AEGiS-WSJ: WHO Warns of Severe Shortfall Of Supplies of Key Malaria Drug

Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.

WHO Warns of Severe Shortfall Of Supplies of Key Malaria Drug

Wall Street Journal - December 23, 2004
Gautam Naik at gautam.naik@wsj.com

LONDON - The World Health Organization warned that a vital antimalarial drug will be in short supply next year, potentially making it harder to treat patients who would otherwise have received treatment.

The drug, known as Coartem and made only by Novartis AG of Switzerland, is the only effective single-pill medicine against falciparum malaria, the deadliest form of the disease.

Coartem is vital because the malaria parasite has increasingly become resistant to most other front-line antimalarials such as chloroquine. The WHO had originally forecast that 60 million Coartem treatments would be delivered in 2005, but has now halved its projection to 30 million treatments.

Novartis, the sole manufacturer of the drug, blamed the shortfall on being unable to get sufficient raw materials from China for key ingredients.

As a result, "some big countries will continue to ... use ineffective treatments, and will see no change in the current situation" in terms of reducing the burden of malaria, said Andrea Bosman, a medical officer at Geneva-based WHO. Mr. Bosman singled out Uganda, Kenya and possibly Nigeria, as countries most likely to be affected by the shortfall.

The revised projection is bad news for the global fight against malaria, a disease that claims at least one million lives each year, most of them African children. Five years ago, the WHO and other groups launched an ambitious plan to halve the malaria burden by 2010. But the parasite has proven stubbornly resistant to most efforts.

In the last few years, drugs like Coartem -- a potent combination pill -- have emerged as key to treating the disease and saving lives because they overcome the parasite's drug resistance. Coartem's firepower comes from an ingredient called artemether, which is based on artemisinin, a compound that's extracted from a plant known as sweet wormwood. The plant is currently cultivated mainly in China and Vietnam, though other countries are starting to grow it as well.

A spokesman for Novartis said, "Agricultural production wasn't sufficient to meet the need" for Coartem anticipated by the WHO. The Swiss company said it has ramped up production capacity to meet the 60 million treatment forecast, but couldn't obtain enough raw material from its Chinese suppliers to deliver that quantity in 2005.

The shortfall comes at a time when many developing countries, after years of resisting the shift away from cheap but ineffective malaria drugs, are increasingly basing their malaria policies on artemisinin-based drugs. Forty countries, half of them African, have officially adopted such medicines since 2001. Recently, the Global Fund -- an organization that finances the fight against AIDS , tuberculosis, and malaria -- also made a big commitment toward funding such treatments.

This isn't the first time that the WHO and Novartis have failed to meet forecasts for the drug. For 2004, Novartis expects to provide a total of five million Coartem treatments, half of the amount originally projected. Critics argue that the WHO and Novartis could have done more to meet the projected need for 2005.

"The tragedy is that countries [who need the drug] have done what they're supposed to do. It's the WHO and Novartis that are letting the countries down," said Daniel Berman, an official at the group, Doctors Without Borders, who specializes in access to medicines.

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