E-drug: MSF on malaria
-------------------------------------------------------------------------
[Thanks to Valeria Frighi for spotting this. Copied as fair use.
HH]
Lancet 3/5/2003
http://www.thelancet.com/journal/journal.isa
Money being wasted in fight against malaria, says MSF
Helen Frankish
WHO and UNICEF appealed for urgent increased action to
combat malaria, after the publication of a joint report to mark
Africa Malaria Day. The Africa Malaria Report 2003, released on
April 25, stressed that the death toll from malaria is still
"outrageously high", killing more 3000 children in Africa every
day, and that effective antimalarial drugs and insecticide-treated
bed nets are not widely available to those who need them.
"Millions of people continue to suffer and die unnecessarily with
90% of malaria deaths occurring in Africa alone", said Atoumata
Nafo-Traore, Executive Secretary of the Roll Back Malaria
Partnership Secretariat, at the launch of the report in Nairobi,
Kenya. "We now have the tools and the knowledge that are
needed to slow the progress of malaria. But we have not yet
managed to deploy them on a sufficient scale Africa-wide."
At a conference held simultaneously in London, UK, to mark the
release of the report, Jane Crawley, an adviser to WHO's
malaria department, noted that widespread use of
insecticide-treated bed nets could greatly reduce malaria
transmission. Coverage with nets, however, remains poor. "Only
15% of children less than 5 years are sleeping under nets, and
an even smaller proportion --less than 3%--are sleeping under
nets that have been insecticide-treated."
During pregnancy, sleeping under insecticide-treated nets
reduces the risk of giving birth to low birthweight babies and
babies that are likely to become anaemic, both of which
increase the risk of death. But, at less than 10%, use of bed
nets among pregnant women is still low, Crawley said.
Resistance to antimalarial drugs is perhaps the greatest
challenge in malaria treatment, the report noted. Resistance to
the antimalarial drugs choloroquine and sulfadoxine-
pyrimethamine is now so high in parts of Africa that both drugs
are virtually useless.
In a report published on the eve of the WHO report, Medecins
sans Frontieres (MSF) said the continuing use of ineffective
drugs despite high levels of resistance is leading to increasing
treatment failures and death. Effective malaria treatments, such
as artemisinin-based combination therapy, should become more
widely available, the report argued, and donor agencies should
support implementation of artemisinin-based combination
therapy, rather than "wasting their money on funding drugs that
don't work".
WHO currently recommends combination treatment with two
antimalarial drugs that have different targets within the malaria
parasite, one of which should be an artemisinin derivative.
Artemisinin drugs, which have been used for longer than 10
years in Asia, are rapidly acting, highly effective, and well
tolerated. No resistance to artemisinins has been reported to
date.
Several African countries have already changed their drug
protocols--or are in the process of changing them--to include
more effective treatments. For instance, KwaZulu province in
South Africa has successfully changed to artemisinin-based
combination therapy as first-line treatment, and Burundi,
Zambia, and Zanzibar in Tanzania are preparing to implement
the switch. However, lack of money and international help has
forced some countries to switch to another monotherapy, or to
less expensive non-artemisinin combinations.
"Since 2001, WHO experts have recommended replacing failing
malaria medicines with more effective treatments, but donors
have failed to encourage this change, choosing to save money
rather than lives", said Bernard Pecoul, Director of MSF's
Campaign for Access to Essential Medicines. "The G8 and
African leaders' goal of halving malaria deaths by 2010 will
remain a fantasy unless donors are willing to help pay for
treatment that works."
But donors such as the UK Department for International
Development (DFID) and the US Agency for International
Development (USAID), are currently supporting a "go slow"
approach, the MSF report said, mainly due to the higher cost of
artemisinin-based combination therapy. Currently, chloroquine
and sulfadoxine-pyrimethamine cost about US$0.15 per adult
treatment dose, whereas artemisinin-based combination therapy
costs at least US$1-2, although this is expected to go down to
$0.50-0.80 by 2004-05 as orders for the drug increase.
"But what would you rather do", said Nick White (Mahidol
University, Thailand, and Oxford University, UK), "waste money
on old, cheap drugs that you know don't work, or fund a more
expensive treatment that will save lives".
MSF estimates that, for all Africa, the cost of changing to
artemisinin-based combination therapy is about $100-200 million
per year.
--
To send a message to E-Drug, write to: e-drug@healthnet.org
To subscribe or unsubscribe, write to: majordomo@healthnet.org
in the body of the message type: subscribe e-drug OR unsubscribe e-drug
To contact a person, send a message to: e-drug-help@healthnet.org
Information and archives: http://www.essentialdrugs.org/edrug