Abstract
Transition studies have started to focus on market formation in innovation systems. This article investigates market formation in a global health transition that was instigated by drug-resistant malaria. We explore how markets for Artemisinin-based Combination Therapies (ACT) in the Greater Mekong Subregion (GMS) were formed at multiple geographical scales and locations. The study reveals the role of public institutes, academia and partnerships in early innovation system development. It demonstrates how transnational organizations created a supportive global landscape for ACT development and deployment. It then reveals how these advancements led to the formation of public-sector and private-sector ACT markets in the GMS. We illustrate how market formation activities took place on global, national and local scales and how structural couplings enabled the functioning of this global innovation system. The lessons learned are particularly relevant now that drug-resistant malaria has once more emerged in the GMS, urgently calling for new therapies and associated end-user markets.
Highlights
Malaria is a poverty-related infectious disease caused by plasmodium parasites
Our study demonstrated that structural couplings in a global health transition span across different geographical scales and can take several forms, including product-development partnerships (DNDi, Medicines for Malaria Venture (MMV)), regulatory arrangements (WHO pre-qualification scheme), subsidy programs (GFATM/AMFm subsidies), and programmatic initiatives (VMW, Public-Private Mix (PPM))
We showed how the pressure of drug resistance led to the discovery of artemisinin, a new class of antimalarial therapies, and how public institutes, academia and partnerships contributed to the early development of the innovation system
Summary
Malaria is a poverty-related infectious disease caused by plasmodium parasites. the global malaria burden has been significantly reduced in the last decades, the disease still takes nearly half a million lives a year (WHO, 2018). One important contributor to the reduced malaria burden has been the global transition from conventional monotherapies to Artemisinin-based Combination Therapies (ACT). The situation even worsened when multidrug resistance spread further to India and Africa, resulting in dramatic increases in global malaria morbidity and mortality (Packard, 2014; Trape, 2001). Despite this emerging health crisis the global uptake of ACT was slow and for years, patients were treated with outdated, substandard or even counterfeit medicines (Bosman and Mendis, 2007; Dondorp et al, 2004; Newton et al, 2006; O’Connell et al, 2011). The formation of markets for this life-saving class of therapies required the establishment of new institutional, regulatory and financial arrangements
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