The company's Director of Public Affairs, Malaria Initiatives, Lee Wells, told AIM on Tuesday that he has been in preliminary discussions with senior health officials, and with Anglican Bishop Dinis Sengulane, who heads the Mozambican branch of the Roll Back Malaria campaign.
He described this as "a preliminary visit", and hoped to be back in Maputo in September to firm up orders for Coartem, a drug which a study published in the respected medical journal "The Lancet" in April 2005 described as "the most effective treatment for malaria in children in Africa where resistance to conventional drugs is high".
Coartem is an artemisinin compound, made from sweet wormwood, a plant grown in China, and used in Chinese herbal medicine for centuries because of its anti-parasitic qualities.
The World Health Organisation (WHO) now recommends Artemisinin-based Combination Therapy (ACT) as a first line treatment in Africa, and Mozambique is committed to switching to ACT, and phasing out the previous drugs such as fansidar.
The older anti-malarial drugs have become increasingly ineffective, as the malaria parasite has developed resistance to them. Very high failure rates from conventional drugs are now reported in parts of Africa and south-east Asia.
A WHO survey of malaria treatments reports that "artemisinin compounds are active against all four species of malaria parasite that infect humans and are generally well tolerated".
Coartem has the WHO stamp of approval, and Novartis has had an agreement with WHO for the past six years to supply Coartem on a not-for-profit basis. Novartis says that so far 36 countries, mainly in Africa, have adopted Coartem as their first line malaria treatment.
The Global Fund to Fight AIDS, Malaria and Tuberculosis was impressed by the drug and noted that so far there has been "no clinical resistance to Coartem".
Novartis claims cure rates in excess of 95 per cent for Coartem after just three days of treatment, meaning that fewer second line drugs are required.
There are two drawbacks. Wells pointed out that the company needs orders well in advance, because it has to grow the plant.
From planting the seeds to harvesting the wormwood takes seven months. Then the artemisinin must be extracted, the compounds produced and the drug tablets manufactured and packaged. This gives a minimum total lead time of 14 months.
The second problem is the price. Coartem costs an average of one US dollar per treatment, even with Novartis making no profit on it. For comparison, chloroquine costs just 20 cents per treatment.
However, there is little point in buying cheap drugs, if they can't do the job. The switch from the older drugs to ACT has enormously boosted the demand for Coartem: Novartis said it shipped nine million treatments in 2005, but there was then an enormous jump to 62 million treatment in 2006. The company estimates it has the annual capacity to produce 100 million treatments.
There are two potential sources of funding for Mozambique's supply of Coartem. One is the Global Fund, but Wells believed the money would be more rapidly available from US President George Bush's Initiative against Malaria.
Despite the rise in mortality from AIDS, malaria remains the single largest cause of death in Mozambique. According to the Health Ministry statistics, about six million cases of malaria were diagnosed in Mozambique in 2006 (out of a total population of around 19 million), and these resulted in some 5,000 known deaths.
The real death toll must be considerably higher because of the many patients in remote areas who are unable to reach health units.
SOURCE: AIM
