New York Times: A Chinese herbal drug that is strikingly effective against malaria is in critically short supply because of rising demand, public health officials and pharmaceutical
executives say. As a result, prices for the drug, artemisinin, have quadrupled, and the few companies that make compounds containing it have drastically cut back production. Supply
crises are looming in 40 tropical countries that have recently made it the centerpiece of their antimalarialefforts.
Malaria kills about one million people a year, most of them children. Strains resistant to older drugs have spread rapidly, and artemisinin (pronounced are-TEM-is-in-in), which is extracted from the sweet wormwood plant, wasembraced this year by Western health agencies and donors as the most cost-effective solution.
The sudden shortage “has created a major wave of shock in our organization,” said Dr. Andrea Bosman of the World Health Organization’s malaria control team. Paul Lalvani, procurement manager for the Global Fund to Fight AIDS, Tuberculosis and Malaria, said the countries that had just adopted the drug were “really in a bind.”
While other drugs are available, switching to a new one takes up to a year and can create dangerous confusion, especially in a poor country, he explained; the new drug must be registered, doctors and nurses must be retrained in dosages and side effects, and rural pharmacies must be alerted and restocked.
“Now they’re sitting on the fence wondering if they should go ahead, or wait until the price drops, or pick another drug,” he said.
Wormwood is an ancient Asian fever treatment, and Chinese military doctors trying to aid the Vietcong in the 1970’s proved that its extracts kill malaria parasites. It has been popular in Southeast Asia, but was largely ignored in the West until this year.
Although sweet wormwood grows wild around the world, virtually all of the cultivation is in the hills of China and Vietnam.
Each crop must be planted in January, harvested in the fall, and then dried and processed. Some would-be growers outside China are complaining that they cannot buy seeds. The shortage began soon after a series of meetings in April at which the Global Fund, the W.H.O., the World Bank, Unicef, the United States Agency for International Development and other donors jointly announced that they wanted malaria-prone countries to phase out older drugs like chloroquine and sulfadoxine-pyrimethamine and adopt multidrug combinations containing artemisinin or its derivatives artemether or artesunate.
Even though the new drugs cost 10 to 20 times as much, the donors chose them because resistance to older drugs was running as high as 60 percent in parts of Africa. (A typical adult course of 24 of the newer pills costs the W.H.O. $2.40, as against 20 cents for chloroquine.)
Until early this year, the world consumed about 30 tons of raw artemisinin a year, mostly in Asia, and the price had been steady for several years at about $115 a pound.
But immediately after the W.H.O.’s April forecast that the world would need 130 to 220 tons in 2005, the price rose to $180 a pound. It is now $365 to $455 a pound.
Drug companies in Switzerland and India say they cannot get enough at any price, and blame is being directed at all corners.
Mr. Lalvani, the Global Fund procurement specialist, said the refiners stopped selling this summer, “waiting for the prices to stabilize or go higher.”
Pradeep Nambiar, an executive at Ipca Laboratories, an Indian company, said that its Chinese suppliers had reneged on contracts and that he believed they could be “holding
back stock anticipating a price rise.”
The most vivid evidence of the shortage emerged last Monday, when Novartis, a major Swiss drug company, said it could produce only about half of the 4.5 million courses of its Co-Artem drug that it had promised to deliver to the W.H.O. by March. Its lone artemisinin supplier in China had fallen short, it said.
Co-Artem is the only malaria drug prequalified by the W.H.O., an endorsement of its safety. It also combines two drugs in one pill, making it harder for a patient to give away or sell part of a dose.
As a result, many poor countries, encouraged by donors and Novartis, specifically adopted Co-Artem. Now some, like Zambia and Ethiopia, will have their supplies rationed.
Novartis has a 10-year contract to make its “reasonable best effort” to supply, at cost, all the Co-Artem the W.H.O. asks for. It had made a commitment to deliver 60 million doses by the end of 2005, but even its relatively small first batch will fall short.
Daniel Berman, a campaigner for lower drug prices at the medical charity Doctors Without Borders, criticized Novartis, saying it had underestimated how much raw aterial it would need and had relied on one supplier. Daniela Currie, a Novartis spokeswoman, said the W.H.O. had made its forecast only after the 2004 crop was in the ground and some planned extraction plants were still not built. “These are things we can’t really influence,” she said, adding that Novartis has now found two more suppliers.
She said she had “no evidence” that the company’s Chinese suppliers, who also make drugs that compete with Co-Artem, had cut it off in hopes of taking some of its market share now that the W.H.O. is under pressure to prequalify more drugs.
In conversations with visiting experts from two Western public health agencies, summaries of which were obtained by The New York Times, executives from several Chinese artemisinin refiners blamed their own suppliers for the sudden rise in prices. After the April meetings, they said, the word spread in China that the West wanted the drug.
Because of the artemisinin shortage, the W.H.O. now ranks several pills made in India and China that combine artemisinin with other drugs like amodiaquine and mefloquine as “approved for procurement in the absence of prequalified product.”
Plans are also afoot to grow wormwood in India, Tanzania and southern Africa. Some farmers have had trouble getting potent seeds, but Mr. Nambiar said Ipca had stockpiled
them.
Mr. Lalvani said he was worried.
“For 2005, we’re stuck,” he said. “But let’s not be stuck for the year after that. We need to come up with a solution for this – and right away.”
New York Times Archive 2004/11/24
Tags: Health, Malaria, Vietnam
