Malaria should not kill anymore

Daniel Vasella

April 25, 2006

On April 25th, Africa Malaria Day reminded us that each year 3 million people die of this disease despite the fact that treatments exist. This macabre victory of malaria should neither be incurred to international organizations, nor to the selfishness of the pharma industry nor even to the absence of adapted therapeutic solutions. Poverty and the disorganization of the healthcare systems in endemic zones are the fundamental reasons explaining why it is so difficult to fight this parasite.

The experience of Novartis in this field clearly shows these weaknesses. This experience also necessarily highlights the challenge our society will have to face in order for the 21st Century to truly reveal its promises in terms of healthcare progress.

Among the numerous research programmes initiated by the merger between Ciba and Sandoz, Novartis inherited in 1996 an innovative treatment against malaria called Coartem. Considering the promising clinical data, this drug was developed despite the fact that it was to be sold to a market that is known for not being solvent. Today, this therapy based on a fixed-combination of artemisinin and lumefantrine, has proven an incomparable efficacy with a cure rate above 95%. It has been added to the WHO's essential medicines list". The recent history of this drug nevertheless shows the financial, administrative and logistic meanders the patients have to go through before they can benefit from the treatment itself.

First obstacle : the price in sub-Saharan Africa, the major part of the population earns less than 2 dollars a day, which is too little considering the production and shipping costs of such a drug. The only remaining solutions are philanthropic partnerships.

In 2001, Novartis agreed on a partnership with the WHO in order to provide the drug at cost to developing countries. But surprisingly, although the price of the treatment is very low, African countries have not shown interest : administrative burdens, complicated ordering process, uneasiness associated to change...Explanations are numerous. But as soon as the WHO added Coartem to  its "essential medicines list", demand soared considerably. The publication in The Lancet of favorable studies concerning this treatment also contributed to this increase in demand. In less than three years, the orders for this drug collected by the WHO have increased by 500 000 doses to over 100 million in 2006.

A new obstacle then appeared : supplying enough raw material for the production of the drug. It takes 6 months for the plant to grow from which Artemisinin is extracted and 14 months on the whole from the moment the seeds are planted until the final production of pills. This situation is far from being rare. Nevertheless it was severely pointed out by  certain organizations, often quick at questioning Novartis's sincerity and goodwill. Traditional culture in China was not enough, an agricultural production was developed in Asia and Africa. Meanwhile, the production capacities in Beijing and Suffern (New York) were increased. This way Novartis managed to overpass its production objective by 30 million treatments in 2005. In 2006 the 100 million doses will be reached.

But despite this can we consider that the fight against malaria is won? Unfortunately no. Other difficulties subside. Despite our production efforts, despite the fact that Novartis provides this drug at cost, considerable amounts of stock ready to be shipped remained in our warehouses. We have been victimized by the enormous gap between the forecasts and the number of firm orders that were passed. Although the WHO's estimates amounted to  50 million doses in 2005, the firm orders only amounted to  half of the 30 million produced doses. No matter how revolting, everybody's efforts were undermined by the weakness and lack of efficiency of local health services.

Drugs exist. They are available. They can be paid for, since the Global Fund as well as other philanthropic organizations have the necessary funds. But somehow in the process the system is jammed. In most African countries, the market does not ensure the fact that drugs are ordered and received in time. Health services are poor or inexistent.

Infrastructures and administrations in charge of healthcare issues struggle constantly to do their jobs. Today Malaria is the target, tomorrow it could be Aids, tuberculosis or leprosies... Although they are very useful "World Days" are not enough. The efforts of the pharma industry will be  useless unless they are part of stable political and health structures. They will never bring anything if governments are not committed to enabling their populations to access schooling, drinkable water, food and basic public healthcare and hygiene services.

The major problem of poor countries in terms of healthcare is governance. If Pharma businesses cannot deny or neglect their responsibilities, they are nonetheless powerless without the goodwill of local authorities. It is therefore necessary to wish for an increased collaboration between governments, international institutions and private groups. Without this mutual responsibility, nothing will ever succeed.

Daniel Vasella
Chairman and CEO
Novartis AG