August 20, 2022 | By Shen Li, Associate Director; Alex Henderson, Senior Associate, Bridge Consulting
This article will explore:
- China’s domestic experience in eliminating malaria
- The Chinese government’s increasing engagement with Africa on anti-malaria projects
- Increased participation of Chinese pharmaceutical companies in supporting Africa’s anti-malaria efforts
- Gaps of Chinese pharmaceutical companies hindering their global impact
Today is World Mosquito Day, a global commemoration of British medical doctor Sir Ronald Ross’ 1897 discovery that Anopheles mosquitoes cause the transmission of malaria to humans. This discovery has formed the base of the world’s decade-long efforts in fighting malaria – one of the most life-threatening infectious diseases in the world. Though there are still an estimated 241 million malaria cases worldwide, thanks to innovations from all sectors against this mosquito-borne parasite, malaria has proven preventable, curable, and ultimately eradicable.
China’s particular success story in eliminating malaria can prompt optimism in other developing countries. While intergovernmental and multilateral efforts are commonly known to provide support for malaria-affected countries, the contributions of pharmaceutical enterprises – particularly Chinese pharmaceutical enterprises – in eliminating malaria are underutilized. As their influence increases, the road to eradicating malaria around the world will accelerate.
China’s malaria elimination campaign
In the 1940s, China had over 30 million malaria cases. The disease was rampant in the south, close to other hotspots across mainland Southeast Asia. Over the last two decades, China ramped up its efforts and reduced the number of cases in the 1990s to just 5,000 annually by providing staff training, laboratory equipment, antimalarial medicines, and introducing new methods to control mosquito propagation.
In 2010, the Chinese government launched a new malaria elimination program to achieve country-wide elimination by 2020. A key element of their effort was pioneering a method known as the “1-3-7” strategy.
The “1-3-7” referring to reporting malaria cases within one day, confirming and investigating within three days, and implementing the appropriate public health response to prevent further transmission within seven days. On 30th June 2021, the World Health Organization (WHO) certified that China was officially malaria-free.
China-Africa cooperation in malaria
With this success in hand, China has accumulated decades of valuable experience in malaria elimination and has sought to establish health cooperation partnerships with other developing countries, including in Africa, to assist in their malaria elimination campaigns.
The African continent carries a disproportionately high share of the global malaria burden, with 95% of malaria cases and 96% of malaria deaths. According to the WHO, African countries accounted for just over half of all malaria deaths worldwide: Nigeria (31.9%), the Democratic Republic of the Congo (13.2%), Tanzania (4.1%), and Mozambique (3.8%). Most unfortunately, children under five years old accounted for about 80% of all malaria deaths in Africa.
Since the inception of bilateral and multilateral frameworks such as the Forum on China-Africa Cooperation (FOCAC) and South-South Cooperation, China has expanded its health cooperation to include projects for malaria and other neglected tropical diseases (NTDs). Through trainings in China and Africa, where Chinese experts are often deployed, African medical workers have benefitted from knowledge and expertise sharing to boost their understanding of malaria control and treatment interventions. China has also helped African countries develop monitoring systems, provide antimalarial drugs, insecticidal nets, and other medical support.
African countries have benefitted from customizing China’s 1-3-7 strategy to local conditions. From 2016-2018, China helped Tanzania by adapting its strategy to 1-7 taking into account the country’s unique features. This resulted in an 80% reduction in malaria cases in a high-burden district. The 1-3-7 Chinese model of fighting malaria is also being implemented in other African countries, including Burkina Faso, Senegal, and Zambia.
Beyond the 1-3-7 strategy, Chinese experts have developed other novel solutions that are being applied in Africa. In Sao Tome and Principe, a Chinese expert team devised a strategy of mass drug administration (MDA), whereby residents simultaneously took Artequick (a Chinese-developed drug made of artemisinin, piperaquine, and a small dose of primaquine) to flush out malaria parasites. Malaria incidence dropped from 60% to 3% in the towns near the capital Sao Tome under the MDA pilot project. This groundbreaking strategy has also proved effective in Comoros and other African countries.
Amplified roles in combating global malaria efforts for Chinese pharmaceutical enterprises
In parallel with bilateral cooperation efforts, Chinese pharmaceutical enterprises have increased R&D, production, and supply of antimalaria drugs and equipment, as well as the provision of personnel training and other technical support to Africa’s public health systems. Below are several examples of such developments that have helped to bring a positive impact on global malaria efforts:
- Fosun Pharma currently has thirty products that have passed the WHO prequalification, making it the world’s largest manufacturer of antimalarial drugs to pass prequalification.
- The long-lasting insecticidal mosquito net produced by Tianjin Yorkool is the first pesticide formulation product in China to be approved by the international standard of the Joint Meeting on Pesticide Specifications (JMPS) of the WHO and the Food and Agriculture Organization (FAO). It has also been listed in the UN procurement catalogue.
- Kunming Pharmaceutical Group is the largest Artemisia planter in China and the largest antimalarial drug supplier in the world.
- Fosun Pharma has become a supplier of antimalarial drugs to the Global Fund, UNICEF, the WHO, and drug purchase centers in African countries. By the end of 2021, it supplied more than 200 million artesunates for injection in the international market, saving more than 48 million patients with severe malaria.
- Shanghai Pharmaceutical has invested in and built factories in Sudan since the 1990s. Its antibiotic drugs and artemisinin series of antimalarial products are sold locally and exported to other African countries.
- Yorkool has become one of the world’s largest suppliers of new anti-malaria, insecticide, and mosquito nets, with a global market share of more than 10%. It is the only cooperative supplier designated by the WHO and the Global Fund in China. After completing its production base in Cangzhou, it is expected that their annual output of long-term insecticide mosquito nets will reach 50 million and become the world’s largest mosquito net production base.
On August 18, 2018, during the high-level conference on China-Africa Health Cooperation and the Third Beijing Health Conference, Fosun Pharma donated artemisinin antimalarial drugs worth USD 240,000 to the Ministry of Health of Zambia | Source: 中国网
- In 2017, Fosun Pharma acquired Tridem Pharma, a French drug distribution company, to carry out local registration and import distribution and marketing of pharmaceutical products in Africa.
- Tridem Pharma’s business currently covers 35 African countries, nearly 90% of the continent. In October 2021, Tridem Pharma’s first African regional drug distribution center opened in Côte d’Ivoire, helping to improve the supply capacity of medical and health products. This project helped simplify the supply process, ensure the safety of the supply chain, reduce the risk of drug shortages, and start prompt emergency responses to help countries in the region deal with public health crises.
4. Training and technical support
- Kunming Pharmaceutical Group, Fosun Pharma, and other enterprises have hosted antimalaria training courses for developing countries held by the Chinese Ministry of Commerce and other departments. These courses promoted exchange at the technical level and built trust between scientists and health professionals.
- Fosun Guilin Nanyang Pharmaceutical and the African Collaborating Center for Pharmacovigilance (ACC) worked together to strategically conduct post-market safety evaluations of antimalarial drugs and other infectious diseases.
How can Chinese pharmaceutical enterprises increase their roles in global malaria efforts?
While Chinese pharmaceutical enterprises’ role in combatting malaria in Africa has increased, challenges remain. The two most significant gaps include:
1. A huge potential for more Chinese products to be WHO prequalified
Although China has proved its ability to produce high-quality and low-cost health intervention tools on a large scale, only a select number of Chinese pharmaceuticals have passed WHO prequalification and obtained access to the UN and other multilaterals organization’s procurement list.
For example, although Chinese scientists successfully developed finished artemisinin products, only 3% to 5% of the global market supply is made in China. For comparison, in 2009 alone, Indian pharmaceuticals managed to take more than 15 million people’s worth of market shares of the Coartem drug from Novartis through the production of prequalified generics.
The number of prequalified products made in China also needs to be improved in the field of rapid detection reagents, mosquito nets, and other products. The Bill & Melinda Gates Foundation (BMGF) is attempting to play a more influential role in helping Chinese medical products pass the WHO prequalification. A BMGF program officer told the media last June that the foundation was supporting seven antimalarial products from five Chinese enterprises to pass WHO prequalification by 2024.
2. Lack of participation in global advocacy efforts
Chinese pharmaceutical enterprises are grossly underrepresented in international fora. Tridem Pharma (acquired by Fosun Pharma), for example, was the only Chinese enterprise participant at the Kigali Summit on Malaria and NTDs in June. Chinese pharmaceutical enterprises generally lack strong external policy-related communications and advocacy around specific infectious disease issues. Compared to other European and American pharmaceutical giants like Pfizer, Novartis, GlaxoSmithKline, the scale of Chinese pharmaceutical enterprise involvement in global health fora remains small.
In contrast, Eisai, a Japanese pharmaceutical company with similar sales volume to China’s top pharmaceuticals, was able to participate in the Kigali Summit actively. On top of this, the company aligned its vision with the London Declaration and provided high-quality diethylcarbamazine (DEC) free of charge for lymphatic filariasis elimination campaigns worldwide.
Announcement of the London Declaration. Participants include Margaret Chan, former WHO Director-General, Bill Gates, Co-Chairman of the Gates Foundation, and Haruo Naito, President, and CEO of Eisai | Source: Eisai
The ability of companies to participate in and provide expertise on key health issues is instrumental in gaining access to higher-level resources at a relatively low cost, building a positive international image, and creating more favorable conditions for their products to enter a broader market.
Chinese pharmaceutical enterprises, especially those that have carried out medical and health cooperation in Africa, must broaden their international horizons and actively seek collaboration with multilateral organizations or frameworks, such as the Global Fund and the Uniting to Combat NTDs.
Simultaneously, the Chinese government can help to raise awareness and facilitate further cooperation between the private sector, international organizations, civil society organizations, think tanks, and the media on how to leverage the potential of Chinese pharmaceutical enterprises in anti-malaria initiatives. Doing so will present improved opportunities to achieve China’s global health ambitions and – for this specific issue of high concern – to afford other developing countries with increased tools, drugs, and expertise so that they also can have a malaria-free success story to tell.
About The Authors
Shen Li is the Associate Director for press relations and communication at Bridge. With her 10 plus years of working experience in state-owned media, Shen Li is keen to help clients enhance their influence on social media with customized and innovative communication strategies.
Alex Henderson is a Senior Associate at Bridge. He has 9 years of experience in foreign affairs and international cooperation. He is passionate about enhancing positive relations and collaboration between stakeholders that seek to bring positive change into the world. Find Alex on LinkedIn.