The Clinton Foundation is tackling a challenge that faces the world market for artemisinin-based combination therapy (ACT) medicines – the supply, demand and ultimately the price of the basic ingredient. The move by malaria control partners to get countries to switch to ACTS and save lives amid the failing efficacy of chloroquine and sulfadozine-pyrimethamine was relative swift and did not account for the normal market forces involved in introducing new pharmaceutical products, especially when these are provided free or at cost to the end user.
In addressing Kenya’s rapid policy change to ACTs, Zurovac and colleagues concluded that, “Changes in clinical practices at the point of care might take longer than anticipated. Delivery of successful interventions and their scaling up to increase coverage are important during this process; however, this should be accompanied by rigorous research evaluations, corrective actions on existing interventions and testing cost-effectiveness of novel interventions capable of improving and maintaining health worker performance and health systems to deliver artemisinin-based combination therapy in Africa.” They also said that policy makers should be “carefully prepared for a myriad of financial, political and legislative issues that might limit the rapid translation of drug policy change into action.”
According to news reports, “In 2002, Clinton established an HIV/AIDS initiative that sought to negotiate lower prices for anti-retroviral treatments, and he since has expanded his focus to include malaria treatments such as artemisinin-based combination therapies, or ACTs. One of the factors making the price of artemisinin so volatile – fluctuating from $155 to $1,100 per kilogram in recent years – has been a wildly erratic cycle of shortage and excess of the extract.”
Earlier this year, one of the major producers of ACTs, Novartis, announced, “a 20% average reduction in the price of CoartemÂ® tablets (artemether/lumefantrine 20 mg/120 mg), the state-of-the-art artemisinin-based combination treatment (ACT) for malaria. Starting this Friday, which is World Malaria Day, this price reduction will increase access to Coartem for millions of malaria patients, especially children in low income regions of Africa.”
Of course Novartis, like other producers must not only rely on supplies of this natural product which is subject to the normal risks of agricultural production, but also to the fact that countries who need ACTs do not always order their supplies in a timely and coordinated manner. This is despite the fact that Novartis has had an edge on other ACT manufacturers by being the first WHO prequalified drug, guaranteeing its priority purchase through Global Fund grants.
The AP story goes on to explain that, “Clinton said he has negotiated with six suppliers involved in producing ACTs that have agreed to certain price ceilings that the foundation says will help keep prices constant and not so dependent on the fluctuating cycles.The agreements are with two suppliers at three levels of the supply chain â€” raw material, processing and final formulation â€” and the foundation hopes to add more suppliers.”
Previously we have addressed the potential for synthetic artemisinin production as well as the need for continued research into new and alternative malaria drugs. Stabilizing the price of the raw product will certainly have short term benefits. The long term requires increasing the scope of our malaria treatment arsenal.