[e-drug] MSF supports UNITAID's Artemisia revolving fund proposal

E-DRUG: MSF supports UNITAID's Artemisia revolving fund proposal
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Dear e-drug

[UNITAID had a board meeting today, January 29, to discuss a.o. a proposal to support establishing a revolving fund to ensure enough artemisinin are planted this year in anticipation of the scaling up of making available combination medicines including artemisinin for treatment of malaria. Moderator]

We would like to draw your attention to a letter that MSF has written to
the UNITAID Board highlighting the risks of shortages of artemisinin starting material, and supporting the Artemisia revolving fund proposal as a way of ensuring that ACT products are available.

The text of the letter has been pasted below, or to download MSF's letter
to UNITAID click on the following link:
http://www.msfaccess.org/fileadmin/user_upload/diseases/other_diseases/MSF%20letter%20to%20UNITAID%20board%20re%20artemisinin%20supply%20FINAL.pdf

Leyla Pope
Communications Officer
Medecins Sans Frontieres
Campaign for Access to Essential Medicines
Tel. + 41(0) 22 849 89 88

January 27, 2009

Dear UNITAID Board member,

I am writing to you because Medecins Sans Frontieres (MSF) is very
concerned about the risk of shortages of artemisinin starting material (the
raw material extracted from Artemesia plants) that puts the global scale-up
of artemisinin-based combination therapy (ACT) treatment at risk.

We think that the Artemisia revolving fund proposal before you this week is
an opportunity for UNITAID to make a fundamental contribution to ensuring
that ACT products are available as the global scale-up begins gaining
speed.

MSF is treating about 1.2 million patients with confirmed malaria a year.
We are supportive of the various attempts to scale-up malaria treatment
more widely but we also know, from previous experience, how critical drug
supply is. MSF has already spoken out on this issue, calling for an
artemisinin starting material project when we experienced artemisinin and
ACT shortages in 2004-2005.

Current best estimates, based on available stocks and current planting
efforts, demonstrate that there will be a shortfall of about 40 tons of
artesiminin starting material in 2010 to produce the expected 240 million
treatments needed*. Technical paper to ensure sustainable API supply to
meet global ACT demand. Drafting Members: A. Bosman (WHO), H. den Besten
(IDA Solutions), M. Cutler (FSC), J. Pilloy (OTECI), I. Singh (CHAI), J.
Van Erps (RBM Secretariat), P. Yadav (MIT). Discussed at RBM/PSM WG meeting
on 9 December 2008 Taking into account that it takes about 14 months from
the planting of Artemisia annua to the availability of the finished
product, the availability in 2010 depends on what is being planted by
farmers in the next weeks and months.

We believe that market forces will not resolve the short-term artemisinin
supply problem. Because it is extracted from plants, the supply of
artemisinin is impacted by the highly volatile market of food crops which
affect farmers' decisions of whether or not to plant Artemisia annua.

Experts indicate that not enough Artemisia is currently being planted to
secure starting material needs in 2010. Main artemisinin extractors are now
stating that they did not receive clear signals or orders and will not
extend their planting commitments. Some finished product makers are
claiming that shortages will not be a problem but there might

be a fatal confusion, as has happened historically in this market, between
theoretical capacity to produce and binding commitment to do so. By the
time tenders are issued for the Global Fund, the Affordable Medicines Facility for malaria (AMFm) and the other program purchases, it will be too late to secure starting material supply.

While there are reasons to believe that increased demand stimulated by
increased donor funding and the launch of the AMFm will lead to long-term
stabilization of the market, this will likely take two to three years. As
the artemisinin market is not mature today it needs some stabilization and
support.

We therefore welcome and strongly support the proposal of a revolving fund
that has been made to UNITAID to provide a 60% advance payment of the
expected shortfall (at a fair price) to eligible extractors to stimulate
increased planting at this critical time. We understand that this is a
temporary mechanism and that there is limited financial risk as most of the
USD 9 million could even be recuperated after a two-year period.

Stabilizing the artemisinin market appears to be within UNITAID's mission;
and we therefore urge UNITAID board members to support the current proposal
and carefully weigh the risks of not acting.

Yours sincerely,

Tido von Schoen-Angerer, MD
Executive Director
Campaign for Access to Essential Medicines
Medecins Sans Frontieres International

*Technical paper to ensure sustainable API supply to meet global ACT
demand. Drafting Members: A. Bosman (WHO), H. den Besten (IDA Solutions),
M. Cutler (FSC), J. Pilloy (OTECI), I. Singh (CHAI), J. Van Erps (RBM
Secretariat), P. Yadav (MIT). Discussed at RBM/PSM WG meeting on 9 December
2008