WHO Warns of Severe Shortage of Key Anti-Malarial Drug

January 6, 2005
By Erik Wasson and The Wall Street Journal

The World Health Organization warned on Dec 22 that a vital anti-malarial drug will be in short supply next year, potentially making it harder to care for patients who would otherwise have received treatment.

But National Malaria Center Director Duong Socheat said Wednesday that, unlike African countries required by the WHO to buy the drug, Cambodia will not be affected by the shortfall because it imports its key ingredient directly from China.

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 60 million Coartem treatments would be delivered in 2005, but has now halved its projection to 30 million treatments.

Novartis 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 the WHO.

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, which claims at least one million lives each year, most of them African children.

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 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 have officially adopted such medicines since 2001.

"Although Cambodia follows the WHO's Good Manufacturing Product policy, it is allowed by the WHO to import artemisinin directly from China, and we do not use the Novartis drug because it is too expensive," Duong Socheat said. "Based on our field testing our drugs are effective and we use them along with melifloquine to treat malaria."

"How can one company supply the whole world?" he asked. "That is where the problem is, at the factory."

This isn't the first time that the WHO and Novartis have failed to meet forecasts for the drug. For 2004, Novartis expected to provide a total of five million Coartem treatments, half of the amount originally projected.