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Open Access Highly Accessed Review

Stabilizing supply of artemisinin and artemisinin-based combination therapy in an era of wide-spread scale-up

Rima Shretta1* and Prashant Yadav2

Author Affiliations

1 Systems for Improved Access to Pharmaceuticals Services, Management Sciences for Health, 4301 North Fairfax Drive, Suite 400, Arlington, VA, 22203, USA

2 William Davidson Institute, Ross School of Business and School of Public Health, University of Michigan, 724 East University Avenue, Ann Arbor, MI, 48109, USA

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Malaria Journal 2012, 11:399  doi:10.1186/1475-2875-11-399

Published: 2 December 2012

Abstract

The global demand for artemisinin-based combination therapy (ACT) has grown sharply since its recommendation by the World Health Organization in 2002. However, a combination of financing and programmatic uncertainties, limited suppliers of finished products, information opacity across the different tiers in the supply chain, and widespread fluctuations in raw material prices have together contributed to a market fraught with demand and supply uncertainties and price volatility. Various short-term solutions have been deployed to alleviate supply shortages caused by these challenges; however, new mechanisms are required to build resilience into the supply chain. This review concludes that a mix of strategies is required to stabilize the artemisinin and ACT market. First, better and more effective pooling of demand and supply risks and better contracting to allow risk sharing among the stakeholders are needed. Physical and financial buffer stocks will enable better matching of demand and supply in the short and medium term. Secondly, physical buffers will allow stable supplies when there are procurement and supply management challenges while financial buffer funds will address issues around funding disruptions. Finally, in the medium to long term, significant investments in country level system strengthening will be required to minimize national level demand uncertainties. In addition a voluntary standard for extractors to ensure appropriate purchasing and sales practices as well as minimum quality and ethical standards could help stabilize the artemisinin market in the long term.

Keywords:
Artemisinin; Artemisinin-based combination therapy (ACT); Safety stock; Buffer stock; Physical buffers; Financial buffers