MARKET DYNAMICS OF ACTs IN THE PUBLIC SECTOR · MARKET DYNAMICS OF ACTs IN THE PUBLIC SECTOR ......

25 November 25 November 20082008Guilin, P.R. ChinaGuilin, P.R. China

ARTEMISININ FORUM 2008ARTEMISININ FORUM 2008ARTEMISININ FORUM 2008

MARKET DYNAMICS OF ACTsIN THE PUBLIC SECTOR

MARKET DYNAMICS OF MARKET DYNAMICS OF ACTsACTsIN THE PUBLIC SECTORIN THE PUBLIC SECTOR

Presented by

Dr Andrea BosmanGlobal Malaria Programme

Presented by

Dr Andrea BosmanGlobal Malaria Programme

79 countries have adopted ACTs

Continent Countries Drug LineBurkina Faso, Burundi, Cameroon, Congo, Côte d'Ivoire, Democratic Republic of Congo, Eq. Guinea, Gabon, Ghana, Guinea, Liberia, Madagascar, Eritrea, Mali,

Mauritania, Senegal, Sao Tomé & Principe (ST&P), Sierra Leone, Sudan (S), Tchad, Zanzibar

AS + AQ 1st

Angola, Benin, Botswana, Cape Verde, Central African Republic, Comoros, Ethiopia,Gambia, Guinea Bissau, Kenya, Malawi, Mozambique, Namibia, Niger, Nigeria,

Rwanda, Uganda, S. Africa, Tanzania, Togo, Zambia, Zimbabwe

AL 1st

Côte d'Ivoire, Djibouti, Gabon, Sudan (N), ST&P, Zanzibar AL 2nd

AFRICA

Djibouti, Somalia, Sudan (N) AS + SP 1st

Cambodia, Malaysia, Thailand AS + MQ 1st

Bangladesh, Bhutan, Laos, Myanmar, Philippines, Nepal, Papua New Guinea, Solomon Islands, Sri Lanka, Timor Leste, Vanuatu,

AL 1st

Indonesia AS + AQ 1st

Afghanistan, India, Iran, Pakistan, Saudi Arabia, Tajikistan, Yemen AS + SP 1st

Viet Nam, China DP 1st

Iran, Papua New Guinea, Saudi Arabia, Yemen AL 2nd

Ecuador, Peru AS + SP 1st

Bolivia, Colombia, Peru, Venezuela AS + MQ 1st

Brazil, Colombia, Guyana, Suriname AL 1st

SOUTHAMERICA

ASIA

66 are deploying ACTs

66 are deploying ACTs

Updated21 Nov 2008

AQ=amodiaquine; AL=artemether/lumefantrine; AS=artesunate; DP=dihydroartemisinin/piperaquine; MQ=mefloquine; SP=sulfadoxine/pyrimethamine;

ARTEMISIA FORUM 2008 - 25 November 20083 |GLOBAL MALARIA PROGRAMME

Adoption, deployment, past procurement for the public sector market of ACTs

Adoption, deployment, past procurement for the public sector market of ACTs

0.5 0.6 2.1 5

31.3

82.7

97

130

0

20

40

60

80

100

120

140

2001 2002 2003 2004 2005 2006 2007 20080

10

20

30

40

50

60

70

80

ACT procured No countries: ACT 1st line No countries deploying

Mill

ions

of A

CT

trea

tmen

tcou

rses

Cum

ulat

ive

num

bero

f cou

ntrie

sForecast6-24 months from adoption to implementation6-24 months from adoption to implementation


Round 7 GFATM approved62% of malaria grants, and Round 8 approved 68% of malaria grantsUNITAID: new funding for AIDS, TB and malaria medicinesAffordable Medicine Facility(AMF) for malaria – GFATM approved roll-out plan for 11 countries to start in April 2009

Successful malaria applications to Round 6, 7 and 8 of GFATMSuccessfulSuccessful malaria applications malaria applications to Round 6, 7 and 8 of GFATMto Round 6, 7 and 8 of GFATM

Millions USD

Increasing resources for ACTsIncreasing resources for ACTs

0

200

400

600

800

1000

1200

1400

1600

Round 6 Round 7 Round 8

Approved


JSI

Who pays and buys ACTs for public sector

U.S. President Malaria Initiative

World Bank's Malaria Booster Programme

UNICEF

UNITAID

WHO

Governments

Bilateral Agencies

NGOs

FUNDING AGENCIESW

HOM

SFID

AUNOPS

CMS

MEG

MIS

SIONFA

RMA

PROCURING AGENCIES

CMS = Central Medical Stores of countries;MEG = Medical Export Group;MSF = Médecins Sans Frontières;

Less Funds

Low Volumes

UNICEF

CROWN A

GENTS

GFATM


Price reduction of artesunate + amodiaquineover 6 UNICEF/WHO joint tenders

Price reduction of Price reduction of artesunateartesunate + + amodiaquineamodiaquineover 6 UNICEF/WHO joint tenders over 6 UNICEF/WHO joint tenders

0

0.5

1

1.5

2

2.5

2003 2004 2005 2006 2007 2008

Company A+X Company A Company B

Company C Company D Company E

Price per adult treatment course (USD)

No

t co

-bli

stere

d 14-38% 4-28%

10%5-10% 0- 12%


Price reduction of Coartem®(artemether-lumefantrine): 2003 - 2008

Price reduction of Price reduction of CoartemCoartem®®((artemetherartemether--lumefantrinelumefantrine): 2003 ): 2003 -- 20082008

0

0.5

1

1.5

2

2.5

2003 2004 2005 2006 2007 2008

6 x 1 tab 6 x 2 tabs 6 x 3 tabs 6 x 4 tabs

Price per adult treatment course (USD)

25 % 22 %


High costs and heterogeneous quality of ACTsLarge use as monotherapies in the private sector, with limited information over efficacy, safety and quality

Threat of oral artemisinin monotherapiesin the private sector

Global ACT demand and market trends | 13 October 2008GLOBAL

MALARIA PROGRAMMEARTEMISIA FORUM 2008 - 25 November 20088 |GLOBAL MALARIA PROGRAMME


Proportion of ACT treatment failures in Cambodia (2001-2007)

Proportion of ACT treatment failures in Cambodia (2001-2007)


Parasite clearance time in Pailin (2007)Parasite clearance time in Pailin (2007)

AS 2 mg/kgAS 4 mg/kg & MQ

0 12 24 36 48 60 72 84 96 108

120

0.0001

0.001

0.01

0.1

1

10

100

time (hours)

para

sita

emia

as

% fr

om a

dmis

sion

(geo

met

ric m

ean)

0 12 24 36 48 60 72 84 96 108

120

0.001

0.01

0.1

1

10

100

1000

time (hours)

para

sita

emia

as

% fr

om a

dmis

sion

(indi

vidu

al d

ata)

FULLY SENSITIVE PARASITES


WHO recommendation to phase out oral artemisinin monotherapies

WHO recommendation to phase out oral artemisinin monotherapies

1. 19 January 2006 – WHO Press Release 2. Monitoring marketing practices and position of NDRA on http://malaria.who.int/3. Dissemination of WHO position via WHO Offices, WHO staff briefings, inter-

country and regional meetings with MOH officials 4. 19 April 2006 – WHO technical briefing on malaria guidelines

and artemisinin monotherapies5. Alignment of funding and procurement agencies6. 23 May 2007 - WHA Resolution 60.187. 24 August 2007 – WHO informal consultation with

manufacturers of artemisinin-based antimalarials 8. WHO country meetings with pharmaceutical companies

(India, China, Pakistan, Viet Nam)


0

5

10

15

20

25

30

Identified in 2006 Identified in 2007 Identified in 2008

Not yet contactedNo intention disclosedIntention to complyWithdrawn monotherapies

Number of companies

Manufacturers of oral artemisinin monotherapies: 12/68 (18%) withdrew their products

22/68 (32%) intend to comply with WHO ban

SubstandardMedicines ?


National Drug Regulatory Authorities: 36/78 (47%) in line with WHO recommendation

National Drug Regulatory Authorities: 36/78 (47%) in line with WHO recommendation

0

10

20

30

40

50

60

70

Janu

ary Apri

lJu

lyOcto

ber

Janu

aryApri

lJu

lyOcto

ber

Janu

aryApri

l

Risk of development of resistanceRisk of development of resistance

2006

2006

2007

2007

2008

2008

No. countries marketing oral artemisinin monotherapiesNo. countries marketing oral artemisinin monotherapiesNo. countries marketing oral artemisinin monotherapies

MARKET DYNAMICS OF ACTs IN THE PUBLIC SECTOR · MARKET DYNAMICS OF ACTs IN THE PUBLIC SECTOR ......

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