Extending the P4M model to other medicines

With the organisational capacity and resources necessary to add value to other agricultural products, the Poppy for Medicine project model would provide Afghan farming communities with significant opportunities for economic diversification.

Afghan medicine production factories: multipurpose tools for economic diversification

The model factory outlined in Appendix I would have the capacity to process up to twenty metric tons of raw poppy materials into morphine each year. However, as an additional security measure for the Poppy for Medicine projects, it is likely that the actual quantity of raw poppy materials processed into morphine each year would be significantly less than twenty tons. Limiting the quantity of raw materials to be processed, would allow the morphine processing time to be concentrated into the weeks immediately following the spring poppy harvest, thereby minimising the period of exposure in which the raw and semi-processed poppy materials could be diverted. The time required to process into morphine three metric tons, the quantity of raw materials that ten individual project communities could produce, would amount to just eight weeks (May-July).

Making best use of medicine processing factory capacity

As such, under the Poppy for Medicine project model, the manufacture of morphine medicines will only occupy less than a quarter of a factory’s operational time each year, leaving the factories available to add value to other agricultural products cultivated in the region throughout the rest of the year. Initial research suggests that it is possible to extend the Poppy for Medicine project model, and the medicine factory, to produce other plant-based medicines suited to the Afghan context.

This Economic Case Study investigates the possibility of producing Artemisinin, the active pharmaceutical ingredient in much-needed new malaria medicines, using the Poppy for Medicine project model. As with the local production of morphine, a model scenario is presented to shed light on the potential economic impact that the production of additional medicinal products would have on the communities and regions within which Poppy for Medicine projects would be implemented.

Artemisinin: a widely needed anti-malarial medicine

Malaria poses one of the greatest threats to human life in the developing world and can kill a child within 24 hours. As such, effective treatment needs to be accessible within hours of the onset of symptoms for both adults and children. However, the most effective malaria treatment medicines are too expensive for the majority of those who require them.

Since 2001 the World Health Organisation has recommended the use of artemisinin-based combination therapies (ACTs) to treat drug-resistant malaria. Artetemisinin is an active pharmaceutical ingredient from the plant Artemisia annua, a common wormwood that grows in many parts of the world, including Afghanistan. It has been estimated that there are approximately 500 million episodes of clinical malaria per year, the majority of which should ideally be treated with ATC, and a recent conference of malaria experts called for increases in the global production of Artemisinin.

Artemisia suited to Afghan agronomic and economic conditions

Artemisia annua L., the plant from which artemisinin is extracted, grows naturally in sunny, semi-arid nutrient-poor regions, the very agronomic conditions found in many parts of Afghanistan, particularly those regions within which poppy is cultivated. Grown in pH neutral to slightly alkaline soil, in terms of agricultural inputs Artemisia has similar fertilisation requirements to the poppy crop, and like poppy, Artemisia requires frequent light irrigations and significant weed control.

The cultivation of Artemisia is also suited to Afghan farming communities’ current economic conditions. As a low volume, high value crop, it is likely that A. annua can be successfully grown on the small plots of farmland prevalent in rural Afghanistan, without the need for additional labour inputs external to a farming family’s manual labour capacities.

Producing Artemisinin through Poppy for Medicine projects

The Poppy for Medicine project model is premised on the logic of rural Afghan communities cultivating and adding value to low-volume, high-value crops as a means of diversifying their economic activities away from poppy cultivation. Using the Poppy for Medicine project model to cultivate Artemisia as a cash crop would benefit Afghan farming communities by increasing the incomes of farmers not contracted to cultivate Poppy for Medicine in any one year; by diversifying the community’s economy; and by increasing returns on the initial investment in establishing the factory.

Artemisinin production cycle complementary to morphine production cycle

The growing and harvest cycle of Artemisia is complementary to the poppy to morphine processing cycle. Harvesting takes place in the summer – well after the harvesting of poppy crops in the springtime - and is completed within a month. This staggered harvest time provides an obvious practical product-management opportunity for the Poppy for Medicine processing factory, and with a few adjustments, the factory may be able to extract Artemisinin for sale on the international pharmaceutical market.

As with the local cultivation of Poppy for Medicine crops, farmers in an Artemisinin-producing project community would be contracted to grow Artemisia, and would use the project community’s Economic Diversification Fund to bulk-purchase seeds, fertilisers and other agricultural inputs, as well as any necessary harvesting equipment. The harvested crop would then be purchased from farmers by the project community for the production of Artemisinin.

Local production of medicinal products would benefit local communities and the Afghan Government

Processed in the local medicine factory, the Artemisinin extracted from project communities’ artemisia crops could be sold to the Afghan Government, and the profits recycled back into the communities through the Fund for Economic Diversification. As with the production of morphine through Poppy for Medicine projects, by operating as the ‘middleman’ in trading Artemisinin on the international market, the Afghan Government would benefit from the domestic production of medicinal products.

Artemisinin production scenario

  • 1 medicine factory services 10 Artemisinin projects of 20 small farms each, with an average of 0.37 ha per farm under Artesimia cultivation

  • These farms produce 185 metric tons in raw Artemisia materials

  • Purchased from the farmers at USD 400 per metric ton

  • Transformed into 1,110 kg of pure Artemisinin

  • Sold to the Afghan government for 250 per kg, in this model scenario these medicines would provide each project community with a cash injection of over USD 28,000

  • Afghan government sell these medicines to manufacturers of ACT for 300 per kilo