Transcript Expected Outcomes

Forecast of ACT needs based on
current and expected changes
in antimalarial treatment policies
Presented by Dr A. Bosman
Access to Prompt and Effective Treatment
Malaria Policy and Strategy Team
Roll Back Malaria Department
Procurement, Quality and Sourcing Project:
Prequalification of Antimalaria Drug Products
WHO/Roll Back Malaria – 3 May 2004
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Response to increasing resistance
of P.falciparum to antimalarial drugs
WHO Informal Consultation on “ Use of
Antimalarial Drugs” (November 2000, Geneva):
The potential value of drug combinations, notably
those including an artemisinin derivative (ACT),
to improve efficacy, delay development of drugresistance and prolong the useful therapeutic life of
antimalarial drugs was widely accepted.
Recommended that combinations that do not contain
an artemisinin derivative could be a preferred option
for reasons of cost and accessibility in some countries
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Untried and Untested ?
ANTIMALARIAL DRUGS IN CLINICAL TRIALS
TOTAL= 435
Artemisinin group
32
Chloroquine group
28
16
175
Quinine group
115
Mf
MSP
13
SP
150
94
130
Amo
Pq
Hf
(Courtesy of Prof N.White)
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Combination therapies
recommended by WHO
WHO Technical Consultation on
“Antimalarial Combination Therapy” – April 2001
FDC
• Artemether/lumefantrine
Artesunate + amodiaquine
ACTs
MDT
Artesunate + SP
Artesunate + mefloquine
Amodiaquine + SP
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WHO recommends ACTs
Malaria endemic countries which are
experiencing resistance to currently used
antimalarial monotherapies (chloroquine,
sulfadoxine/pyrimethamine or amodiaquine)
should change treatment policies
to the highly effective
Artemisinin-based Combination Therapies
WHO/RBM Position Statement - November 2003
WHO/Roll Back Malaria – 3 May 2004
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Role of Combination Therapy (CT)
Amodiaquine + Sulfadoxine/Pyrimethamine,
limited to countries of West Africa, as interim policy
for countries unable to move immediately to ACTs
Limitations of AQ+SP:
1.
2.
3.
4.
5.
Restricted to few countries in West Africa due to drug resistance;
Unlikely to delay resistance because widely used as monotherapies;
Combined use endangers their potential as partner drugs for ACTs;
Risk of compromising efficacy of SP - only option for IPT in pregnancy;
Resources for policy change and implementation should be directed to
the most effective and durable treatment policy.
WHO/RBM Position Statement - November 2003
WHO/Roll Back Malaria – 3 May 2004
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35 countries adopted ACTs
Continent
AFRICA
16: 1st-line
3: 2nd-line
ASIA
9: 1st-line
2: 2nd-line
SOUTH
AMERICA
5: 1st-line
Countries
Options Level
Burundi, Cameroon, Eq. Guinea, Gabon, Ghana, Liberia,
South Sudan, Sao Tomé & Principe, Zanzibar
ART + AQ
1st-line
Benin, Comoros, Kenya, South Africa, Tanzania, Zambia
CoA
1st-line
Côte d'Ivoire, Mozambique, Senegal
CoA
2nd-line
North Sudan
ART + SP
1st-line
Cambodia, Laos, Myanmar, Thailand
ART + MEF
1st-line
Bangladesh, Bhutan
CoA
1st-line
Indonesia
ART + AQ
1st-line
India (5 Provinces)
ART + SP
1st-line
Viet Nam
CV-8
1st-line
Papa New Guinea
ART + SP
2nd-line
Philippines
CoA
2nd-line
Ecuador, Peru
ART + SP
1st-line
Bolivia, Peru
ART + MEF
1st-line
Guyana, Surinam
CoA
1st-line
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Trends in malaria treatment policy
1st-line:
S.Africa
ACT
Viet Nam
Rwanda
Colombia
AQ+SP
Malawi
Botswana
SP/AQ
S.Africa
<1993
Uganda
Zimbabwe
Mozambique
PNG
Philippines
DRC
1999
Eritrea
Burundi
Tanzania
Kenya
1998
Burundi
Comores
Gabon
Bolivia
Laos
Myanmar
Surinam
Senegal
Ethiopia
CQ+SP
Cambodia
Peru
Thailand
Zambia
Zanzibar
2000
2001
Cameroon
2002
Côte d'Ivoire
2003
2004
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Adoption of ACTs in 1st-quarter 2004
Africa
Benin, Eq. Guinea, Ghana,
Kenya, Liberia, Sao Tome,
N Sudan, S Sudan, Tanzania
Asia
Bangladesh, Bhutan, India
South America
Ecuador, Guyana
Promoting factors: drug resistance +
international pressure + commitment of GFATM resources
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Countries' choices of ACTs:
the current situation
30 countries: 1st-line
CV8
CoA
ART+AQ
5 countries:
2nd-line
1
ART+SP
10
10
4 1
CoA
4
ART+SP
4
ART+MEF
20 more countries are currently
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considering policy change to ACTs
WHO Technical Consultation on
Forecasting of Artemisinin-based Combination
Treatment (ACT) Requirements for Malaria
WHO/HQ Geneva, Switzerland, 23-24 February 2004
Country estimations of
ACT requirements
Global forecast of
ACT requirements
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Global forecasts of ACTs
Global forecasts of ACTs for the transition period 2004 -2005
Recent change to ACTs – consumption data not applicable for new medicines.
Market forces (demand & supply) will intervene soon to provide real-time data to
manufacturers and funding agencies
1. Focus on countries introducing 1st-line ACTs in 2003 - 2005
2. Morbidity-based method using WHO’s most recent estimates of country
malaria incidence (all age groups)
3. No adjustment for treatment based on fever
4. Upper and lower limits (= 60% if distribution limited to public sector only)
WHO Technical Consultation on Forecasting of ACT Requirements for Malaria
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Global forecasts of ACTs
Lower
Upper
2004
30,007,678
50,012,796
2005
131,583098
219,305,163
Forecasts for
procurement only
by the public sector
Based on total morbidity
estimates (for both public
and private sectors)
These are conservative estimates based on country needs,
and current processes of policy change
Based on the following assumptions:
1.
country-wide deployment,
2.
implementation 9 months after adoption of the new policy, and
3.
funding available
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ACT forecast for Africa
Lower
Upper
2004
18,481,420
30,802,367
2005
91,677,810
152,796,350
Forecasts for
procurement only
by the public sector
Based on total morbidity
estimates (for both public
and private sectors)
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Number of Treatments
(millions)
Global forecasts of ACTs
and production capacity
Minimum
Maximum
200
150
100
Scale up
required for end
2005
Current ACT
50
production capacity
0
2004
2005
Year
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GFATM funding of ACTs
GFATM - the largest financial supporter of ACTs in countries
A total of about US$ 41 million has been committed over the full 5-year
life of GFATM Board-approved proposals from endemic countries for the
purchase of ACTs in three proposal rounds. In addition funds for
chloroquine, SP or amodiaquine can be reprogrammed to ACTs if needed
7000000
6000000
5000000
Total annual number
of ACT treatments
(eq. adult doses)
funded by GFATM
4000000
Annual
Cumulative
3000000
2000000
1000000
0
1st round 2nd round 3rd round
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Momentum is high to ensure
access to effective antimalarial treatment
The costs of estimated global ACT requirements far
exceeds the current level of ACT financing by the GFATM.
An enhancement of the financial resources for purchasing
ACTs is, therefore, urgently required to both encourage
endemic countries to adopt these effective treatment
policies and to stimulate the market.
Malaria is a highly treatable disease, and very effective
treatment is available in the form of ACTs. WHO calls on
all RBM partners to unite in a global coalition to enable
countries accelerate access to ACTs and make these lifesaving medicines affordable to the people in need.
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