THE GOODWILL PILL MESS

By ANDREW PURVIS/KIGALI

At the peak of the Rwandan refugee crisis nearly two years ago, the pharmaceutical giant Eli Lilly, based in Indianapolis, Indiana, proudly announced "the largest product donation in Lilly's history and...the largest one-time pharmaceutical donation ever." The press release went on to say, "This is yet another example of Lilly's commitment to giving, especially in times of human tragedy. We are responding to the dire needs of the Rwandan refugees."

Well, sort of. The trouble is the gift was an antibiotic called CeclorCD, which is not on the World Health Organization's list of essential drugs for the treatment of refugees. Nor is it on the treatment schedules of any countries in central Africa. Because of the risk of causing resistance to more valuable drugs commonly used in the region, the leading relief group, Doctors Without Borders, says it would never prescribe such a medication in the camps. Even so, Lilly sent enough for 1.3 million people. Barrels containing 200,000 tablets each arrived in Rwanda, with only a handful of inserts to explain (in English) how they should be used. Today aid workers and local health officials are still trying to figure out how to dispose of 6 million pills, many of them expired.

The CeclorCD donation underscores what many aid workers consider a growing problem. Huge quantities of inappropriate and sometimes expired medicines and health pills are being sent to trouble spots from Bosnia to Burundi, tying up overstretched health staff and logistical resources and posing a risk to recipients who may take them for the wrong reasons or after they have begun to deteriorate. Donors include U.S. pharmaceutical companies that receive a substantial tax benefit in exchange for exporting unused stock, as well as pharmacies and individuals around the world who may not know any better.

Dr. Hans Hogerzeil, of the WHO's Action Program on Essential Drugs, says the problem is widespread: 45% of donations received in 1994 by the WHO office in Zagreb, for instance, were either worthless or expired. In Sudan aid workers have received contact-lens solution and appetite stimulants--a bizarre contribution to a country experiencing famine. Health workers in Rwanda are still sorting through crates of "odorless" garlic pills, ginseng extract and Tums antacids delivered during the war. A WHO pharmacist working in the Balkans says, "Staff members have risked their lives under sniper fire trying to identify medications that turn out to be useless." Since drugs sometimes arrive poorly labeled, often in a foreign language, errors do occur. Three years ago, 11 Lithuanian women were temporarily blinded by an improperly marked drug that local doctors thought was for a gynecological complaint. It turned out to be veterinary worm medicine.

While international health officials stress that the majority of gifts are genuine and deeply appreciated, they want to put a stop to donations that may be motivated in part by interests other than those of the recipients. Dr. Erik Schouten, who has worked with Doctors Without Borders in emergency-relief operations from Georgia to Rwanda, contends that drug firms are too often chiefly interested in clearing shelves and saving costs. "Some of these companies are just transporting their problems to the Third World," Schouten says. Moreover, the U.S. tax code allows a write-off of as much as twice the production cost for gifts to the needy.

In the case of CeclorCD, Lilly spokesman Fritz Frommeyer insists that the company's impulse to do good was authentic. He concedes that the tablets were excess stock nearing expiration and that the tax benefits were "one facet" of the decision, but he adds, "We felt that it was the right thing to do." AmeriCares, one of the groups that distributed the medicine, was unaware that such large quantities of CeclorCD had been shipped through other agencies. Operations director Andrew Hannah acknowledges that the drug was not used "to the extent first anticipated" but argues that given the circumstances, the organization felt that sending even this antibiotic would be helpful.

The WHO is drafting guidelines that would, among other things, limit gifts to medications that are included in essential-drug lists and that would not expire for at least 12 months. Some in the U.S. pharmaceutical industry are lobbying for exceptions. A consultant has warned ominously that the guidelines might force all drug donations from the U.S. to cease. But Hogerzeil expects a compromise to be adopted by the WHO at a meeting of U.N. agencies this month. "Bona fide donations will still be permitted," he says. If he is right, then countries suffering from natural and man-made disaster should continue to receive drugs, but only those that clearly do some good.