Clearing out the bad air

After long resistance, foreign aid donors now favor the use of artemisinin, an extract of qinghaosu, or sweet wormwood, for the treatment of malaria.

[Artemisinin] cut the death rate by 97 percent in a malaria epidemic in Vietnam in the early 1990's.
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As a plant material, artemisinin cannot be patented, said Dr. Allan Schapira, a policy specialist for the Roll Back Malaria campaign of the World Health Organization. Nor can the simple extraction process. Some synthetics, he said, are old and off patent, which public health officials like but pharmaceutical companies do not, because they make a larger profit from drugs on which they have patent monopolies.

No company has registered artemisinin in the United States, said Dr. Nick White, a professor of tropical medicine at Mahidol University in Thailand, because sales would be too small to justify the cost of seeking approval from the Food and Drug Administration.

Now, with more purchases, fears of a shortage that would push prices up are developing. The W.H.O. estimates that 100 million doses will be needed by late 2005, and the world now has only about a third of that.

Wouldn't increasing sales increase the incentive for a company to register artemisinin and then use registration to enforce a worldwide patent monopoly?

Even if enough artemisinin can be made, obstacles will arise, experts warned. For example, Dr. Kopano Mukelabai, a malaria specialist at Unicef, said shopkeepers would have to be trained not to sell one or two pills to patients who lacked the money for a full course of 12.
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Also, counterfeiting will become a problem. In Kenya in 1997, Mr. Allan said, he found 120 versions of sulfadoxine-pyrimethamine for sale, "ranging from very good drugs to talcum powder." A recent study of artemisinin drugs in Asia "found that 38 percent were fakes," he said. "We can expect the same thing to happen in Africa."

Which is not to say that people in developing countries who either don't understand how diseases develop resistance or are unscrupulous can't cause problems.

[Richard Allan, director of the Mentor Initiative, a public health group that fights malaria epidemics,] favors giving artemisinin away to remove the counterfeiters' profit motive.

Yeah, good luck with that.