent. Without a significant shift in patent policy, utilizing vaccines to eradicate diseases appears to be an impossible task for low and middle-income governments to undertake on their own.

Both quotes from: