ABSTRACT
The geography of artemisinin-based combination therapies (ACTs) innovation and industry is uniquely distributed. Originally developed in China, it was subsequently globalized through the WHO, humanitarian medicine, and the multinational companies Novartis and Sanofi. Dissemination was encouraged by the public and common good status of the basic molecules, which it was legal to duplicate and combine. The ACTs developed under the impetus of the Drugs and Neglected Diseases Initiative (DNDi) Foundation were also placed in the public domain. Novartis did not defend the patent that it co-owned with China on the combination of artemether and lumefantrine, while Sanofi exploited the combination of artesunate and amodiaquine (ASAQ) that had not been patented by the DNDi. ACT production is now dominated by Indian generics manufacturers, who market their WHO-prequalified products in the global donor market, while copies from African producers are sold in local and regional markets. In 2011, the DNDi started to transfer the ASAQ technology to a factory in Tanzania, with the aim of obtaining WHO prequalification, unprecedented in Africa for this type of drug. While Chinese firms have lost control of the ACT industry, China remains the main supplier of active ingredients, particularly natural artemisinin.
