In recent years, the humanitarian activities of the pharmaceutical industry have grown to such size and scope that they have become a truly significant part of the global efforts to fight disease and improve public health in the developing world. In sheer size, the industry's health spending in developing countries rivals that of the World Health Organization. More important, the collaborations among pharmaceutical companies and their partners - many of the world's leading humanitarian, academic, govern-mental, multilateral and community-based organizations - have benefited tens of millions of people living in more than 100 developing countries around the world. Of the lessons companies have learned from these experiences, two stand out: First, what contributes most to the effectiveness of humanitarian programs are the collaborative efforts to build local infrastructure and capacity so that products reach those who need them. "Removing cost as a barrier (by providing medicine free of charge) is not enough in itself to ensure that the medicine gets to the people who need it most," two company officials wrote in 2001. "Even the simplest pharmaceutical intervention faces tremendous challenges in delivery."

Second, building these effective partnerships is long, hard work. Pharmaceutical companies invest enormous amounts of time, money and expertise in these initiatives to ensure that donated medicines and services reach their intended targets. From the original decision to contribute medicine, a company's commitment often expands to include creation of the networks, training tools and infrastructure needed to administer the medicine or implement preventive measures. This work is often performed under daunting conditions involving poor and, in some cases, nonexistent delivery infrastructure. Most companies also make long-term commitments to their global partners. Even donations made in the aftermath of natural disasters involve much more than short-term emergency relief. Some of the biggest programs profiled in this report have been operating in the field for years. In many cases, companies have pledged categorically that their involvement will continue until the target diseases are eradicated. Moreover, these collaborative efforts at the local level provide an impetus for improvements in the primary health care systems. In one case, the training of local health workers in the distribution, administration and monitoring of medicine for river blindness enabled these same workers to carry out other health interventions, such as administering Vitamin A and diagnosing cataracts.

The global partnerships detailed in this report are only one part of the solution to the problem of inadequate access to needed medicines in developing nations. Despite a record of significant contributions, the pharmaceutical industry cannot meet this challenge alone. Success depends on governments and the international aid community doing their part through sustainable financing; investments in infrastructure, including education; and the exercise of political will to direct the pace of change.