1. Access to Medicines: Antimalarials WHO/UNICEF Technical Briefing Seminar 10 October 2007 Silvia Schwarte Supply Chain Management Global Malaria Programme

2. Access to Medicines: Antimalarials | 10 October 2007 2 | Malaria 107 countries: 350-500 million episodes/year (Africa: 57% of all cases) Over-consumption of antimalarial drugs: 40-60% of all cases treated as malaria are febrile episodes Treatment availability: predominantly private sector (limited control with limited information on efficacy, safety and quality; use of mono- therapies, patient`s compliance, resistance) Disease of poverty: low market attraction for companies (many products instead of quality, lack of innovator products, stability, artemisinin-based mono-therapies)

3. Access to Medicines: Antimalarials | 10 October 2007 3 | WHO recommendations: ACTs WHO Guidelines for the Treatment of Malaria: AL, AS+AQ, AS+SP, AS+MQ National antimalarial medicines policy Risk of resistance (decreased in vitro sensitivity; in vivo: increased Parasite Clearance Time) Ban of oral artemisinin-based mono-therapies

4. Access to Medicines: Antimalarials | 10 October 2007 4 | (1.) National Medicines Policy and (2.) Procurement and Forecast of ACTs Millions of ACT treatment courses Cumulative No. of countries adopting ACT as 1st-line Rx Cumulative number of countriesadopting ACTs as1st-line treatment Cumulative number of countriesdeploying ACT s Forecast: 124 Million

5. Access to Medicines: Antimalarials | 10 October 2007 5 | ACT - market situation Fig. 1: Estimates of artemisinin dry leaves production (metric tonnes) Fig. 2: Artemisinin prices (USD/kg) over time

6. Access to Medicines: Antimalarials | 10 October 2007 6 | New ACTs on the market in 2007-2009 New ACTs on the market in 2007-2009 AS-MQ 2010200920082007 co-blistered products AS-AQ CD-AS (CDA) DHA-PPQ Paediatric Coartem™ Pyronaridine-AS Pyramax™ AS-Naphthoquine AS-Piperaquine < 2006 Fixed-dose combinations artemether- lumefantrine + Resistance

7. Access to Medicines: Antimalarials | 10 October 2007 7 | The way forward… New extraction processes New sources of artemisinin (e.g. biotechnology yeast cultures, high yield seeds) Mechanisms to avoid shortages and price fluctuation (safety stocks of artemisinin, predictable funding: AMFm, UNITAID) Pre-qualification: API and finished products Reliable forecasting: SCM-database

8. Access to Medicines: Antimalarials | 10 October 2007 8 | Thank you!