E-DRUG: Guardian: We're losing the malaria battle!
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[Malaria is not rolling back.... Here a story from mounting pressure in the
UK to change the donor policy to shift from CQ/SP to artemisinine-based
combination products. Copied as fair use. WB]
http://www.guardian.co.uk/life/feature/story/0,13026,1229673,00.html
We're losing the malaria battle
A Chinese plant extract offers hope, but only if Britain is prepared to act
decisively, writes Sarah Boseley
Sarah Boseley
Thursday June 3, 2004
The Guardian
While the fight to get Aids drugs to people in Africa has been noisy and
relatively high-profile, the struggle for effective treatment for an older
killer has been going on in a largely subdued fashion in the background.
Malaria kills more than a million people every year, most of them children
under five. Unlike Aids, there are drugs to cure it. Yet the World Health
Organisation's big campaign launched in 1998 to halve malaria deaths by 2010
is not working. More people are dying.
Lack of will, shortages of money and logistical difficulties have all played
a part in the failures of the campaign, Roll Back Malaria. But the biggest
problem of all now is the nature of the parasite that causes the disease
when it is transmitted to humans by the bite of the anopheles mosquito. It
has shown an unnerving ability to evolve, building resistance to the drugs
used against it with alarming rapidity.
Chloroquine, the drug that used to be first-line treatment in Africa, looked
like the perfect anti-malarial when it was developed in 1934. It is very
cheap, easy to administer and has no side-effects, unlike quinine which is
truly horrible to take and can cause temporary deafness and tinnitus. But
chloroquine is now virtually useless and the second-line drug, sulfadoxine
pyrimethamine (known as SP or by its brand name Fansidar) is failing fast.
In many parts of Africa resistance to chloroquine has reached 90%.
The British National Formulary - the drug bible for healthcare
professionals - states unequivocally that in most parts of the world the
malaria parasite "is now resistant to chloroquine which should not therefore
be given for treatment". Resistance to the newer SP has now reached 60% in
parts of Burundi and Uganda.
In the past six months there has been a concerted effort by malaria experts
and campaigners to speed the introduction of new drug combinations using
derivatives of the Chinese plant artemesia, which has long been used in Asia
against malaria. They have shown excellent results in trials.
The new drugs are 10 times as expensive as the old, but useless drugs cost
lives. An article by malaria experts led by Amir Attaran, of the Royal
Institute of International Affairs in London, in the Lancet medical journal
in January caused uproar when it accused the World Health Organisation and
the UN's Global Fund for Aids, tuberculosis and malaria of "medical
malpractice" for continuing to pay for chloroquine and SP. But the article
appears to have focused minds.
Most donor countries and international organisations now accept that the
ACTs (artemisinin-based combination therapy) are the only way forward in
spite of the price. USAID and Unicef are on board, says the volunteer
doctors' organisation Medecins Sans Fronti�res, but they accuse one
government of dragging its feet: ours.
"What we're finding quite difficult with DFID (the department for
international development) is that they won't make a policy," says Christa
Hook, an Edinburgh-based doctor who works on MSF's malaria programme.
"They say that they just respond to what the country asks for. This is very
frustrating because we know from what countries tell us that they do not put
forward the possibility of better treatment. It is not enough to say
somebody asks us for drug X so we give it."
She cites Uganda as an example. DFID has been funding programmes there for
four years, using chloroquine together with SP, even though there is a
resistance problem with chloroquine on its own and in combination. If the
Ugandan government is now recognising it needs to switch to ACTs, it is not
because of advice from DFID, says MSF. DFID doesn't see a problem in failing
to be proactive. "We support countries in making their own decisions on
national drug strategies," says a spokeswoman.
So far there is no resistance to the artemisinin drugs, and to preserve
their efficacy as long as possible the WHO recommends that they should be
used in combinations with other drugs. That way they hit different
biochemical targets of the parasite.
Resistance will eventually build - that is the nature of evolution - but it
is not expected to happen fast. "There are some drugs to which resistance
grows very slowly," says Dr Hook.
"Quinine is a good example. Like quinine, these drugs have a plant-based
complexity which may be helpful. And if you have a very short half-life, it
stops resistance building. Artemisins have the shortest half-life of any
malaria drugs." This means that they are cleared quickly from the body. It
also means they need to be taken for seven days, but in combination, the
treatment can be effective within three.
If ACTs are to be widely used, then farmers need to start planting.
Artemesia grows easily in Vietnam, but widespread cultivation won't happen
until the farmers are sure of their market, which is another reason why the
malaria experts want governments and institutions to make commitments.
All those involved are frustrated at the failure even to slow malaria down.
Medicines for Malaria, the non-profit foundation that is directing efforts
from pharmaceutical companies into artemisinin-derived and other malaria
drugs, points out that it is "both a cause and a result of poverty and a
major constraint to economic development", costing Africa $12bn a year in
lost GDP.
Those sort of sums make the amounts needed to pay for ACTs seem like pocket
money.
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