Novartis is expanding access to quality malaria treatments in the growing African middle class Donnerstag, 21. Februar 2013 - 13:40
Technology, economy and science transform the battle against malaria
February, 2013
Two critical moments in the battle against malaria came in 2001. First, Novartis introduced the first fixed-dose artemisinin-based combination therapy, or ACT. Later that year, Novartis and the World Health Organization (WHO) joined forces to provide ACTs without profit to public health systems in developing countries. This landmark agreement came at a time when public-private partnerships were still largely untested.
The initial goal of the Novartis Malaria Initiative was to deliver two million antimalarial treatments within four years. It long ago surpassed that goal, and over 500 million treatments have been delivered since 2001, contributing to a significant reduction of the death toll from malaria.
Along this incredible journey, Novartis also worked with the Medicines for Malaria Venture (MMV) to develop the first pediatric formulation ACT for babies and children who find it difficult to swallow bitter-tasting tablets. More than 150 million pediatric ACT treatments have been delivered without profit by Novartis. Today, Novartis continues to supply ACT treatments without profit to public health systems in malaria-endemic countries.
While confirmed malaria cases in recent years have dramatically dropped in many countries, significant challenges remain. Far too many people in Africa never obtain the ACTs they need - including over 500,000 children under age five who die from malaria each year.
But after years of working against malaria, Novartis has learned that simply producing more treatments will not be enough to win the battle against malaria. It will also require innovative distribution strategies, and research into newer and even more effective antimalarials must continue for science to stay one step ahead of the parasite. For Novartis, the next steps are clear.
Technology: Simple solution yields real results
Despite the massive number of antimalarial treatments delivered to public health facilities in Africa each year, it's not uncommon for them to run out of treatments. The problem often lies in unreliable supply chains. To help address this problem, Novartis is leading SMS for Life, a unique public-private partnership to help developing nations improve their supply chains.
Falling under the umbrella of the Roll Back Malaria Partnership, the program uses SMS text messages and electronic mapping technology to help suppliers avoid running out of medicine, which retailers call “stock-outs.” The program is remarkably simple. Every Thursday, workers in all registered health facilities receive an SMS message asking for their supply levels. These workers then count their stock of medicines and report back via a free text message. Reminders are sent if a response is not received. Then on Monday, the medical district officer receives a consolidated report and can make new orders or redistribute medicine between facilities within a few days, rather than waiting possibly 2 or 3 months.
SMS for Life is producing real results. The first test sites in Tanzania saw antimalarial treatment stock-outs (ACTs and quinine injectables) drop from 79% to less than 26% in 2010, and the number of facilities that had no form of the Novartis ACT fell from 26% to less than 1%.
Today, SMS for Life reaches all 5,000 public health facilities across Tanzania. Novartis expects to launch similar programs also including other medicines and diagnostic test in Ghana, Kenya, and Cameroon in 2013.
New economy drives new healthcare demands
The early success of SMS for Life demonstrates how creative thinking and new approaches can make all the difference. But while SMS for Life is helping improve the supply chain of public health facilities, an even greater challenge lies in reaching the hundreds of thousands of private outlets across Africa, where increasing numbers of people now go to obtain high quality ACTs.
This increasing focus on the private sector reflects Africa's changing economy. While much of the continent remains mired in poverty, the last decade brought remarkable growth fueled by a rising international demand for Africa's oil, minerals, and other commodities. This growth has led to the emergence of a viable African middle class, which the African Development Bank defines as having a per capita daily consumption of USD 2 to USD 20.
Africa's growing economy is having a huge impact on a wide range of industries, including healthcare. A recent African Development Bank report noted that “middle class Africans tend not to rely entirely on public health services and seek more expensive medical care when ill.” Indeed, up to 50% of patients in Africa now seek antimalarial treatment from private retailers, such as small pharmacies, patent medicine stores and general stores.
And yet while the rise of the private sector has been critical in delivering treatments to more people in Africa, private sector outlets often sell sub-standard, low-quality medicines. This has proven particularly true of antimalarial treatments.
Novartis took a first step in bringing its antimalarial treatment to the private sector in 2010 when it joined the Affordable Medicines Facility for Malaria initiative, or AMFm, which aims to subsidize ACTs in the private sector.
This groundbreaking program has operated in eight countries during its initial two-year trial period and more than 66 million Novartis treatments were provided to patients in the project's first phase. Yet while AMFm is unquestionably an important step forward, the program has not always been able to meet consumer demand for ACTs. The demand is huge: Notwithstanding the success of the Novartis Malaria Initiative in the public sector, only one in three patients treated for malaria in sub-Saharan Africa receives an ACT.
The Novartis Malaria Initiative launched a complementary program in 2012, aiming to expand access to ACTs by ensuring that treatments make it to private outlets and that they are sold at a low price. Novartis applies a differential pricing model designed to make its antimalarial medicines affordable while also creating a sustainable business model that won't be subject to donor funding.
Equally important, the Novartis program is also designed to teach private suppliers and patients how to use the medicines properly. The program has been recently started in Malawi, Nigeria, Kenya, Uganda, Tanzania, Zambia, Rwanda, Ghana and Ethiopia.
Science races to stay ahead of the parasite
Malaria is a parasitic disease, and it's only a matter of time before the parasites adapt and build resistance against available treatments. This is why scientists work to stay one step ahead of the parasite to provide innovative treatments to support elimination efforts.
In fact, studies in South East Asia have shown the first signs of delayed response to ACTs. Patients are still being cured but it takes longer.
In the last two years alone, Novartis scientists have discovered two new classes of antimalarials. If successfully developed, they would be the first new antimalarials in many years not belonging to the artemisinin class, and they would provide a completely new option to treat the disease.
The first compound, known as KAE609, is currently in Phase II clinical testing. It is a so-called spiroindolone molecule that rapidly and potently killed malaria parasites in a Phase II study. The second compound belongs to a new class of dual-acting compounds known as imidazolepiperazines (IZPs). Novartis researchers reported the discovery of this class in 2011, explaining that it targets the parasite at both the liver and blood stage of its reproductive cycle. Scientists believe that future antimalarials will have to work against both blood and liver stages. The lead candidate in the Novartis IZP program is now in Phase I clinical trials. If it can be confirmed in clinical trials, the activity of the IZP compound class on liver-stage parasites gives this class promise for both the prevention and treatment of malaria.
New directions, same goal
From creating innovative distribution models to developing groundbreaking treatments, the long-term objective of Novartis remains the same: helping to eliminate malaria.
Elimination means ensuring treatments are available in both the public and private sectors. It also means using new technology to prevent stock-outs, and designing new pricing models to make drug delivery sustainable. Elimination will also entail more research and the development of new treatments.
Since 2001, the Novartis Malaria Initiative has been on a journey to help people in developing nations live healthier lives. Novartis and its partners have been able to deliver an unprecedented number of treatments, and have contributed to the dramatic declines in confirmed malaria cases in many countries.
The last decade was marked by great progress, and the future looks even brighter. With its new access program, SMS for Life, and novel compounds under research, Novartis is poised for a remarkable decade ahead in the battle against malaria.