Failure to Adopt New Drugs Fuels Rise of Malaria

New drug-resistant strains of malaria could thwart global efforts to halve malaria deaths by 2010 unless major players in the fight against the disease speed up the rollout of vital new drugs, health experts say.

Ninety percent of all malaria deaths are in Africa, where experts say the emergence of drug-resistant strains help maintain a staggering death rate, particularly among children. An African child dies from malaria every 30 seconds."There is every reason to believe that mortality from malaria has been rising in Africa over the last 15 years as a result of drug resistance," Robert Snow, professor of public health at the Kenyan Medical Research Institute, told Reuters AlertNet, a humanitarian Web site run by Reuters Foundation."Basically non-malaria mortality in children has dropped over time, but deaths attributed to malaria have risen."The only explanation, Snow said, is that existing drugs became less effective during the same period.The Roll Back Malaria initiative -- a partnership between the U.N. World Health Organization (WHO), the U.N. Children's Fund (UNICEF), the U.N. Development Programme and the World Bank -- aims to halve the mortality rate of a disease that kills between one and 3 million people a year.Under the U.N.-sponsored Millennium Development Goals, the international community agreed to try to halt and begin to reverse the spread of malaria by 2015.In an editorial last week, the Lancet medical journal said the Roll Back Malaria initiative had failed to control the disease and may actually have done more harm than good.But the WHO said global goals could still be met."Many countries will go beyond these targets," said Andrea Bosman, a medical officer in the WHO's Malaria Strategy and Policy Team. "But the majority will be challenged."These are very ambitious targets to be met over a short amount of time, but if there's a concerted effort among donors, things can be improved." Some experts say that optimism is misplaced, given the slow rate at which big global funders of anti-malaria programs have been willing to pay for a new class of anti-malarial drugs, called artemisin-based combination therapies."The fact is, they (big global funders) have cost us several years of progress and cost us several million lives," said Amir Attaran, a professor of law and population health at Ottawa University.OBSOLETE DRUGSAttaran caused controversy last year by accusing the WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria of knowingly funding the purchase of obsolete drugs in countries where drug-resistant strains of malaria topped 90 percent.The WHO recommended in 2001 that countries with drug resistance should switch to artemisin-based medication and the United States -- which provides up to one third of the Global Fund's malaria budget -- approved the new drugs for use in Africa in 2002.And yet in 2003 the WHO and Global Fund spent more on drugs considered obsolete than on artemisin-based medicines.Funding obsolete drugs, Attaran said, killed people and was a waste of precious aid money.Jon Liden, head of communication at the Global Fund, said that many countries were simply not ready or willing to switch to artemisin-based drugs."Artemisin-based drugs are 10 to 15 times more expensive, and countries weren't willing to change, at first, because of costs," he said."Nobody could trust that the Global Fund, or anyone else, would pay for the drugs in the future," he said. Many countries also faced huge opposition from donors -- including the U.S. Agency for International Development and the British Department for International Development -- who were unwilling to stump up the cash, said Bosman of Roll Back Malaria."They did not understand there was no other option."Liden said it was unfair to blame the Global Fund. In 2003, he said, artemisin-based drugs were not being rolled out in earnest by anyone, including the WHO."We were hung out as scapegoats," he said.However, Liden agreed with some of the criticism. "Academics said this is unacceptable, and we agree with this," he said."Since then, we have not only acknowledged that we provided the wrong drugs, but we have looked at countries that should have Artemisin-based drugs."The Global Fund is now helping countries modify grant requests to cover the cost of artemisin-based drugs, but many nations are still using obsolete drugs. Bosman said many countries were reluctant to change, especially in central and west Africa.He said they sometimes came under pressure from local manufacturers of obsolete drugs or from import companies with links to senior government officials.The drive toward artemisin-based drugs coincides with a shortage of their key ingredient, derived from the plant artemisia annua, also known as Sweet Annie or annual wormwood, which is grown mainly in China and Vietnam.Kenya and Tanzania recently started growing the plant, but there are fears that demand will still outstrip supply, and the Global Fund is working with producers to increase production."We need several hundred million doses for 2006," said Liden. "But what do you do when demand has gone up several thousand percent, the production cycle is 18 months, and the shelf life is 18 months?"Roll Back Malaria is setting up a fund to guarantee advance orders for artemisin-based drugs."We are acutely aware that while we're working these problems out children continue to die," Liden said.(Source: Reuters Health, April 2005)