Semi-synthetic artemisinin

The effort to diversify the artemisinin supply to increase access to lifesaving treatments

In most malaria-endemic countries, the primary treatment for malaria is artemisinin-based combination therapy (ACT)—reliable access to which is critical for malaria patients. To keep this lifesaving treatment accessible, a stable and resilient supply chain is vital. However, the vegetal supply of artemisinin, the key starting material for these treatments, is vulnerable to several risks, including:

Price volatility, common in commodity markets like oil, for example, that could hurt the ability of manufacturers to keep the supply of ACTs stable, affordable, and available to patients globally.
Weather- and climate-related risks that can impact artemisia annua crops, the plant that vegetal artemisinin is derived from, which threatens the ability of manufacturers to meet demand affordably and reliably.
Production concentrated largely in one country, which yields 97% of all artemisinin used in global health supply chains.

Since 2022, PATH has led an effort to understand the current state of the market for vegetal artemisinin and semi-synthetic artemisinin (SSA), a non-vegetal artemisinin, within the antimalarial commodity market and advocate for a diversified artemisinin supply made up of a mix of SSA and vegetal artemisinin.

The opportunity to build a resilient antimalarial supply chain

SSA is a potential solution to the market and supply chain challenges associated with vegetal artemisinin because:

It can help mitigate the risks posed by the geographic concentration of vegetal artemisinin production as it is not dependent on crop yields, contributing to a more secure supply chain.
It is not vulnerable to weather- and climate-induced disruptions, enabling stable sourcing even as extreme weather events and other challenges of a changing climate persist.
It could create opportunities to support the sustainable local production of this essential medicine in communities that need it most, by transferring technology to regional manufacturers.

Overcoming the barriers hindering the adoption of semi-synthetic artemisinin

Ensuring a diversified artemisinin supply made up of a mix of SSA and vegetal artemisinin is critical in anticipation of an unpredictable crisis for the reasons outlined above. Additionally, it is important to note that SSA cannot be immediately procured at a moment’s notice due to relatively long production timelines. Therefore, dependable demand is necessary to ensure production lines remain active and SSA is available when needed. This is like fire insurance, you need to have it before your house is on fire.

However, manufacturers of ACTs have been slow to adopt SSA for use in their products. Even though vegetal artemisinin prices have been historically volatile, PATH has received consistent feedback in conversations with manufacturers that the current incentives to use SSA cannot sufficiently overcome the current price gap between SSA and vegetal artemisinin, preventing the diversification of their artemisinin supply.

To overcome these barriers, PATH advocates for increased collaboration, commitment, and sharing of responsibilities between international agencies, manufacturers, and global procurers, as well as growth in the number of manufacturers that develop SSA to create more competition and lower prices. PATH has also developed market analyses of the artemisinin and ACT market to increase understanding of challenges faced in these markets and the role SSA can play to diversity supply chains.

Safe and affordable ACTs save the lives of millions of malaria patients—many of whom are children under the age of five—every year. Increasing the uptake of SSA has great potential to keep these lifesaving therapies accessible.