Thousands of people could die unnecessarily from malaria in coming months following unexpectedly low orders for a pioneering drug, reports the World Bank press review Monday.
Novartis, the Swiss pharmaceutical group, said it had received orders for only 13 million treatments of Coartem, its “artemisinin combination therapy” (ACT), despite estimates from health experts that demand for this year would be 30 million treatments.
The shortfall highlights gaps in the complex international mechanisms set up to fund, procure and supply treatments for malaria. It poses a challenge for Novartis, which has agreed to provide Coartem at cost as part of a program of corporate social responsibility. But the company is reluctant to invest substantially in additional manufacturing capacity if orders do not increase to meet the larger production volumes.
The company has been criticized by health activists for not making enough effort to meet demand, estimated by the World Health Organization for next year at 120 million treatments.
However, the volume of orders received appears to confirm its concerns that even countries at high risk of malaria that have committed themselves in principle to buying ACTs are moving too slowly, reflecting internal bottlenecks as well as a reluctance by foreign donors to provide enough long-term financial assistance.
The news will add to a debate – featured in US talks this weekend between the WHO, the World Bank, the Gates Foundation and the Roll Back Malaria partnership – over the creation of a centralized agency to subsidies and purchase ACTs for the developing world.
Novartis own efforts to scale up production could separately be put at risk by profiteering by Chinese drugs companies and farmers that supply the key raw material for its ACT.
Meanwhile, activists are looking to the World Bank to provide up-front financing of the supply chain, which generics companies would need before getting involved.
Novartis insists that it is happy to see other manufacturers produce Coartem, and has waived the patent on the drug in the developing world. However, its ability as a multinational to subsidies the drug’s development and produce it at cost means there is little financial incentive for generics companies to enter the market on commercial terms.
Malaria does not garner as many headlines as HIV/AIDS but the damage it causes is devastating. There are 300 million to 500 million infections a year and in Africa alone the estimated annual economic impact is 12 billion US dollar.
The problem is getting worse. After a decline in malaria during much of the twentieth century – as a result of widespread spraying to kill the mosquitoes that transmit the disease, nets to protect people and the dissemination of drugs to treat it – infection rates in parts of the developing world began to increase in the 1990s.
Resistance to drugs such as chloroquine has spread in parts of Asia, Africa and Latin America. In Africa, these trends have been exacerbated in many countries by collapsing healthcare systems.
It is against this bleak background that so much excitement has been created by Coartem and other potential drugs based on artemisinin.
Kilde: www.worldbank.org
