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Forecast of ACT needs based on current and expected changes in antimalarial treatment policies

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:

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Forecast of ACT needs based on current and expected changes in antimalarial treatment policies

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  1. 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

  2. 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 drug-resistance 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

  3. TOTAL= 435 Untried and Untested ? (Courtesy of Prof N.White)

  4. FDC MDT Combination therapies recommended by WHO WHO Technical Consultation on “Antimalarial Combination Therapy” – April 2001 • Artemether/lumefantrine • Artesunate + amodiaquine ACTs • Artesunate + SP • Artesunate + mefloquine • Amodiaquine + SP

  5. 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

  6. 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: • 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

  7. 35 countries adopted ACTs

  8. Trends in malaria treatment policy 1st-line: Burundi Cambodia Comores Peru S.Africa Gabon Thailand Bolivia ACT Viet Nam Laos Zambia Myanmar Zanzibar Surinam Rwanda Mozambique Colombia AQ+SP Senegal Uganda Eritrea CQ+SP Ethiopia PNG Zimbabwe Philippines Botswana Malawi Burundi SP/AQ Tanzania Cameroon Côte d'Ivoire S.Africa Kenya DRC <1993 1998 1999 2000 2001 2002 2003 2004

  9. 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

  10. Countries' choices of ACTs:the current situation 30 countries: 1st-line 5 countries: 2nd-line CV8 CoA ART+AQ 1 ART+SP 10 1 10 4 CoA 4 4 ART+MEF ART+SP 20 more countries are currently considering policy change to ACTs

  11. Country estimations of ACT requirements Global forecast of ACT requirements WHO Technical Consultation on Forecasting of Artemisinin-based Combination Treatment (ACT) Requirements for MalariaWHO/HQ Geneva, Switzerland, 23-24 February 2004

  12. Global forecasts of ACTs WHO Technical Consultation on Forecasting of ACT Requirements for Malaria • 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 • Focus on countries introducing 1st-line ACTs in 2003 - 2005 • Morbidity-based method using WHO’s most recent estimates of country malaria incidence (all age groups) • No adjustment for treatment based on fever • Upper and lower limits (= 60% if distribution limited to public sector only)

  13. These are conservative estimates based on country needs, and current processes of policy change • Based on the following assumptions: • country-wide deployment, • implementation 9 months after adoption of the new policy, and • funding available Lower Upper Global forecasts of ACTs 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)

  14. 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)

  15. Scale up required for end 2005 Global forecasts of ACTsand production capacity Minimum 200 Maximum 150 Number of Treatments (millions) 100 Current ACT production capacity 50 0 2004 2005 Year

  16. 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 GFATM funding of ACTs Total annual number of ACT treatments (eq. adult doses) funded by GFATM

  17. 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 life-saving medicines affordable to the people in need.

  18. The time of poor drugs for poor people is over

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