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Abstract Background This case study describes how a public-private partnership initiated to develop a new anti-malarial combination, ASAQ Winthrop, has evolved over time to address issues posed by its effective deployment in the field. Case description In 2002, DNDi created the FACT project to develop two fixed-dose combinations, artesunate-amodiaquine and artesunate-mefloquine, to meet the WHO anti-malarial treatment recommendations and international regulatory agencies approval standards. In 2002, Sanofi-aventis had started a development programme for a fixed-dose combination of artesunate and amodiaquine, to replace its co-blister combination. DNDi and sanofi-aventis joined forces in 2004, with the objective of developing within the shortest possible time frame a non-patented, affordable and easy to use fixed-dose combination of artesunate and amodiaquine adapted to the needs of patients, in particular, those of children. The partners developed Coarsucam®/Artesunate Amodiaquine Winthrop® ("ASAQ Winthrop") which was prequalified by the WHO in 2008. Additional partnerships have since been established by DNDi and sanofi-aventis to ensure: 1) the adoption of this new medicine by malaria-endemic countries, 2) its appropriate usage through a broad range of information tools, and 3) the monitoring of its safety and efficacy in the field through an innovative Risk Management Plan. Discussion and evaluation The partnership between DNDi and sanofi-aventis has enabled the development and pre-qualification of ASAQ Winthrop in a short timeframe. As a result of the multiple collaborations established by the two partners, as of late 2010, ASAQ Winthrop was registered in 30 sub-Saharan African countries and in India, with over 80 million treatments distributed in 21 countries. To date, 10 clinical studies, involving 3432 patients with ASAQ Winthrop were completed to document efficacy and safety issues identified in the Risk Management Plan. Conclusions The speed at which ASAQ Winthrop was adopted in the field shows that this drug fits the needs of patients and health authorities. It also demonstrates the power of partnerships that combine different sets of strengths and skills, and that evolve to include additional actors to meet new global health challenges for poverty-related diseases.

Objectives. Four hundred million people or more may be exposed to iodine deficiency worldwide, in developing countries in particular. Because of the practical problems with existing methods for the large-scale prevention of iodine deficiency, the authors developed a new approach to collective prophylaxis. Methods. This approach relies on the controlled diffusion of iodine into water from a silicone elastomer. Silicone matrices installed in a bore well released iodine at a rate sufficient to permit the daily per capita intake of at least 100 [Mu]g of iodine, the amount recommended by the World Health Organization. The matrices were tested over The year in a village in Mali, West Africa, an area in which goiter was highly endemic. The effects on the well water and population were compared with those of a placebo system in a control village. Result. An increase in urinary iodine levels was observed in the treated population, and after 12 months the incidence of goiter had fallen from 53.2% to 29.2%. ions. I new concept, adaptable to all sources of water supply, may contribute to the eradication of iodine deficiency. (Am J Public Health. 1993;83:540-545), Use of a silicon elastomer for the controlled release of iodine into drinking water may help prevent iodine deficiency diseases. Iodine deficiency disorders affect more than 400 million people and are especially devastating in developing countries. Existing methods for preventing iodine deficiency - iodization of salt, injections of iodinated oil and consumption of iodinated oil - are expensive and demanding. The device used for the controlled release is a silicon matrix containing the salt sodium iodide (NaI). Water penetrates the matrix, dissolving the salt and releasing it over a one-year period. In Mali, a device containing NaI was immersed in the well of a village of 107 people and a similar device without NaI was immersed in the well of a village of 94 people. After six months, the percent of the population in the village with the NaI device with severe iodine deficiency dropped from about 75% to zero. After 12 months, the incidence of goiter, an iodine deficiency disease, dropped from 53.2% to 29.2%. There were no changes in the village that did not receive the NaI device.

As a responsible player in the global pharmaceutical industry, Sanofi-Aventis recognizes its special responsibility to provide poor countries with access to drugs and vaccines. This is a key component of the Group's approach to sustainable development. As such, the Access to Medicines department draws on Sanofi-Aventis' expertise in order to address major public health issues, starting with the treatment of malaria, tuberculosis, sleeping sickness, leishmaniasis and epilepsy, as well as access to vaccines. The department has four main activities: research and development of new drugs; improvement of existing treatments; information, communication and education of patients and healthcare professionals; and development of a differential pricing and distribution policy adapted to patients' income, with a "no profit-no loss" equilibrium.