February 25 2008: 10:04 AM EST
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A new approach to an old disease

A public-private partnership tries to take a bite out of malaria by merging two drugs into one.


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A nurse shows the current malaria treatment.

(Fortune Magazine) -- Charles Kimando, a doctor in Kenya, has long been frustrated with his limited arsenal of drugs to treat malaria. The parasitic disease makes its appearance after heavy rains in Embu, the central Kenyan town where he is based. Kimando has access to a drug called Arsucam, but it treats malaria with two different pills, one of which tastes terrible and sometimes has side effects. "It can be hard to get people to take the available drugs," he says.

Last fall Kimando became one of the first physicians in Africa to prescribe a new drug made by French pharmaceutical company Sanofi-Aventis (SNY). (Sanofi also makes Arsucam.) The drug, known as ASAQ, melds the two treatments used in Arsucam into one pill; it also marks a new approach to addressing a disease that kills more than a million people a year.

The drug, which will sell for less than $1 a pill and won't be hugely profitable, is the result of a public-private partnership model that makes new medicines accessible to the poor. It turns out that a nonprofit organization in Geneva, Drugs for Neglected Diseases Initiative (DNDi), had figured out a way to combine the two antimalaria drugs and was looking for a corporate partner to conduct clinical trials and market and produce the drug on a large scale. "It was the marriage of both of our needs," says Robert Sebbag, a vice president for Sanofi.

Sanofi's aim was not entirely altruistic, says Bernard Pécoul, executive director of DNDi, a doctor and public health specialist who spearheaded the antimalaria project. "It's good for their image," he says, "but it will also help with the penetration of these countries' markets."

ASAQ was launched early last year and is now being rolled out in West Africa and Kenya. It is still awaiting registration in a dozen countries and lacks prequalification from the World Health Organization, which could hold up deployment.

Malaria has rebounded in sub-Saharan Africa in the past 20 years, as the parasite that causes it grew resistant to standard treatments. But of the 1,400 new drugs developed worldwide from 1975 to 1999, only four were antimalarials.

Among the most promising new antimalarials are drugs that derive from or synthetically copy artemisinin, a compound found in a Chinese shrub. ASAQ is one such artemisinin-based combination therapy. Medicines for Malaria Venture, another Geneva nonprofit, is partnering with several pharmaceutical companies to develop others. "The pipeline of malaria drugs is pretty robust right now," says Mark Grabowsky, director of malaria programs for the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

Novartis manufactures the most widely available artemisinin-based therapy, Coartem, which, like ASAQ, is patent-free and sold at cost. But K.M. Bhatt, a professor of infectious and tropical diseases at the University of Nairobi, says that ASAQ's low pill count - two pills once a day for three days, compared with four Coartem pills twice a day for three days - gives it an advantage over other treatments. Patients are more likely to comply with the regimen, she says, and there is less chance of developing resistance.

Sanofi says it has more antimalaria drugs in the pipeline. But René Cazetien, an executive in the company's Access to Medicines program, says developing new drugs remains slow and costly. "We have to think more about partnerships to figure out how to fund the research," he says.  To top of page