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PLOS BLOGS Speaking of Medicine and Health

Buying a Coke in Africa: are there lessons for malaria?

Many African countries face serious shortages of essential global health tools, such as malaria drugs and mosquito nets.  Often when these shortages are discussed, someone makes the “Coca Cola” comparison (i.e. how is that Coke reaches everywhere, but health tools don’t?).

Having just returned from a reporting fellowship in  Sudan and East Africa, I can tell you from first hand experience that it really is possible to buy a bottle of Coke in some very remote places that are suffering shortages of medicines and nets.  Sarah Boseley, health editor of The Guardian, found the same thing, and in fact the title of her recent feature on the medicines crisis in Katine, Uganda, was “In Katine, a Coke is easy to buy. Medicine isn’t.”

Coca Cola has obviously achieved a major feat in establishing these distribution channels.  Nevertheless, the Coca Cola analogy isn’t a perfect one.  For example, when there was still a debate (which is now over, thanks in part to a study in PLoS Medicine) on whether mosquito nets should be given to the poor for free, or whether they should be “socially marketed” (i.e. sold), the Coca-Cola comparison was often mentioned by the “social marketeers.”  The marketeers’ belief was that poor people would value a net more if they had paid for it.  But some malaria experts rejected the comparison.  In a compelling feature article in the New York Times in 2007, Arata Kochi, director of the WHO’s malaria program, said: “I’m not sure whether the poorest of the poor actually drink Coca-Cola.”  Yes, the soft drink has great market penetration, but the world’s poorest remain too poor to actually buy it.

Sarah Boseley’s piece provoked some fascinating responses, and the one from Coca-Cola representative, David Cox , caught my eye:

“Like Sarah Boseley, Coca-Cola is concerned about the lack of vital medicines reaching Katine and other communities throughout Africa. So we are examining if it is possible to use the success of the distribution system for our drinks, and the expertise behind it, to help tackle this challenge. It is not as easy as it may seem. The reason that Coca-Cola and our other products are so widely available in Africa is largely because of the efforts of independently-owned small businesses that make money for each case they deliver. Any initiative to distribute medicines or other essential public goods has to maintain these commercial incentives or they simply will not work.”

To me that seems like a brutally honest point: the company is a commercial outfit and the distribution chain works by using commercial incentives.  End of story.

OK, but what if the supply chains and the commercial incentives remained totally intact and the global health tools were simply added to the crates that carry the Coke bottles?  It’s an intriguing idea, and there’s a charity called Colalife which is trying to get it off the ground (I read about Colalife in this month’s Good Magazine, which gives 100% of the subscription fees to innovative non-profits).  Colalife is trying to develop an “aidpod” that fits between the bottles and carries “much needed ’social products’ such as oral rehydration salts and high-dose vitamin A tablets.”  Colalife submitted its proposal to Google’s Project 10 to the 100, a “call for ideas to change the world by helping as many people as possible,” though it didn’t make it to the final 16 (by the way, voting on the final 16 ends on Oct 8 2009).  The picture (published under a Creative Commons Attribution-Noncommercial-No Derivative Works license) shows Colalife’s founder, Simon Berry, holding a mock-up of the pod.


Simon Berry unveils “Mark II” of the aid-pod. Credit: Cafe du Monde

Colalife is an interesting take on the Coca Cola analogy.  Berry is looking for an international NGO to take the project further.  He’s also trying to get Coca Cola to sponsor it. I personally think that’s a bad idea, for two reasons.  First, it could create a real or perceived conflict of interest (for example, the company might see it as an additional marketing opportunity).  Second, the soft drinks and fast food industry in general isn’t exactly known for its public health promotion (as The Lancet editors wrote recently, in an editorial highly critical of the industry’s promotional tactics, “if the industry continues on its present trajectory, the public’s opinion of Big Food is going to follow that of Big Tobacco and decay as quickly as a Coca-Cola-drinker’s teeth”).

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