Super-Resistant Malaria Strains Likely Without Global Subsidies
Of Critical New Therapies, According To New Study In Health Af-
fairs
----------------------------------------------------------------
http://www.healthaffairs.org
09 Mar 2006
Subsidies for the costs of artemisinin combination treatments
for malaria are needed immediately to prevent the emergence of a
malaria superbug, finds a new study released today in the
March/April issue of Health Affairs. It warns that failure to
provide this support could allow the malaria parasite to become
resistant to all known treatments, possibly by the end of the
decade.
The malaria parasite already has defeated previously effective
treatments, contributing to a global resurgence in malaria. Now
there is fear that one of the most effective drugs ever devel-
oped for malaria, artemisinin, could suffer the same fate.
Health experts have sought to avert a multi-drug resistant form
of malaria by insisting that artemisinin be administered in com-
bination with other malaria drugs. By presenting two drug tar-
gets instead of one, this tack frustrates the parasite's ability
to develop resistance. But in malaria-endemic countries, so-
called "Artemisinin Combination Therapies," or ACTs, are largely
unaffordable.
"Our results indicate that a subsidy is needed sooner rather
than later because cost and availability issues are prompting
people in malaria-endemic countries to misuse artemisinin as
monotherapy. This is likely to speed up development of resis-
tance," said lead author Ramanan Laxminarayan, of the Washing-
ton, D.C.-based Resources for the Future. "Even delaying the
subsidy by a few years would accelerate resistance and could
leave us with no effective drugs against a disease that already
kills millions each year-most of them children in sub-Saharan
Africa."
The malaria study is one of many articles in the journal's
March/April issue offering insights into a range of policy op-
tions on global health dilemmas. Together with a March 7 brief-
ing in Washington, D.C., the new Health Affairs issue launches
an aggressive, long-term initiative, funded by the Bill &
Melinda Gates Foundation, to focus more attention on global
health policy research.
The Laxminarayan study argues that subsides should be used to
make combination therapies as affordable as "monotherapies"-or
single drugs-and, moreover, to assure that at least two types of
low-cost ACTs are widely available. According to the authors,
this latter finding-that distributing more than one type of ACT
is also essential to avoiding a rapid proliferation of drug-
resistant parasites-shows that the predominant "idea of using
the same ACT combination worldwide deserves serious reconsidera-
tion."
The authors find that immediate subsidies of up to $1 per dose
for two different types of ACTs could reduce patient costs to as
little as US 30 cents per dose. This would make the therapies
affordable and significantly delay the emergence of drug resis-
tance, buying time for the development of new therapies and vac-
cines. In addition, the subsidies could immediately save many
thousands of lives every year.
Serving as co-authors on the study, funded by the Roll Back Ma-
laria partnership, were Mead Over, a senior economist at the
World Bank, and David L. Smith, a staff scientist at the U.S.
National Institutes of Health Fogarty International Center.
Health Affairs, published by Project HOPE, is a bimonthly mul-
tidisciplinary journal devoted to publishing the leading edge in
health policy thought and research. Copies of the March/April
2006 issue will be provided free to interested members of the
press. Address inquiries to Christopher Fleming at Health Af-
fairs, Tel. + 1-301-347-3944, or via e-mail:
mailto:press@healthaffairs.org
Selected articles from the March/April 2006 issue are available
free on the journal's Web site http://www.healthaffairs.org
--
Leela McCullough, Ed.D.
Director of Information Services
SATELLIFE
30 California Street, Watertown, MA 02472, USA
Tel: +1-617-926-9400
Fax: +1-617-926-1212
mailto:leela@healthnet.org
http://www.healthnet.org