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Leadership Interview: Collaboration is crucial to the future and sustainability of the fight against malaria

Interview with Dr Vasella - Chairman and Chief Executive Officer (CEO) of Novartis

[RBM leadership interview conducted by Katya Halil, Communications Officer, Roll Back Malaria Partnership Secretariat, March 2009]

Q: What sparked your interest in malaria?

Dr Vasella: Malaria is a devastating disease and we saw that we could potentially make a difference in helping those who were suffering from the illness. So we engaged in a collaboration with Chinese scientists and developed a highly effective malaria treatment called Coartem ®, in developing countries and Riamet®, in industrialized countries. Coartem®, the first fixed-dose artemisinin-based combination therapy (ACT) approved and recommended by WHO, has a success rate above 97%.

The impact has been considerable. Since its launch we have helped to save over 550’000 lives. Last year alone we delivered over 70 million treatments mostly to African countries. In order to maximize access we subsidize the product and partner with governments, WHO, UNICEF, the Global Fund to fight AIDS, Malaria and Tuberculosis, the United Nations Development Programme, Medicines for Malaria Venture, African health authorities and many more organizations, often under the umbrella of the Roll Back Malaria Partnership.

While we make no profits on this product we have the satisfaction to contribute significantly to the recovery of many people and reduce the enormous economic burden of malaria. My colleagues at Novartis feel unanimously positive about our not-for-profit work. This enhances the identification with our company and creates internal alignment.

Q: How does Novartis contribute to the fight against this disease?

Dr Vasella: Our most important contribution is Coartem. In past years deliveries have grown exponentially – and it was a rocky start several years ago. It really wasn’t until a research study on Coartem’s dramatic effectiveness was published in the Lancet that we saw a rapid change in attitude to replace older often ineffective medicines with this new treatment that combines two compounds - known as an "artemisinin combination treatment" or ACT. This resulted in forecasts of an immediate need for 100-150 million treatments per year which we couldn't meet at the time. Nevertheless, it was clear that demand would increase, so we invested heavily to expand production capacity at state-of-the-art facilities in China and the United States to ensure a reliable supply. Today, we have a capacity to produce 100 million treatment courses a year. The increased volume also improved our productivity so we could lower the treatment price for the public market in 2008 by an average of 20% to now US$0.80 for adults or US$0.37 for a child’s treatment pack.

We are also engaged in medical training and education in Africa. Novartis addresses the challenges associated with malaria treatments, including access and distribution, by hosting a series of biannual workshops in Africa at which national malaria control programme (NMCP) managers can share information regarding best practice in their countries.

And now, together with Medicines for Malaria Venture (MMV), Novartis has launched Coartem Dispersible, the first sweet tasting medicine in its class developed for children. Because it is much easier to administer, this new formulation will help to improve compliance and therefore cure rates.

Finally, we also invest in R&D to find new malaria medicines in our not-for-profit research institute in Singapore. This initiative is a true public-private partnership of Novartis with the Wellcome Trust, Medicines for Malaria Venture (MMV) and the Singapore Economic Development Board.

Q: What is the expected added value of the Dispersible Formula?

Dr Vasella: The Dispersible Formula of Coartem is expected to save many young patients’ lives in developing world. Each year there are more than one million malaria-related deaths around the world. Nine out of ten malaria deaths occur in sub Saharan Africa, and the vast majority of malaria-related deaths occur in children under the age of five.

Until now there has been a major unmet medical need for a malaria treatment specifically developed for children. Imagine you’re a health worker or a parent who has to crush each antimalarial pill into tiny pieces in order for your child to swallow it. This has been the only method for treating young children until now . It’s not very successful because crushing tablets is time consuming, medicine is often left behind, and most children dislike the bitter taste.

The new formulation has a sweet cherry flavor and is rapidly dispersible in small amounts of water. This improves treatment compliance, hopefully saving a higher number of the more than 700,000 children under five who die each year from malaria.

We complement the new formulation by providing malaria case management educational programs, which include hands-on training for local healthcare workers, customized training manuals, and user-friendly packaging.

Q: What value does the RBM Partnership bring to Novartis?

Dr Vasella: Novartis is proud to be such a pivotal player in the fight against malaria, but one company cannot do it all alone. Collaboration is crucial to the future and sustainability of the fight against malaria.

We’ve partnered with the WHO and the Roll Back Malaria Partnership since 2001 to improve access to effective malaria treatment in the developing world. From the start, Novartis’ relationship with RBM has been of shared decision-making and risk taking to meet a mutual goal – saving lives.

Recently Novartis supported the RBM Zambezi Expedition, a two-month voyage on the Zambezi River showcasing successes and highlighting challenges associated with the fight against malaria across the six countries of the Trans-Zambezi region. During the expedition, Novartis provided its malaria treatments without profit. This support further underscores our joint commitment to tackling the disease and creating a malaria-free future for children.

I believe the greatest strength of the RBM Partnership lies in the diverse capabilities and expertise of its individual partners. The RBM Partnership adds much value to Novartis because it brings our organization together with others committed to the same cause. In 2004, the RBM partnership helped bring Novartis together with Medicines for Malaria Venture (MMV) to develop Coartem Dispersible. Without the RBM partnership, we would not have had the knowledge and technical expertise of MMV, which was key to the development of this treatment.

Q: RBM partners are scaling up their efforts to reach universal coverage by 2010 against the backdrop of a global economic crisis. How does Novartis envision to support the Partnership in achieving its goals?

Dr Vasella: Novartis envisions supporting RBM to achieve universal coverage by 2010 by improving access and offering its malaria treatments for adults and children to the public and private sectors at the lowest cost possible.

As a dedicated partner in the fight against this disease, Novartis is committed to providing up to 100 million Coartem treatments each year without profit, and to continuing to improve access to vulnerable groups.

Q: How can big pharmaceutical companies be encouraged to develop medicines for diseases that afflict the poor?

Dr Vasella: As most of the pharmaceutical companies are private for profit organizations it is important to incentivize them by various means to invest in this kind of research and development. This includes shared R&D costs, advanced purchase commitments, uniform quality standards to protect patient safety and an independent and last but not least public recognition. Governments of industrialized countries have additional means like fast track reviews of new drug applications to name just one example.

At Novartis we see this engagement as integral to our corporate strategy for sustainable growth and our corporate social responsibility which also includes a voluntary commitment to realizing the Kyoto protocol. In 2008 alone, our access to medicine programs reached 74 million patients and was valued at over USD 1.2 billion or 3% of our sales. We will continue to work hard to remain economically successful and achieve a strong performance. This allows us also to continue our engagement for the poorest people of the world.

I hope that the success of Novartis’ Malaria Initiatives inspires other big pharmaceutical companies and organizations to take on neglected diseases like malaria.