THE ARTEMISININ ENTERPRISE - GHDonline

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Table of Contents 1. Executive Summary 2. Introduction to the 2008 Artemisinin Enterprise Conference 3. The Artemisinin Enterprise Partners 4. The malaria context: 4.1 Roadmap to malaria eradication 4.2 Artemisinin and ACTs 5. The contributions of the AE partner technologies to malaria treatment 6. Conference recommendations to the malaria community Annexes A1. Conference programme A2. List of Conference participants A3. Abbreviations 2
1. Executive Summary The World Malaria Report 2008 highlights that in 2006 there were between 189 and 327 million cases of malaria annually with over 880,000 deaths, 85% of which are children in sub‐Saharan Africa. In the face of increasing parasite resistance to antimalarial drugs such as chloroquine, 75 countries have adopted the 2001 WHO recommendation to switch to using artemisinin combination therapies (ACTs) for the first‐line treatment of uncomplicated malaria caused by the P. falciparum parasite. There is now increasing global investment for ACT treatments to underpin the call for malaria eradication and an unparalleled opportunity for effective and sustained progress. A massive scaling‐up of activity is forecast. This window of opportunity is finite due to the ever‐present threat of the development of resistance to the only effective drugs available ‐ ACTs. The influential report ʺSaving Lives, Buying Timeʺ (Institute of Medicine, 2004) warned that access to effective treatment with ACTs must be expanded in the fight against malaria but this must be accompanied by measures to preserve their effectiveness, such as eliminating the use of artemisinin monotherapies. Against this background there is growing concern that the current global supply chain will be unable to produce consistent, affordable and high quality artemisinin in the quantities that will be required for the projected demand for ACTs. The Artemisinin Enterprise (AE) comprises the Centre for Novel Agricultural Products at the University of York, UK; the Institute for OneWorld Health, USA; and the Medicines for Malaria Venture, Switzerland. Supported by the Bill & Melinda Gates Foundation, the AE projects have a collective aim of rapidly improving the production technologies of artemisinin and developing a more stable, rapidly acting, fully synthetic artemisinin‐like compound. The three projects of the AE represent a portfolio approach to address the need for affordable and reliable sources of ACTs, with complementary technologies that work in different ways and at different points in the supply chain. CNAP iOWH MMV Fast‐track breeding of A annua to increase yields of plant‐derived artemisinin and develop new high‐yielding varieties Artemisinin derived by microbial fermentation in yeast with subsequent chemical conversion Development of a novel class of compounds for their incorporation into antimalarial drug combinations 3
Page 1: THE ARTEMISININ ENTERPRISE REPORT o
Page 5 and 6: An effective, joined‐up communica
Page 7 and 8: artemisinin from plant material by
Page 9 and 10: 3. The Artemisinin Enterprise Partn
Page 11 and 12: Useful genetic diversity does not a
Page 13 and 14: Benefits of new high‐yielding var
Page 15 and 16: Partnership has been a key componen
Page 17 and 18: Synthetic peroxides The first synth
Page 19 and 20: 4. The malaria context Burden of ma
Page 21 and 22: Global targets and tools The Global
Page 23 and 24: The development of Artemisinin Comb
Page 25 and 26: Currently, some seed selection for
Page 27 and 28: ACT and artemisinin market size ‐
Page 29 and 30: Demand versus purchase orders for A
Page 31 and 32: 5. The contributions of the AE tech
Page 33 and 34: Project delivery timelines The timi
Page 35 and 36: 6. Conference recommendations to th
Page 37 and 38: Assess the impact of new variety de
Page 39 and 40: the use of counterfeit drugs, monot
Page 41 and 42: Session 1: Opening and keynote lect
Page 43 and 44: Day 3 October 10 Session 5: Breakou
Page 45 and 46: Philippe Farabolini sanofi‐aventi
Page 47 and 48: Annex 3. Abbreviations Active Pharm

THE ARTEMISININ ENTERPRISE - GHDonline

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