A Defense of the Private Sector

Malnourished Indian children eat a meal at the Apanalaya center, an organization working for the betterment of slum children,
Malnourished Indian children eat a meal at the Apanalaya center, an organization working for the betterment of slum children, in Mumbai,India, Tuesday, Oct. 9, 2012. The United Nations now says its 2009 headline-grabbing announcement that 1 billion people in the world were hungry was off-target and that the number is actually more like 870 million. (AP Photo/Rafiq Maqbool)

Several weeks ago the international charity Oxfam released a report criticizing attempts that have been made to prevent the spread of malaria across the globe. The report detailed the shortcomings of one organization in particular, the AMFm (the Affordable Medicine Facility for malaria). Part of The Global Fund, the AMFm promotes the utilization of the private sector in the distribution and pricing of anti-malarial medications. According to their website, "The AMFm aims to enable countries to increase the provision of affordable ACTs through the public, private for-profit and not-for-profit sectors."

Unsurprisingly the AMFm has denied these shortcomings in the strongest of terms, and vigorously questioned the findings. However, both sides seem to be missing the larger issue.

The actions of the AMFm and the report authored by Oxfam's Dr. Mohga Kamal Yanni point to a larger issue at stake, namely: what is the role of the private sector in public health issues? Should public health issues (in this case malaria) only be the purview of governments and international aid organizations (like Oxfam)? Or can the private sector be utilized as a model for successful distribution and implementation of medical aid and health policy.

Simply to dismiss the private sector out of hand would be a mistake. Private companies play a pivotal role in public health issues. It is only through a marriage of the public and the private that we can see effective change in health issues across the globe.

Perhaps the most prominent example of such cooperation is the work that is being done attempting to provide treatment of HIV/AIDs in Africa. These programs are co-sponsored by governments and multinational pharmaceutical companies, and they work.

They may not work as well as we would like them to, and there is certainly room for ethical improvement on both sides. The drug companies have been known to practice some less than ethical trials on those who are either too poor or too desperate to know better, while there have been numerous accusations leveled at some of the participating governments of misappropriation of funds and widespread corruption. However, the alternative (no programs at all) is too bleak even to contemplate.

This welding of the private and the public seems to be the only practical solution to large-scale public health problems. People often view large, multinational corporations -- in particular Big Pharma -- as an: 'axis of evil' whose sole purpose is to profit off of the backs of those less fortunate than themselves.

Now, it is important to say at the outset that such a simplistic view is almost undoubtedly wrong. To simply assume that all of the employees, officers and shareholders of a company are hatchet-faced misers, who are only concerned with pinching pennies and lining their own pockets is heavy-handed at best, and libelous at worst. There are certainly examples of those who fit such a stereotype, but there are also plenty of examples of those who look nothing like the Scrooges and fat cats that seem to populate the cartoon panels and the public's imagination.

One might say that the only reason that these companies feel even the slightest shred of responsibility is because of the PR benefits. However, even if we were to allow for the sake of argument that such a contentious accusation might be true -- and in reality we shouldn't, at least not without concrete evidence -- the mere fact that their motive is not perhaps completely pure does not invalidate their actions.

Such an assessment points to a fundamentally flawed understanding of the idea of a corporation. Attempting to load corporations with some type of deontological or virtue-based system of morality does not make the slightest bit of sense. Corporations operate under the principles of consequentialism. They are only interested in outcomes, not motives, or intent. Theirs is a world of the tangible bottom line. Our economy is based on survival of the fittest, and to assume anything less from a company would be self-deceiving.

Again we need only to look at how the world community has put pressure on pharmaceutical companies to distribute their anti-HIV/AIDS medication at lower prices in third world countries. Yes, this may have been done not out of the personal empathy of the board members, but does that matter? Those who need the drugs are getting more than they used to get, at lower prices, which is progress regardless of motivation.

The same is true in the case of AMFm and Oxfam. Yes, it is certainly possible, and perhaps even likely, that the anti-malaria medication has not been distributed or prescribed in the most efficient manner. But, to simply rail against the private sector, instead of working with them to solve the problem, points to our larger misunderstanding of the dynamic between the private and public realms when it comes to public health problems. Instead of simply denouncing those on the other side of the proverbial picket line we need to work with them, because that is the only way to face these increasingly daunting medical pandemics.