E-drug: Experts' letter to RBM: review the draft strategy for malaria
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Please find below the copy of a letter which was sent last Friday to
Roll Back Malaria, commenting on the third draft of "RBM Strategic
Orientations 2004-2008." pdf version available at:
http://www.accessmed-msf.org/prod/publications.asp?scntid=2122
0031011177&contenttype=PARA (url made need to repair)
"The new RBM strategy sacrifices life-saving treatment to narrow
cost-effectiveness considerations, and chooses instead to focus
mainly on prevention of malaria. Emphasizing prevention alone for
such a common killing disease will certainly not "roll back malaria".
We believe that "Rolling Back Malaria" is possible with effective
vector control and effective treatment, and that it is not the time to
abandon this important initiative. We call on the WHO for an urgent
and complete rethinking of the RBM 2004-08 strategy based on a
comprehensive review of available evidence and genuine expert
field experience. If RBM is truly committed to reducing the number
of deaths from malaria as soon as possible, it should strive to
provide technical support to assist countries to implement effective
diagnostic tools and widespread ACT use now, and push for
increased donor money to support this."
Looking forward how RBM is going to take these comments into
account in the review of the draft that should be taking place this
month...
Julia Double
Medecins sans Frontieres
Campaign for Access to Essential Medicines
Tel (direct): +41 22 849 84 03
Fax: +41 22 849 84 04
Email: julia.double@geneva.msf.org
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THE TIME TO ACT IS NOW
Dr. Fatoumata Nafo-Traore
Executive Secretary
Roll Back Malaria Partnership
Roll Back Malaria Secretariat
November 28, 2003
Dear Dr. Nafo-Traore,
As experts and health workers committed to improve health care in
the developing world, we are extremely concerned and alarmed by
the newly released draft Roll Back Malaria (RBM) guidelines for
2004-08, which represent a major backward step in malaria control.
Malaria is killing up to 2 million people every year, most of whom
are children in Africa. Despite best efforts to date, global control of
this lethal disease has failed, and infection and death rates are
rising.
Effective malaria control requires effective prevention and
treatment programmes. While the international community is
putting significant efforts to improve prevention measures,
treatment is becoming increasingly difficult because of loss of
inexpensive drugs (chloroquine and sulfadoxine-pyrimethamine
[SP]) to resistance. These drugs simply do not work now in much of
the malaria affected world.
In 2001 the World Health Organization (WHO) took the lead in
acknowledging the need to bring effective treatments to those
affected by epidemics of this devastating disease, advocating the
use of artemisinin-based combination therapy (ACT). It was also
recommended that any country changing national antimalarial drug
policy should change to ACTs. It is well established that ACTs are
the most rapidly and reliably effective antimalarial drugs. Increased
use of ACTs has led to a fall in drug prices; today it cost less than
$US 1 to save the life of a child with malaria using these drugs.
However, chloroquine and SP continue to be provided by donors
and still recommended in many African countries, leading to
avoidable death and wasted resources. These ineffective drugs are
often the only available antimalarials. There is an urgent and
pressing need to increase the availability of ACTs to replace these
failing drugs.
The new RBM strategy sacrifices life-saving treatment to narrow
cost-effectiveness considerations, and chooses instead to focus
mainly on prevention of malaria. Emphasizing prevention alone for
such a common killing disease will certainly not "roll back malaria".
It is widely accepted in the field of HIV/AIDS that there are medical,
macro-economic, social, moral, and ethical imperatives to provide
life-extending treatment to the 6 million people who are in need.
Why is malaria, which is so much easier to treat, any different?
RBM's guidelines set to reverse more than 5 years of consultation
and expert opinion in the field of global control of malaria. We
believe that "Rolling Back Malaria" is possible with effective vector
control and effective treatment, and that it is not the time to
abandon this important initiative. We call on the WHO for an urgent
and complete rethinking of the RBM 2004-08 strategy based on a
comprehensive review of available evidence and genuine expert
field experience. If RBM is truly committed to reducing the number
of deaths from malaria as soon as possible, it should strive to
provide technical support to assist countries to implement effective
diagnostic tools and widespread ACT use now, and push for
increased donor money to support this.
Sincerely,
Dr Abdullah Ali
Malaria Programme Manager
Zanzibar
Dr. Fred Binka
School of Public Health, University of Ghana
Ghana
Prof. Philippe Brasseur,
Institut de Recherche pour le Developpement
Senegal
Professor Oumar Gaye,
Coordinator of the RAOTAP1/WAMTN
West African antimalarial treatment network
Senegal
Dr. F. K. Kato,
Senior Medical Officer,
Malaria Control Programme, Ministry of Health, Kampala
Uganda.
Dr T.K. Mutabingwa
Chairman of EANMAT
Tanzania
Prof. Robert Snow
Head Malaria Public Health Group
KEMRI/Wellcome Trust Collaborative Program
Kenya
Dr. Fran�ois Nosten
Director
SMRU Shoklo Malaria Research Unit
Thailand
Prof. Nick White
Wellcome Trust Mahidol University Oxford Tropical Medicine
Research
Programme
Faculty of Tropical Medicine - Mahidol University, Bangkok
Thailand
Prof. Barry R. Bloom, PhD
Dean, Harvard School of Public Health
Professor of Immunology and Infectious Diseases
Harvard University
USA
Prof. Carol Hopkins Sibley,
Professor of Genome Sciences
University of Washington- Seattle
USA
Allan Rosenfield, MD
Dean, Mailman School of Public Health
DeLamar Professor of Public Health
Columbia University
USA
Ron Waldman, MD, MPH
Center for Global Health and Economic Development
Mailman School of Public Health
Columbia University
USA
Prof. Dyann Wirth, Ph.D.
Professor, Infectious Diseases, Department of Immunology and
Infectious
Diseases
Harvard University School of Publich Health
Director, Harvard Malaria Initiative
Harvard University
USA
Prof. Dr. Marleen Boelaert
Public Health Department
Prince Leopold Tropical Medicine Institute - Antwerpen
Belgium
Docteur Paolo Chiodini
Responsable des projets
CUAMM
Italy
Prof. Umberto D'Alessandro
Head Epidemiology Unit, Dept Parasitology
Institute Tropical Medicine - Antwerp,
Belgium
Pr Martin Danis
Parasitology, University Hospital Pitie-Salp�triere,
Pierre et Marie Curie-Paris 6 University
France
Dr Cristiana De Lorenzi
Alisei
Italy
Dr. Pierre Druilhe
Head of the BioMedical parasitology Unit
Institut Pasteur
France
Suzanne Fustukian
Lecturer, Centre for International Health Studies
Queen Margaret University College - Edinburgh
United Kingdom
Prof. Massimo Galli
Director of the Infectious Diseases Institute
University of Milan
Italy
Dr Philippe J Guerin
Scientific Director
Epicentre - Paris
France
Dr. Christa Hook
Malaria expert,
Medecins Sans Frontieres
United Kingdom
Prof. Giuseppe Ippolito
Scientific Director of the National Institute of Infectious Diseases
Lazzaro Spallanzani, Rome
Italy
Dr. Jean-Marie Kindermans
Malaria Access Campaign
Medecins Sans Frontieres
Belgium
Dr. Marina Madeo
Health Department coordinator
ONG COOPI
Italy
Prof. Mauro Moroni
Coordinator Infectious diseases department
L. Sacco Hospital, Milan
Italy
Dr. Bernard Pecoul
Director Access to medicines campaign
Medecins Sans Frontieres
Switzerland
Dr. W. M. Watkins
Wellcome Trust Fellow,
Department of Pharmacology & Therapeutics, University of
Liverpool
United Kingdom
Prof. Nick Anstey
Head, International Health Program
Menzies School of Health Research,
Darwin, Australia
Dr. Dave Durrheim, MPH&TM, DrPH
Associate Professor James Cook University
Head of School of Public Health and Tropical Medicine
and Director of the Anton Breinl Centre of Public Health and
Tropical
Medicine
Australia
Dr Ric Price
Senior Researcher - Menzies School of Health Research,
Darwin,
Australia
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