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STANFORD GRADUATE SCHOOL OF BUSINESS — Each day in Tanzania, 220 people — most of them children — die of complications from malaria, a curable disease. In part those deaths occur because health facilities in extremely rural areas throughout sub-Saharan Africa have immense problems keeping the anti-malarial drugs in stock.

That reality is unacceptable to Silvio Gabriel, an executive with Novartis Pharma AG, who is leading the international drug company’s charge to eradicate malaria worldwide.

Gabriel, executive vice president and head of the Malaria Initiative at Swiss-based Novartis, spearheaded a pilot project enabling Tanzanian public health workers to keep ample supplies of lifesaving anti-malaria drugs on hand at their medical clinics using cell phone text messaging alerts. The effort has dramatically reduced occurrences of the mosquito-borne illness, even in the African nation’s most remote regions.

Gabriel described the program, SMS for Life, and other campaigns designed to abolish malaria during a talk at the Stanford Graduate School of Business on March 3.

“This is just one example to show what we are doing beyond just bringing the products to the patients in need,” he told the student audience during a talk sponsored by the student Health Care Club and Center for Global Business and the Economy. “If you want, you can call this corporate social responsibility.”

When Novartis founded the SMS For Life test program in 2009, about 78% of the 129 rural public health clinics in Tanzania serving 1.2 million people had no anti-malarial drugs in stock. By the program’s end, only 26% were without. According to the program’s planners, the new system meant 880,000 people in the three pilot districts had access to anti-malarial medicines when the program ended, compared to only 264,000 people at the start.

“I think the important part is we reach a lot of patients,” said Gabriel. “This makes me think every morning to go and say, ‘Let’s do the right things for the millions of patients that are waiting for our product.’”

Cell phones are an integral part of the program Novartis tested. Each week, the system sent out automated text messages to public health care facility staff, prompting them to reply with a detailed tally of the amount of anti-malaria medications they had in stock. With that information, district medical officers could re-distribute lifesaving treatments where they were needed and coordinate emergency deliveries to health facilities in areas that were experiencing malaria outbreaks.

Solving the problem of access is only part of the solution to reducing malaria-related deaths, said Gabriel. Keeping costs down is also key. “If it’s not affordable, it doesn’t work. These are the factors which give us the biggest challenges,” he said.

When it was approved in Switzerland in 2001, Novartis’ prescription anti-malaria treatment Coartem became the most effective on the market, curing 99% of cases within 3 days even in people where the malaria parasite circulating in their bloodstreams had developed resistance to other drugs.

Demand for the drug grew exponentially after a research study published in the journal Lancet showed the drug’s dramatic effectiveness, according to Novartis, which co-developed the drug in collaboration with Chinese partners who supply the active ingredients.

To get the medicine to patients, Novartis and its Chinese partners had to complete one of the largest and fastest scale-ups in the industry in order to go from supplying 4 million treatments in 2004 to 82 million treatments last year, Gabriel said.

To keep up with escalating demand for the drug, Novartis invested heavily to expand its manufacturing infrastructure and diversified production of the supplier base for the production of raw materials, including the drug’s natural ingredient, Artemisinin, which is naturally found in China in the Sweet Wormwood plant. The company also transitioned from a supply system largely dependent on gathering the plant in the wild to commercial plantation cultivation. Since 2005, significant amounts of Artemisinin have been produced in Africa, according to the journal RxPG News.

All that production process streamlining enabled Novartis to lower its price to government clinics of the three-day treatment pack of Coartem from about $1.57 in 1997 to around 76 cents today, Gabriel said. That amount represents the company’s cost.

The company also released a cherry-flavored liquid for children. Some of the medicines come in packaging to explain dosages for adults that cannot read, designed to make sure they take the medication properly.

To obtain funding to buy the product, nations turn to the Global Fund to Fight AIDS, Tuberculosis and Malaria, a public/private partnership based in Switzerland.

Gabriel explained why Novartis sells the drug at cost to governments and others: ‘We want to give our knowledge, our expertise, our best employees to do something which doesn’t give a profit. You need to do things that don’t put profit first.’

— Michele Chandler

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