E-DRUG: Malaria drug politics
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[some recent snippets from the BMJ on malaria and drugs issues;
copied as fair use. Maybe impregnated bednets (like condoms)
should be put on a new WHO Essential Devices List?? WB]
BMJ 2000;320:1228 ( 6 May )
African heads of state promise action against malaria
Gavin Yamey , BMJ
A pledge to halve Africa's malaria deaths by 2010 was signed by
more than 50 of the continent's heads of state last week. The
declaration was made at an international summit on malaria, in
Abuja, Nigeria, hosted jointly by the World Health Organization
(WHO) and the country's president, Olusegun Obasanjo.
The disease causes at least one million deaths worldwide each
year, of which 90% are in sub-Saharan Africa. The summit
coincided with the launch of the WHO's Roll-Back Malaria project
in Africa.
Opening the summit, Tim Menakaya, Nigeria's health minister,
said: "Malaria keeps societies poor, undermines development, and
reduces the incomes of families who are already the poorest in the
world. Every family in Africa pays a malaria tax." Previous efforts to
eradicate malaria in Africa, he said, have been "fragmented and
uncoordinated."
The main focus of the new control programme will be bed nets that
have been treated with insecticide. A recent Cochrane review found
that children who slept under treated bed nets were half as likely to
develop malaria as controls. David Alnwick, chief of health for
Unicef, said: "It is scandalous that 700000 children died last year
from malaria when a $4 (�2.50) bednet could have saved them."
The WHO wants a 30-fold increase in the availability of nets in the
next five years. It also wants every family at risk of malaria to have
immediate access to cheap and effective antimalarial combination
therapy, and every pregnant woman in high risk areas to receive
drug treatment.
The organisation believes that the pharmaceutical industry is willing
to lower the price of antimalarial drugs. David Nabarro, project
manager for Roll-Back Malaria, said: "Negotiating with industry is
now possible." But non-governmental agencies believe that the
industry's stronghold over drug patents prevents poor countries
from affording essential medicines (22 January, p 207).
Malarial control requires annual donations of $1bn (�0.6bn) from
industrialised countries (29 April, p 1161). But Jeffrey Sachs,
director of the Centre for International Development in Harvard, told
the summit that donations alone will be insufficient unless there is
immediate debt cancellation.
"It is a shame," Professor Sachs said, "that the [International
Monetary Fund] has asked Nigeria this year for $1.6bn in debt
service [repayment]. This is five times more than Nigeria's health
budget. These are funds needed to save lives." Only the Canadian
government made a firm promise in Abuja to cancel debt, although
Britain's Department for International Development stated the need
to "speed up" debt cancellation.
The World Bank claims that it donates $150m a year to African
malarial projects, and it has pledged a further $300-500m annually.
Professor Sachs was sceptical about their claims: "The $150m is
not in programmes I have seen, and there are no standalone
[malaria] programmes in Africa. The $300-500m is promising, and
we will now have to monitor them."
Responding to these criticisms, Ok Pannenborg of the World Bank
said: "There are 100 World Bank operations around Africa. The
$150m is money they can use, but whether they do is another
matter."
Details of the WHO's Roll-Back Malaria campaign are at
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BMJ 2000;320:1161 ( 29 April )
News
Control malaria to help defeat poverty, says WHO
Zosia Kmietowicz , London
Interventions against malaria could help to alleviate poverty in
countries where the disease is rife and could substantially boost
economic growth.
According to an analysis carried out by researchers at Harvard
University and the London School of Tropical Hygiene, malaria
knocks as much as 1.3% off the gross national product in regions
such as the Indian subcontinent, Sri Lanka, and sub-Saharan
Africa.
This is far higher than previous estimates, which failed to take
account of the long term effects of malaria on trade, tourism,
foreign investment, and commerce. Repeated bouts of malaria add
to costs through malnutrition and death among children and time
off work among adults.
"Since Sub-Saharan Africa's GDP [gross domestic product] is
around $300bn (�188bn), and since malaria affects nearly the
entire region, the short-term benefit of malaria control can
reasonably be estimated at between $3bn and $12bn per year,"
stated the World Health Organization's commissioned report.
The report calls on the international community, private
foundations, and international agencies to commit $1bn a year to
fund malaria interventions and research. A "malaria vaccine
purchase" fund should also be set up to spur pharmaceutical and
biotechnology companies into developing a vaccine. At the moment
little interest exists in producing a vaccine because there is no
guarantee that the countries needing the vaccine would be able to
buy it.
But a vaccine fund, which has been supported by President Clinton
and the World Bank, would ensure that money would be
available to pay for it. Meanwhile, new therapeutic, preventive, and
diagnostic tools need to be developed, particularly drugs,
insecticides, and dipstick tests.
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Electronic reply by Janssen:
Dear Sir,
I attended the historical Roll Back Malaria (RBM) meeting held
earlier this week in Abuja (Nigeria). Never before has there been so
much determination to tackle the malaria problem. The structural
and preventive measures presented are essential but the power of
therapeutics tends to be forgotten or neglected. With the new
drugs containing Artemether or Artesunate it is possible to bring
back drastically the incidence of malaria. These short acting drugs
are highly efficacious and since they kill both the schizont and the
gametocyte stages of the Plasmodiae they are capable of
interrupting the cycle between man and mosquito. Eventually
mosquito's will no longer be carriers of the parasite and
transmission of the disease ceases.
Since the introduction of these drugs in PR China and in Vietnam
several years ago the incidence and mortality of malaria has gone
down dramatically. Similar results can be achieved in Africa
provided the private sector, NGO's and Governments help to make
these drugs available to every single sufferer from a malaria attack.
Hence, therapeutics will be a major contributor to the success of
this ambitious RBM programme. The costs involved will be quite
reasonable since these medicaments are available in nearly all
African countries at affordable prices. Only a fraction of the budget
proposed at the meeting will be needed to wipe out this disease.
Resistant malaria cases? It is unlikely that resistance of the
parasites will develop. It did not develop in China or other Asian
countries in spite of its broad but not always optimal use over a
prolonged period of time. The mechanism of action explains why:
The peroxide function of the Artesunate drugs opens and releases
singlet oxygen and forms free radicals. This leads to destruction of
the membranous structures of the plasmodia at all cellular or
subcellular levels. This is a well known biochemical fact
documented for antibacterial action of peroxides in general and was
recently demonstrated directly by means of an electron
microscopic study on malaria schizonts in vivo exposed to the
Artemisinin derived drug. This is also confirmed by the failure so far
to create resistance in laboratory models
In addition, the remarkable safety of these drugs and easy administration
adapted for
patients of all ages, will lead to patient satisfaction and good
compliance. We agree, the
RBM programme can be turned into a success very soon if attention is being
given to the
force of adequate therapeutic agents made available to all those who need
them.
Sincerely yours,
Dr. F.H. Jansen, M.D., Ph.D., Internal Medicine. Dafra Pharma ltd, Beerse
Belgium
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