The seedy drug wars

Dan Okoth | 08 Jan 2007
The Standard (Kenya)

A policy shift in malaria treatment last year kicked up a huge storm in the medical fraternity.

While different interest groups attempted to influence the direction of the change, the move also affected the economic sector.

The Government last April ordered the withdrawal of sulphur-based drugs (SPs), used for treating malaria from the market. It replaced them with a new combination treatment, known as Artemisinin-based Combination Therapy (ACT), which experts say is more effective against the killer disease.

Some of the SP drugs commonly used in Kenya included Metakelfin and Fansidar, while some of the newly introduced ACTs include Coartem and Co-Artesiane.

But the change in malaria treatment policy has many groups with huge professional and commercial vested interests. Different groups, including doctors and pharmaceutical companies, have been clamouring to convince the Government, which is the largest consumer of such goods, to order certain ACTs for use in public hospitals.

Drugs too expensive

The push to land Government contracts for the supply of the ACTs has apparently been precipitated by the huge resources allocated by the Global Fund to fight malaria and HIV/Aids.

But recently, new players have joined the supply fray, this time competing to supply the raw materials for the production of the ACT drugs.

While multinationals have been manufacturing ACTs in Kenya, the cost of the drugs remains high.

Metakelfin and Fansidar used to cost about Sh60 per dose, but ACTs manufactured by multinationals used to cost about Sh2,500 a dose before the Global Fund came in. The paediatric form used to cost about Sh1,200, but has come down to about Sh300 a dose. Although the drugs for adults now cost about Sh700 a dose, consumers still feel the price is beyond the reach of the majority.

This has prompted the Government to allow local companies to produce generic versions that cost much less. The Government has also contracted a multi-national pharmaceutical company to supply the drugs to public health outlets where they are given free to the public.

The development has resulted in a high demand for Artemisinin, the main ingredient for producing ACTs.

Consequently, the demand for Artemisia Anua, the plant that contains artemisinin, has shot up dramatically in recent months.

Grown at minimum cost

Although growing the plant locally presents an opportunity for farmers to double or even triple their income, the plant is in short supply in Kenya and local companies rely heavily on supplies from China, where the plant originated, Germany and Belgium.

Only one local company extracts artemisinin, making the product expensive locally. One option the Government could still explore is the plan to grow the plant locally. Although it is being done on a small scale, it remains a tricky affair as myriad ecological and technical odds are stacked against the farmers.

Large agricultural-based multinational companies, which could grow the plant in large commercial scale, have upstaged local smallholder farmers to rake in the profits. Like the extracting company, their monopoly ensures they control prices. It is estimated that the price of a sack of Artemisia Anua (about Sh4,000) could buy two sacks of wheat (about Sh2,000 each) and four sacks of maize (about Sh1,000 each).

However, farmers would be glad to know that there are virtually no farm inputs involved in producing Artemisia Anua. Once planted, it needs no weeding, and has no known pests. In fact, the plant kills pests that affect other plants, making it ideal for inter-cropping. The venture is not labour intensive with work being put in only during harvest time.

The only drawback is that the plant grows well only in certain soils. Rachel Okeyo of the Research and Development at Advanced Bio-Extract says the plant can only grow in certain types of soil. Growing it in other soils and under unsuitable climatic conditions results in low quality leaves.

Artemisia growing in Kenya, she says, is still at the pilot stage at a few sites in Central, Rift Valley and Western provinces, where the company is working with local farmers. "Much of the growing is being done in Uganda and Tanzania where there are perfect ecological and climatic conditions suitable for growing the plant," says Okeyo.

The bulk of leaves processed at the EPZ based artemisinin extracting plant, which is the only one in East and Central Africa, comes from the two countries.

Another challenge facing prospective local Artemisia Anua growers is the cost of the seeds and the sheer size of land required. According to Okeyo, one needs twice as much land as maize to grow Artemisia.

"For instance, if a farmer has two hectares of land to grow the plant, he will only use one hectare as the other hectare would be preserved for drying the leaves. The plant grows so huge that one requires extra space to dry the leaves," she says. The plant, says Okeyo, has to be dried in hygienic conditions to avoid contamination.

"Farmers risk having their produce rejected at the factory if it is found to contain unacceptable levels of contamination. To eliminate that, farmers are obliged to set aside a piece of land specifically for drying the crop," says Okeyo.

Seeds cost a fortune

But if the growing conditions for Artemisia are strict, obtaining the seeds is even trickier. A gram of the seed, says Okeyo, costs between $150 (about Sh10,500) and $200 (Sh14,000). Most farmers, according to the official, cannot afford the seeds and the company advances them the seeds and later deducts the cost from the proceeds of the harvest. The seeds are so tiny that a one-gram packet contains about a thousand seeds.

In a desperate effort to bridge the seed gap, a local company has tried to develop synthetic Artemisia seeds but the fruits of the efforts are yet to show. Producing synthetic Artemisia seeds, says Okeyo, may be viable but is a complicated and expensive affair.

"We are aware some people are trying to do this but we know it is almost untenable because it is very expensive and ultimately the seeds may not be affordable," she says. But farmers who are eager to grow Artemisia have temporarily left it for the rich despite its exciting prospects.

"When the British first introduced tea, it was almost impossible for Africans to grow the crop because of the strict conditions attached. I wonder whether Artemisia has taken on that distinction," says a farmer from Kericho who tried to grow the crop in vain. As local farmers consider the missed opportunities, multinationals import the seeds and rake in millions from their surplus land and local cheap labour.