Helping to Fight Malaria

Malaria kills 2,000 African children every day. That’s a child dying every 30 seconds. With 500 million new cases a year and up to 3 million deaths a year –a large proportion of them children and pregnant women in Africa -- Novartis Chairman and CEO Daniel Vasella traces his own company’s commitment to fighting this growing and deadly health scourge. It began in earnest in 1996 with the merger that created Novartis.

April 24, 2006 - The magic name is Coartem, today the most potent anti-malarial available for non-complicated Plasmodium falciparum – the parasite that enters the body through a mosquito bite and causes fever, dehydration and sometimes death. “As we looked at the development portfolios then,” he recalls, “among many others, there was a drug for malaria. The first clinical trials were promising. But of course, there was also a question about the commercial potential of that product. After all, it’s a disease of the developing world.”

Coartem, the only fixed-dose artemisinin-based combination therapy pre-qualified by the WHO for procurement by United Nations agencies, is a combination of artemether, a derivative of the plant-derived ingredient artemisinin, and the synthetic chemical lumefantrine. Each component acts on different biological targets through differing mechanisms of action, thus effectively reducing parasite load, and also reducing possibilities of developing resistance. Coartem rapidly clears malaria parasites and treats most symptoms with very few side effects. Cures occur after just three days of treatment for up to 95 percent of those affected.

For much of the 20th century, malaria has actually been in decline, thanks to pesticides developed to spray and kill mosquitoes that transmit the disease, new drugs used to treat it, and bed netting, coated with pesticides, to protect people in their sleep when they are at most risk of being bitten. However, infection rates in the developing world increased by the 1990s, in part due to the growth of resistance to existing drugs, the reduction in preventive efforts, and the deterioration of health care systems that simply couldn’t afford to keep up with the demand.

Public health expenditures in Africa on the rise
And while the human toll is terrible, the economic burden in poor countries can also be devastating. Malaria costs African countries annually more than $12 billion in lost gross domestic product. It accounts for 40 percent of public health expenditures – already stretched thin by AIDS and TB epidemics; up to 50 percent of inpatient admissions; and up to 50 percent of outpatient visits in areas of high malaria transmission.

On January 19, 2006, the World Health Organization (WHO) issued new treatment guidelines for malaria, stating that to prevent malaria parasites from developing resistance to artemisinin, uncomplicated falciparum malaria must be treated with artemisinin-based combination therapies (ACTs) and not by artemisinin alone or any other monotherapy.

Happily, wherever Coartem has been used, results thus far have been positive and dramatic. Early efforts in KwaZulu Natal, South Africa, for instance, demonstrated a 90 percent reduction in mortality. With support from the Global Fund, Zambia became the first African country to adopt Coartem as first line therapy in national treatment guidelines and has seen a significant effect on incidence of malaria morbidity and mortality across the country.

Empathy and caring about people
Still, drugs cannot be the only solution to the spread of malaria. “Drugs are available, but they need to reach patients,” Vasella says, recalling a recent trip to sub-Saharan Africa where he witnessed first hand fundamental problems in hygiene, sanitation, health education and prevention, and the need for more efficient distribution systems for treatments. “Then you need to take the necessary preventive step,” he adds. “I think international organizations have to collaborate together with us to solve the problem. We cannot replace what governments need to do, what health ministries need to do. So our contribution is to provide an effective treatment. We can’t suddenly be the health care provider as well.”

Vasella is proud of the commitment and the efforts the company has made in China, in partnership with new suppliers in East Africa, and at its Suffern, New York, facility, where the great majority of the treatments are produced and packaged to be sent to the WHO for distribution to countries in need. “One has to understand that we are normal people,” he comments. “Normal human beings have empathy and they care about other people. So if we succeed in communicating the usefulness of a medication, how it's being applied, how it's potentially going to save lives and potentially alleviate a lot of suffering, most people will respond very positively.”

Need for closing gaps
What is Vasella’s greatest concern now that Novartis has committed to producing nearly 2 billion tablets and millions of doses? That those tablets will not be used. “The projections between what we as a company have received and the realities of the orders,” he says, “is that there is a big gap. And the gap is that our inventories are building up. This year we will produce about 30 million treatments, but we won’t sell 30 million treatments. So that means that WHO and Novartis have to learn how to better align production and the projection of the materials. That is our current challenge.

“Nevertheless,” he emphasizes, “our attitude has been to say we will solve our part of the issue. We want to be able to supply the world. Therefore we are aiming at over 100 million treatments next year, the most rapid increase in capacity of any drug I know of. It has never been done before. And for a product that is not for profit, it is especially remarkable. While we need profits to strive and finance such projects as the Coartem one, we are not just here to make money.”