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Merck's decision may leave more than 2 million children in West Africa unvaccinated and vulnerable to rotavirus in 2020.

At the same time Merck cut the vaccine supplies to West African countries, they began delivering RotaTeq to China.  Each vaccine will likely cost more than $40 per dose.  When asked if there was a connection between the launch in China and Merck not fulfilling their West African commitment, a Merck spokesperson wrote:

When faced with supply constraints, such as this, we evaluate all options to determine how we can fulfill the agreement we made with UNICEF and GAVI-eligible countries to the best of our ability, while at the same time meet the binding contract demands we have with other countries. The product we have allocated to China is what has been approved for use in that country to fulfill the terms of a binding agreement we signed with a local vaccine company in 2012. As I'm sure you can appreciate, the details of that contract is proprietary to Merck; as such, we cannot confirm the number of doses nor discuss price.

"Kids should not be denied vaccines just because they belong to a poor country."-Dr. Mathuram Santosham at Johns Hopkins University

Where does that leave the kids in West Africa? UNICEF, which delivers vaccines to poor countries worldwide, says it's trying to help the West African countries switch to another vaccine.  The World Health Organization prequalified two new rotavirus vaccines manufactured in India earlier this year:  Rotasil and Rotavac.  Both vaccines are available to Gavi at a cost of less than $2 per dose.

Unfortunately, the switch will not be quick-or easy.  Prequalification of a vaccine is the beginning of a long process, including a regulatory actions that must occur.   The process is daunting, with more than a few moving parts that require time and money.  New vaccines may be tested in small pilot programs, health care workers have to be retrained on vaccine administration, clinics need the ability to store and transport the new vaccine.  That will require possibly up to five years for the vaccine to be widely available in West Africa, says Frederick Cassels, at the nonprofit PATH, which helped develop Rotasil and Rotavac.  Even just a delay of a few years would put millions of babies at risk for rotavirus, says Johns Hopkins University's Santosham. "We all as a community should come together and make sure these kids get this vaccine."

According to Merck, their third quarter 2018 worldwide sales were $10.8 billion.  Good for Merck-really.  More profits mean more research, and more lives saved overall.  Most reasonable people realize that companies need to make a profit to stay in business, and that includes pharmaceutical companies.  But the pharmaceutical industry is not like other industries that sell tires or pizza.  Due to the nature of the business, pharmaceutical industry profits are made off of illness and disease--this requires a level of sensitivity and responsibility to the community that the local pizza joint does not need to make.

What level of responsibility do pharmaceutical companies owe to the people?  Has Merck denied their responsibility to the community and turned their back on the poor children of Africa?  Can a company be both profitable and ethical, or are those incompatible values?  These are questions that need consideration, since we live in a world with expanding need, and shrinking resources.