Spike in Demand Drains Supply of Leading Malaria DrugBy Corinne Purtill

November 11, 2003

A surge in demand has led to a shortage of one of the world's most effective malaria drugs that could last into next year, according to the World Health Organization. The Swiss-based pharmaceutical company Novartis has informed the WHO that it has come up short on supplies of the anti-malarial drug artemether-lumefantrine, owing to an insufficient supply of the Chinese herb artemisinin its key ingredient, according to a statement from the WHO. 

As a result, the WHO has informed the 14 countries worldwide that rely on artemether-lumefantrine as their primary treatment against the disease to stock up on 
alternative treatments, the statement said. Cambodia is not among those countries that rely primarily on artemether-lumefantrine, said Nong Saokry, vice-director of the National Malaria Center. However, he said, the center's officially recommended line of treatment is artesunate-mefloquine, which belongs to the same family of drugs—artemisinin-based combination therapy, or ACTs as artemether-lumefantrine. 

It was unclear whether the shortage of artemisinin that Novartis was facing would affect other companies producing artesunate-mefloquine. Though malaria drugs were late in arriving to the Ministry of Health's central warehouse, currently there are "100,000 blisters [of drugs] to send to all the provinces, all the health centers," Nong Saokry said. Were Cambodia to experience a shortage of its key drug, it would revert to treatment with quinine and tetracycline, which are used less frequently because several strains of the disease here have developed resistance against them. 

Artesunate-mefloquine is recommended over other drugs, as it works faster to kill local parasites, he said. ACTs are the most effective treatment against falciparum malaria, the deadliest form of the disease, according to the WHO. In Cambodia, 95 percent of malaria cases are falciparum, and many are drug-resistant strains. Artemisinin has been hailed by drug developers and epidemiologists worldwide as an effective malaria-fighting drug that can tackle strains of the disease that have evolved to resist more common treatments. The drug is derived from the sweet wormwood plant, and during a malaria outbreak in Vietnam in the early 1990s, it cut the death rate by 97 percent, according to a May article by The New York Times. 

But as the current shortage shows, pharmaceutical companies looking to harness the plant's qualities have yet to coordinate booming demand for the drug with the plant's intractable cultivation cycle. The plant from which artemisinin is extracted requires at least six months to mature, and the extraction and refinement process can take another three to five months, the WHO said. In 2001, the WHO placed only 220,000 orders for the drug, the statement said. This year, demand was predicted at 10 million orders. The shortage is expected to last through March 2005, the WHO said.