How Africa became the world's most important market for artemisinin-based malaria treatments — yet captures almost none of the value from the plant it farms

Africa's Bitter Medicine: The Continent That Grows the Cure but Buys the Drug

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Africa carries the heaviest disease burden of any region on earth. It accounts for 25% of the global disease burden despite holding just 18% of the world's population. Of all the diseases that define that burden, none is more concentrated on the continent than malaria. In 2023,

there were an estimated 263 million malaria cases worldwide, with 94% of them occurring in the WHO African Region. Malaria-related deaths were estimated at 597,000, with 95% of them occurring in sub-Saharan Africa.

The primary weapon against malaria is artemisinin — a compound derived from the plant Artemisia annua, commonly known as sweet wormwood. The story of how Africa grows this plant, ships it abroad, and then buys it back as an expensive finished medicine is one of the most striking examples of value extraction on the continent. It is also one of the most urgent commercial and public health arguments for African agro-processing and pharmaceutical investment.

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## **The Scale of the Market**

Global annual demand for Artemisia annua leaves currently stands at an estimated

25,000–26,000 tonnes, yielding approximately 420–430 tonnes of artemisinin.

The pharmaceutical value chain built on that raw material is considerable:

the global artemisinin market was valued at $1.2 billion in 2025, projected to reach $2.3 billion by 2034 at a CAGR of 7.5%.

Every single tonne of artemisinin demand is ultimately driven by Africa's malaria burden. Yet Africa currently holds only around

2% of the global artemisinin market by revenue — estimated at $1.3 million in 2024.

The continent consumes the product in enormous volumes but produces virtually none of it at a commercial pharmaceutical level.

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## **What Africa Imports — and What It Pays**

The pharmaceutical import dependency of Africa is staggering.

Ninety-five per cent of all medicines used in Africa are imported, and the continent accounts for just 3% of all medicine production globally.

For active pharmaceutical ingredients (APIs) — the core compounds that make medicines work — the situation is even more extreme.

Africa imports over 95% of its active pharmaceutical ingredients, mainly from India and China. Importing them makes local production expensive and vulnerable to foreign pricing.

As of 2019, as much as 70 to 90 percent of the drugs consumed in sub-Saharan Africa's estimated $14 billion pharmaceutical market were imported, with Africa sourcing more than 75% of its pharmaceutical imports from the European Union, India, and China.

For antimalarials specifically, the picture is equally revealing.

Africa imports up to 80% of its pharmaceutical needs. Of the 375 medicine producers in the region, only six manufacture drugs to WHO prequalification standards. The rest are constrained by underinvestment, infrastructure limitations, and regulatory challenges.

The human cost of this dependency is compounded by the commercial cost.

Heavy importation of drugs inflates final prices in pharmacies and hospitals due to shipping, tariffs, currency fluctuations, and distributor margins.

For malaria treatments that are needed at volume across populations where disposable income is extremely limited, this pricing premium costs lives.

Treatment of malaria in children with ACT is low in sub-Saharan Africa, with just over half of children — 56% — treated with anti-malarial drugs receiving the first-line treatment ACT in 2023. In West and Central Africa in particular, ACT treatment is alarmingly low, approximately half that of Eastern and Southern Africa — 45% versus 79%.

The gap between what is recommended and what is actually administered reflects not just health system weakness, but the price barrier created by import dependency.

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## **The Paradox: Africa Grows the Plant**

Here is the central paradox. Artemisia annua thrives in African soil.

In Africa, Artemisia has been introduced for cultivation in Cameroon, Ethiopia, Kenya, Mozambique, Tanzania, Uganda, and Zambia — all in high-altitude regions with a pronounced cool period. Commercial production of Artemisia in Africa has largely been centred in Kenya and Tanzania. In East Africa, yields average 2.5 tonnes per hectare.

Over the last thirty years, it has been planted widely across East Africa and Madagascar — including Kenya, Madagascar, Ethiopia, and Tanzania — Central Africa including Burundi, Cameroon, DRC, Rwanda, Sudan, and Uganda, and West Africa including Burkina Faso, Gambia, Mali, Nigeria, Senegal, and Togo.

East Africa has in fact become the world's third largest growing region for Artemisia annua.

Although not native to the region, East Africa "is now the third most important growing region in the world" after China and Vietnam. Cultivation in Kenya alone now supports at least 4,000 smallholder farmers growing more than 4,000 hectares of the cash crop.

The raw material is African. The farmers are African. The land is African. But the processing, extraction, formulation, and pharmaceutical manufacturing happen elsewhere — primarily in China and India.

Chinese companies mainly provide APIs for foreign pharmaceutical companies to produce final dosages and account for 85% of the world market.

Africa grows the ingredient. Asia makes the medicine. Africa buys it back.

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## **Who Is Leading in Africa**

Within Africa, Kenya has been the most commercially advanced.

The planted area in East Africa was principally in Kenya — nearly 65% — followed by Uganda at 19% and Tanzania at over 19%. Both small and large farms were involved.

The commercial infrastructure built around Artemisia in Kenya includes Botanical Extracts EPZ Limited (BEEPZ) and African Artemisia Ltd. in Tanzania — contract farming operations that supply dried leaf for extraction.

North Africa hosts the largest share of pharmaceutical manufacturers in Africa, with about 270 firms in 2024, most of them in Egypt. Nigeria dominates West Africa, Kenya leads in East Africa, and South Africa is the main hub for Central and Southern Africa.

However, a critical structural flaw persists across all of these hubs.

Most African producers operate at the lower end of the value chain. They do not manufacture active pharmaceutical ingredients. Instead, they import APIs, mostly from Asia, and carry out local formulation and packaging. This model puts African pharmaceutical manufacturers at a disadvantage as most of the value in the industry lies upstream in API production.

Nigeria has made specific moves to change this.

Emzor Pharmaceuticals announced plans to build a facility to produce APIs, with a special focus on antimalarials. Emzor is also the only African-based producer to manufacture misoprostol, an essential maternal health medicine, on the continent.

In November 2024,

USAID announced a commitment to procure 4.8 million doses of life-saving malaria tablets from Nigerian pharmaceutical leader Swipha.

These are meaningful steps, but they remain exceptions in a continent-wide landscape of formulation-only manufacturing.

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## **The Boom-and-Bust Problem**

One of the defining structural weaknesses of the current global artemisinin supply chain is price volatility.

Artemisia annua and artemisinin prices have fluctuated significantly over the past five years, creating a boom-and-bust cycle where demand and supply oscillate inversely. Manufacturers tend to keep low inventory, which limits their ability to respond to demand fluctuations. Over 2022 to 2024, artemisinin prices were below cost, prompting manufacturers to store artemisinin.

Artemisinin prices have ranged from as low as $109 to as high as $231 per kilogram within a five-year period. For African smallholder farmers contracted to grow Artemisia annua, this volatility translates directly into income instability — suppressing investment and long-term commitment to cultivation. It also reflects the core problem: African farmers bear the agricultural risk of the supply chain without participating in the pharmaceutical value added at the end of it.

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## **The Emerging Resistance Threat and What It Means for Supply**

A new dimension of urgency is entering this picture.

In recent years, there have been reports from Africa of emerging parasite resistance to artemisinin — the core compound of the best available medicines to treat malaria. Parasite resistance to artemisinin has been identified in notable areas including Eritrea, Rwanda, and Uganda.

Under a scenario of widespread resistance to both artemisinin and a partner drug, modelling estimates there would be 16 million more malaria cases each year, around 360,000 more severe cases requiring hospitalisation, and nearly 80,000 additional malaria deaths annually. The yearly economic impact across the African continent was estimated at US$1 billion.

This threat amplifies the case for African-led pharmaceutical development — not just production of existing ACTs, but research, development, and investment in next-generation formulations rooted in African scientific capacity.

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## **The Opportunity: What Africa Could Capture**

The strategic opportunity is clear and substantial. The global artemisinin market is projected to grow from $1.2 billion in 2025 to $2.3 billion by 2034. Africa grows the raw material. Africa is the primary end market. Yet Africa captures under 2% of the market value today.

The full value chain — from cultivation to extraction, API production, formulation, and finished medicine distribution — represents an integrated industrial opportunity that sits squarely within the continent's existing agricultural base. The land is ready. The climate is suited. The farmers already exist. What is missing is extraction infrastructure, API manufacturing investment, regulatory harmonisation, and capital.

African countries face significant budget gaps requiring urgent resource mobilisation. The Global Fund identified that Member States require at least $1.5 billion USD just to sustain existing levels of malaria interventions between 2024 and 2026. Another $5.2 billion is needed annually for the continent to make progress towards elimination.

That capital requirement, viewed differently, is an investment pipeline — one that impact investors, development finance institutions, and African governments have every commercial and moral reason to mobilise.

The COVID-19 pandemic already made the case by force.

Major medicines exporting countries such as China and India imposed export restrictions to prioritise domestic needs. This left African manufacturers unable to source critical ingredients and medicines, causing many local pharmaceutical operations to stall.

Africa cannot afford to let that happen again with malaria — the disease that kills more of its children than any other.

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## **Conclusion**

The Artemisia annua story is Africa's pharmaceutical paradox in miniature. The continent hosts the disease, grows the plant, and buys the finished cure — at a price set in Mumbai and Shanghai. The land, the labour, the climate, and the demand are all African. The processing and the profit are not.

Changing this requires investment in extraction and API manufacturing infrastructure, policy frameworks that incentivise local value addition over raw leaf export, and continental regulatory harmonisation that gives African-made medicines access to the full 54-country market. AfCFTA provides the legal architecture. The climate provides the agronomic foundation. The malaria burden provides the demand. What is now required is the will to retain the value.

Africa does not need to keep buying back its own medicine. It needs to make it.

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*Africa Brew Brief | RIC Brands — RIC Brands' intelligence platform tracking African agribusiness, coffee trade, and origin stories. Follow the brief: https://share.google/vnz8ZqMf6ujiKPr4j | wilbert@ricbrands.com*