Drug Partnership Introduces Cheap Antimalaria Pill

boy with malaria

Joao Silva for The New York Times

A child at a clinic in Beluluane, Mozambique, last spring after learning that he had malaria.

In Africa, the disease kills 3,000 children each day.

 

Published: March 1, 2007

A new, cheap, easy-to-take pill to treat malaria is being introduced today, the first product of an innovative partnership between an international drug company and a medical charity.

 

The medicine, called ASAQ, is a pill combining artemisinin, invented in China using sweet wormwood and hailed as a miracle malaria drug, with amodiaquine, an older drug that still works in many malarial areas.

A treatment will cost less than $1 for adults and less than 50 cents for children. Adults with malaria will take only two pills a day for three days, and the pill will come in three smaller once-a-day sizes for infants, toddlers and youngsters.

In Africa, malaria kills 3,000 babies and children each day, but combination drugs like this are not available for children under 11 pounds, and they require taking a larger number of pills each day, as many as 24 for some adult versions.

“This is a good thing,” said Dr. Arata Kochi, chief of the World Health Organization’s global malaria program, who has publicly demanded that drug companies stop making pills that contain artemisinin alone because they will lead to resistant strains of malaria. “They’re responding to the kind of drug profile we’ve been promoting.”

Doctors like to treat diseases with multidrug cocktails because it cuts down the chance that resistance to any one drug will develop.

Adm. R. Timothy Ziemer, coordinator of President Bush’s $1.2 billion Malaria Initiative, said the program would be willing to buy the new pill, assuming it meets international safety standards and is requested by countries the initiative supports.

Sanofi-Aventis, the world’s fourth-largest drug company, based in Paris, will sell the pill at cost to international health agencies like the W.H.O., Unicef and the Global Fund for AIDS, Tuberculosis and Malaria.

The rollout of the drug is the result of a two-year partnership between Sanofi and the Drugs for Neglected Diseases Initiative, a campaign started by the medical charity Doctors Without Borders to find new drugs for tropical diseases.

Doctors Without Borders, better known by its French name, Médecins Sans Frontières, has long been one of the harshest critics of the pharmaceutical industry, charging that it spent billions on drugs like Viagra, Ambien and Prozac for rich countries and almost nothing on diseases killing millions of poor people.

But, recognizing that new drugs would have to come from the industry’s major players, Doctors Without Borders founded the initiative in 2003 and began seeking partnerships. This is the first to come to fruition.

“This was not a love wedding, it was a reasonable wedding,” said Dr. Robert Sebbag, Sanofi’s vice president for access to medicines. “But reasonableness is often more important for a long marriage. They’ve seen we are not nasty people working against poor countries and seeking only profits.”

In an unusual move, Sanofi has decided not to seek any patents so the pills can be freely copied by generic companies like those in India. The drugs themselves are too old to patent, but the one-pill formulation could have been.

Sanofi will also produce a branded version, called Coarsucam, for the private market, to be sold at three or four times the public price. It will be sold only in Africa, Indonesia and the Philippines, the company said, not in the United States or Europe.

In another innovation, Sanofi will meet with pharmacists’ organizations in poor countries and give them incentives to sell Coarsucam at two different prices — at less than $1 to very poor customers and $3 to $4 to wealthier ones.

It will leave it to the pharmacists to estimate which of their customers lived on less than the cutoff income, which is about $40 a month, Dr. Sebbag said.

“Even in these countries, you always have some people who can pay,” he said.

The company has already experimented with the idea in six African countries, from Mali to Kenya to Madagascar, when selling its previous version of the drug combination, which was separate pills of each drug in a blister pack.

“It’s not a perfect system,” Dr. Sebbag admitted. “But we had about a 50-50 division, and we have not seen any cannibalization of the private market by the public.”

The company will package the cheaper Coarsucam differently and have its sales staff check to make sure that pharmacies are not selling the cheap product at the high price.

Neither version, at either price, will bring Sanofi much profit, “but in terms of symbolism, it means a lot,” Dr. Sebbag said.

One reason for keeping the price low, he said, was to remove the incentive for counterfeiters to produce fakes, which is a serious problem in Asia and a growing one across Africa. Fake malaria drugs — most offered as artemisinin — may be involved in up to 200,000 deaths from malaria each year.

ASAQ and Coarsucam will not replace a rival drug, Coartem from Novartis, a Swiss pharmaceutical company, that has been sold cheaply to the W.H.O. since 2001. Coartem combines another form of artemisinin with lumefantrine, another Chinese drug, and in East Africa, it works better than ASAQ because resistance to amodiaquine is common.

“But ASAQ is much more easy to use,” said Dr. Bernard Pecoul, director of the Drugs for Neglected Diseases Initiative. “And it is nearly half as expensive.”

Novartis used to sell Coartem to public health agencies at close to $3 per adult treatment; its price has dropped recently to about $1.70 as Indian companies announced the development of generic versions. Dr. Kochi said he expected prices to fall further with the competition from ASAQ.

“It’s the chain reaction of market competition,” he said. “This is exactly what we wanted.”

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