Artemisinin Enterprise Projects:

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Why are Artemisinin-based Combination Therapies (ACTs) the mainstay of malaria treatment?

Artemisinin is a fast acting and highly effective anti malarial against both Plasmodium falciparum and Plasmodium vivax malaria. The parasites are rapidly cleared from the blood. To safeguard the effectiveness of artemisinin, it is best used in combination with a longer-acting partner drug. Since the 2001 WHO endorsement of Artemisinin-based Combination Therapy (ACT) as 1st or 2nd line therapy for uncomplicated P. falciparum malaria, ACTs have been adopted by 75 countries.
Where does artemisinin come from?

Artemisinin is currently sourced from low yield, non-optimised varieties of the medicinal plant Artemisia annua (sweet wormwood).
Why are ACTs expensive?

Artemisinin production represents a significant proportion of the manufacturing cost of ACTs. Artemisinin is derived from the medicinal plant Artemisia annua, but yields from the plant are low, quality is variable and supplies are uneven. Market instability has led to extremely volatile artemisinin prices that, in recent years, have ranged from USD $180 to $1700/kg.
What will be the impact of the three new supply sources on the ACT market?
The projects in the Artemisinin Enterprise aim to improve artemisinin production technologies, which should:
- diversify the sources of high quality artemisinin,
- lower the cost of artemisinin production,
- stabilize supplies, reducing market volatility,
- provide new antimalarial combinations,
- make high-quality ACTs less expensive and therefore accessible to more people who need them.
Will the new technologies replace plant-produced artemisinin?

Plant-based production will continue to play an important role in the ACT manufacturing process in the future. Nonetheless, it is clear that there is a need for additional sources of artemisinin. It is anticipated that synthetic alternatives, fermentation and high yield A. annua will all be needed to secure supply and reduce the cost of artemisinin.
What about other problems with ACTs, such as distribution?

Access to ACTs is a daunting challenge. To make affordable ACTs available to those who need them, other supply chain problems such as stability, leakage to the black market, counterfeiting, distribution, and private sector regulation must also be addressed. However, within a wider strategy that addresses both disease control and supply chain issues, the production of inexpensive ACTs remains essential.
Who will get access to these new sources of artemisinin?

The Artemisinin Enterprise supports the manufacturing and distribution of high-quality ACTs that meet recommended standards. The presence of sub-standard and counterfeit drugs on the market undermines effective malaria control. The projects are collaborating to ensure the new technologies do not enter substandard drug or monotherapy supply chains.
Are Artemisia teas effective against malaria?

The use of such teas to treat malaria is not recommended by the WHO. It has been reported that the concentration of artemisinin in A. annua tea is too low to be responsible for antimalarial activity and increases the risk of resistance developing.
Are you going to patent your discoveries?

Our intellectual property strategies are aimed an ensuring that patients in endemic countries have the full opportunity to benefit from our discoveries. Patents can help us in this aim, for example, by ensuring that the new technologies will not be used for the production of sub-standard drugs or monotherapies.
How will these new approaches be incorporated into the emerging ACT subsidy mechanisms?

The Artemisinin Enterprise has the same ultimate aim as the subsidy; to increase access to high-quality ACTs by the people who need them. The new technologies being developed by the Enterprise will reduce costs at the pre-manufacturing end of the value chain.
When will these new technologies become available?

It is anticipated that the seeds will be the first products to enter the market. The other technologies will become available in the years thereafter.
Does the Artemsinin Enterprise support the new drive for malaria eradication?

The Artemisinin Enterprise supports the goal of the eradication of malaria from the planet. The toll of malaria is unacceptable; the majority of the disease burden is carried by children under five and pregnant women in rural and impoverished areas. It is hoped that our collective efforts will significantly contribute to the goal of eradication by helping to make ACTs affordable to those who need them.