A Chinese herbal drug that is strikingly effective against malaria is in critically short supply because of rising demand, public health officials and pharmaceutical executives say.
As a result, prices for the drug, artemisinin, have quadrupled, and the few companies that make compounds containing it have drastically cut back production. Supply crises are looming in 40 tropical countries that have recently made it the centerpiece of their anti-malarial efforts.
Malaria kills about 1 million people a year, most of them children. Strains resistant to older drugs have spread rapidly, and artemisinin (pronounced are-TEM-is-in-in), which is extracted from the sweet wormwood plant, was embraced this year by Western health agencies and donors as the most cost-effective solution.
The sudden shortage "has created a major wave of shock in our organization," said Dr. Andrea Bosman of the World Health Organization's malaria control team. Paul Lalvani, procurement manager for the Global Fund to Fight AIDS, Tuberculosis and Malaria, said the countries that had just adopted the drug were "really in a bind."
While other drugs are available, switching to a new one takes up to a year and can create dangerous confusion, especially in a poor country, he explained; the new drug must be registered, doctors and nurses must be retrained in dosages and side effects, and rural pharmacies must be alerted and restocked.
"Now they're sitting on the fence wondering if they should go ahead, or wait until the price drops, or pick another drug," he said.
Wormwood is an ancient Asian fever treatment, and Chinese military doctors trying to aid the Vietcong in the 1970s proved that its extracts kill malaria parasites. It has been popular in Southeast Asia, but was largely ignored in the West until this year.
Although sweet wormwood grows wild around the world, virtually all of the cultivation is in the hills of China and Vietnam.
Each crop must be planted in January, harvested in the fall, and then dried and processed. Some would-be growers outside China are complaining that they cannot buy seeds.
The shortage began soon after a series of meetings in April at which the Global Fund, the WHO, the World Bank, UNICEF, the US Agency for International Development and other donors jointly announced that they wanted malaria-prone countries to phase out older drugs like chloroquine and sulfadoxine-pyrimethamine and adopt multidrug combinations containing artemisinin or its derivatives artemether or artesunate.
Even though the new drugs cost 10 times to 20 times as much, the donors chose them because resistance to older drugs was running as high as 60 percent in parts of Africa. (A typical adult course of 24 of the newer pills costs the WHO US$2.40, as against US$20 for chloroquine.)
Until early this year, the world consumed about 30 tonnes of raw artemisinin a year, mostly in Asia, and the price had been steady for several years at about US$230 a kilogram.
But immediately after the WHO's April forecast that the world would need 130 tonnes to 220 tonnes next year, the price rose to US$360 a kilogram. It is now US$750 to US$910 a kilogram.
Drug companies in Switzerland and India say they cannot get enough at any price, and blame is being directed at all corners.
Lalvani, the Global Fund procurement specialist, said the refiners stopped selling this summer, "waiting for the prices to stabilize or go higher."