ACTs – Short-Term, Long-Term

Two recent articles demonstrate how countries, anxious to treat malaria cheaply with the newer artemisinin-based combination therapy (ACT), are exploring ways to grow Artemisia anua locally and feed that into the local pharmaceutical industry. Growing Artemisia anua in Kenya may offer local farmers a chance to ‘triple their income.’ This assumes large scale multinational commercial growers don’t get the edge on production and that more the one current extracting facility begins operation. Likewise in Nigeria laws are being considered that would promote local growing and production. These actions promise a boon for both national health and economic development.

Reliance on the ‘shrub’ that produces artemisinin is a challenging process requiring the right soil and climatic conditions, as well as attention to the relatively short period when the chemical is at optimal levels within the foliage. Success also rests on meeting infrastructural demands such as good quality roads and transport.

A question exists whether a short-term gain in local production might eventually be offset by efforts to synthesize artemisinin. Discover Magazine in its December 2006 issue named Jay Keasling, a Chemical engineer at the University of California at Berkeley, as its scientist of the year (2006) for pioneering ways to use ‘synthetic biology’ to produce artemisinin in the lab (or eventually factory) using genetically engineered bacteria and/or yeast. Keasling’s team has already been working several years on this process and has received awards from the Gates Foundation to advance the effort further. They may have a viable process ready for production by 2010 and bring the cost of a dose down to 10 US cents. Even with major price reductions by one of the major international manufacturers of ACTs, the cost today is at least one US dollar through programs receiving support from the Global Fund to Fight AIDS, TB and Malaria.

While it is good that many approaches are being followed to bring ACTs closer to the people who need it at a cheaper price, synthetic production is the process that in the long run will likely provide the cheapest route. Hopefully governments and pharmaceutical companies are not setting up local farmers in Africa for economic disappointment down the road when the synthetic production of artemisinin becomes viable.

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