THE ARTEMISININ ENTERPRISE - GHDonline

was the most appropriate drug treatment to be used ‐ but it had a prohibitively high price.
In 2001, AL was added to the WHO Essential Medicines List, and Novartis and the WHO
reached an agreement in which Novartis would supply AL at cost to the public sectors of
malaria endemic countries to improve access to this life‐saving ACT. Both of these key
decisions were influenced by the Millennium Development Goals (MDGs) which, among
other objectives, emphasised improved access to the most effective antimalarial treatments.
In April 2002, the WHO recommended ACTs as first‐line treatment for uncomplicated
P. falciparum malaria in chloroquine‐ and SP‐resistant geographical regions. The ACTs
currently recommended by the WHO are AL, artesunate/amodiaquine (AS/AQ), artesunate/
sulfadoxine‐pyrimethamine (AS/SP), and artesunate/mefloquine (AS/MQ).
Regulating quality of artemisinin and ACTs
Given the potential risk of developing resistance to ACTs, the malaria community is taking
the necessary precautions to prolong the efficacy of this drug class. These measures include:
(i) use of co‐formulated drugs to ensure patients consume combination treatments only; (ii)
removal of monotherapies and ineffective drugs from the market; and (iii) ensuring
countries and donors purchase and finance only high quality ACTs that meet international
quality standards.
Ensuring the quality of artemisinin and ACTs is one of the major challenges facing effective
malaria control. To address the quality issue, major international funding agencies (eg
Global Fund, President’s Malaria Initiative) have established policies to purchase drugs that
meet internationally accepted quality standards, such as ACTs that have been prequalified
by WHO and stringent regulatory authorities, with some caveats and exceptions.
Artemisia Cultivation
ACTs are unusual in the pharmaceutical industry because they are the only high volume
product ‐ with sales of more than 100 million treatments annually ‐ that continue to contain
a natural product derived from plants. Agriculture provides many high‐volume
commodity food and non‐food products from the cultivation of established crops that have
benefited from many years of plant breeding. In contrast, Artemisia annua, the medicinal
plant producing artemisinin for ACT manufacture, has undergone a very short period of
plant breeding for improved yield and robust agronomy, despite its importance for ACT
production.
Artemisia annua is native to China and is able to grow in many different climates including
high altitude temperate areas in China, Vietnam and East Africa. China and Vietnam
produce some 70% of the global supply of artemisinin, with East Africa producing 20%.
Other countries in which Artemisia annua is grown include India, Ghana, Kenya, Tanzania,
Uganda, Nigeria, Mozambique, Madagascar and Brazil.
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