New Child-Friendly Malaria Drug Presents Distribution Challenge

Robert Guth | 27 Jan 2009
Wall Street Journal
Novartis AG and a nonprofit partner said they have devised a pill that overcomes a longstanding challenge in developing countries: getting children to take their malaria medicine. The next challenge, however, will be distributing it to those children in the first place.

Cures for malaria are largely designed for adults; the pills are often bitter and too big to swallow for children, who account for most of the more than one million people killed each year by the mosquito-borne disease, malaria experts say.

On Tuesday, the partners will roll out a new children's drug, called Coartem Dispersible, that is small, cherry-flavored and dissolves easily.

The Swiss pharmaceutical giant and Medicines for Malaria Venture, a nonprofit organization focused on malaria drugs, have tested the pill in Africa, trying various flavors including mango, said MMV Chief Executive Chris Hentschel. "The surprise was it was liked by African children who had never tasted cherry," Mr. Hentschel said.

Still, the new pill faces a critical challenge: getting it to the people who need it. In recent years, new investment has poured into creating drugs for afflictions common in developing countries. But efficient channels to distribute the products are rare, giving rise to what health workers call "pile-up" of drugs trying to reach villages and health clinics.

"This is a big step forward," said Richard Feachem, a malaria expert and professor at the University of California, San Francisco. But "there is no silver bullet and there never will be one."

The new pill, which has received regulatory approval in Switzerland and in several African countries, is based on an existing Novartis malaria treatment called Coartem that is designed for adults and is often crushed to better suit children. The drug uses artemisinin, a compound derived from a wormwood plant. The children's version required four years and millions of dollars to develop.

Distribution of Coartem and other drugs is largely done through an international nonprofit fund set up for the purpose of paying for medicines in developing countries.

The fund helps a local government buy the drugs, which are then distributed free through national medical centers and hospitals. Coartem Dispersible will be included in such programs. But the public distribution misses many rural areas, which often aren't reached by national health-care facilities.

"In the end the only drug that matters is the drug that is swallowed," said Novartis Chief Executive Daniel L. Vasella.

Another challenge is lowering the drug's price. Many existing malaria medications have lost their effectiveness as the parasite that causes the disease has built up resistance to the treatments. But they're cheaper than new treatments like Coartem, which on average costs about 80 cents per treatment. And people in countries where the drug is used sometimes mark up the price.

MMV is testing ways of subsidizing small local sellers of the drug in rural areas. In Uganda, it is working with the Clinton Foundation to develop ways of getting drugs to rural retailers at around five cents per treatment.

MMV officials said they also are working with governments to train health workers in local communities to help people manage their health and treatment of diseases like malaria.