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Access to Medicines: Antimalarials
WHO/UNICEF Technical Briefing Seminar
10 October 2007
Silvia SchwarteSupply Chain Management Global Malaria Programme
Access to Medicines: Antimalarials | 10 October 2007 2 |
MalariaMalaria
107 countries: 350-500 million episodes/year (Africa: 57% of all cases)
Over-consumption of antimalarial drugs: 40-60% of all cases treated as malaria are febrile episodes
Treatment availability: predominantly private sector (limited control with limited information on efficacy, safety and quality; use of mono-therapies, patient`s compliance, resistance)
Disease of poverty: low market attraction for companies (many products instead of quality, lack of innovator products, stability, artemisinin-based mono-therapies)
Access to Medicines: Antimalarials | 10 October 2007 3 |
WHO recommendations: ACTsWHO recommendations: ACTs
WHO Guidelines for the Treatment of Malaria: AL, AS+AQ, AS+SP, AS+MQ
National antimalarial medicines policy
Risk of resistance (decreased in vitro sensitivity; in vivo: increased Parasite Clearance Time)
Ban of oral artemisinin-based mono-therapies
Access to Medicines: Antimalarials | 10 October 2007 4 |
(1.) National Medicines Policy and(2.) Procurement and Forecast of ACTs(1.) National Medicines Policy and(2.) Procurement and Forecast of ACTs
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110
2,10,5 0,65
31,3
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2001 2002 2003 2004 2005 2006 2007
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ACT procured No. countries w ACT 1st line No. countries implementing
Mil
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AC
T t
reat
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lati
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o.
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CT
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1st-
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x
Cumulative number of countries adopting ACTs as 1st-line treatment
Cumulative number of countriesdeploying ACTs
Forecast: 124 Million
Access to Medicines: Antimalarials | 10 October 2007 5 |
ACT - market situationACT - market situation
Fig. 1: Estimates of artemisinin dry leaves production (metric tonnes)
Fig. 2: Artemisinin prices (USD/kg) over time
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2003 2004 2005 2006 2007 2008
Asia
Africa
others
Access to Medicines: Antimalarials | 10 October 2007 6 |
New ACTs on the market in 2007-2009 New ACTs on the market in 2007-2009
AS-MQ
2010200920082007
co-blistered products
AS-AQCD-AS (CDA)
DHA-PPQ
PaediatricCoartem™
Pyronaridine-ASPyramax™
AS-Naphthoquine
AS-Piperaquine
<2006
Fixed-dose combinations
artemether-lumefantrine
+
Resistance
Access to Medicines: Antimalarials | 10 October 2007 7 |
The way forward…The way forward…
New extraction processes
New sources of artemisinin (e.g. biotechnology yeast cultures, high yield seeds)
Mechanisms to avoid shortages and price fluctuation (safety stocks of artemisinin, predictable funding: AMFm, UNITAID)
Pre-qualification: API and finished products
Reliable forecasting: SCM-database
Access to Medicines: Antimalarials | 10 October 2007 8 |
Thank you!
