The Market for Artemisinin-Based Combination Therapies and the New Era of “Market Makers”

The pharmaceutical market is not tailored to cater the needs of patients who are located in the economically disadvantaged Southern countries, particularly in Sub-Saharan Africa. International organizations are working in numerous ways to overcome this challenge and to increase the access to medicines at affordable prices in the global South. They recommend and proscribe drugs, shape national policies, assure drug quality, provide funding and technical assistance, manage the supply chain, negotiate prices with manufacturers, decide who can compete and influence the behavior of competitors. Recently, some international organizations like Drugs for Neglected Diseases Initiative (DNDi) and Medicines for Malaria Venture (MMV) have successfully ventured into new drug development for tropical diseases. This has resulted in the evolution of complex relational dynamics and interdependencies between states, firms and international organizations. The structural power to bargain in such relationships often does not lie with states but rather with international organizations who create conditions under which firms would agree to invest in a particular venture. Thus, international organizations have acquired the role of "market makers" who not only convert the need for medicines into real demand but also shape the institutional environment for market functioning by setting up the rules of exchange for market transactions. However, this phenomenon is not well studied. In this regard, this study sheds light on the role of international organizations in the creation and functioning of the market for artemisinin-based combination therapies (ACTs) for malaria. It explains the role of WHO treatment guidelines in the global acceptance and legitimization of ACTs and WHO prequalification program in assuring quality. It further elaborates on the importance of donor funding, negotiation with manufacturers, the introduction of new ACT formulations to increase competition and stabilization of the supply of raw artemisinin on the reduction of treatment prices. It also explains how business strategies of firms are shaped by the action of international organizations.