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Nonprofit Consortium Develops Low Cost Malaria Drugs

An international non-profit drug consortium says it has developed two low-cost, highly effective malaria pills. Older treatments increasingly rendered ineffective, because the malaria parasite is becoming resistant to them. The new compounds are unpatented, inexpensive, and easy to take.

The new malaria therapies combine the ancient Chinese herb artemisinin with drugs based on quinine. The World Health Organization (WHO) has recommended artemisinin combinations since 2001, because of the growing uselessness of long-established, cheap medicines like chloroquine, an older quinine therapy. Oxford University tropical medicine expert Nick White says the increasing failure of the older drugs to work has caused malaria to spread. But he notes that the new artemisinin combinations have the potential to reverse that trend.

"Better drugs are now available," he said. "The drugs that do work reliably are the artemisinin combinations. They are particularly good because they rapidly and reliably treat malaria. The patient gets better more quickly following these drugs than other drugs, the cure rates are very high, and that is very important. This is a life threatening infection."

The World Health Organization (WHO) currently recommends four artemisinin combinations, but high cost and procurement problems on the local and regional levels have prevented wide access to them. In addition, only one pairing merges both drugs into a fixed dose tablet, the easiest way to take them.

Now, a consortium called the Drugs for Neglected Diseases Initiative has developed two more tablets that blend artemisinin and another drug. The formulations mean that a patient will have to take only two pills a day instead of eight. They will be available by late 2006 for between $1 and $2.50 for adults, depending on which combination it is, and will be less expensive for children.

"It's critical that these drugs are very inexpensive," added Nick White. "That is why I think this initiative is important. And secondly, they are simple to give. Simplicity is very, very important. So if you can't separate them and it's all in one pill, that's very, very important."

The Drugs for Neglected Diseases Initiative that developed the new malaria therapies is an independent, non-profit group established two years ago by Doctors Without Borders, the World Health Organization, and private sector research institutions in Brazil, France, India, and Malaysia. Its executive director, Dr. Bernard Pecoul, announced the new medicines at a meeting of the American Society of Tropical Medicine and Hygiene in Washington.

He says the French pharmaceutical firm Sanofi Aventis will manufacture one of the pills, artesunate-amodiaquine, for sub-Saharan Africa and parts of Southeast Asia where resistance to older drugs is high. The Brazilian government laboratory Far-Manguinhos will produce the second tablet, artesunate-mefloquine, for the South American market. Both have agreed not to earn profit. Dr. Pecoul says the drugs will also be unpatented, allowing other pharmaceutical firms to produce them as global demand increases. He says the World Health Organization estimates there is a market of up to 100 million people for the artesunate-amodiaquine combination alone.

"You have huge potential use of this product," said Dr. Pecoul. "So it's quite important to imagine in the future to have several sources for this product in order to increase the availability."

Dr. Pecoul says the Drugs for Neglected Diseases Initiative is seeking licensing for the therapies in countries hardest hit by malaria in Africa, Asia, and Latin America.

Oxford University's Nick White, who is based in Thailand, says even more fixed dose tablet forms of artemisinin combinations are needed, as are new malaria medicines beyond artemisinin.

"You would be mad as a biologist to say resistance will not happen," added Mr. White. "It has happened to all drugs. I do believe artemisinin resistance will happen. In fact, resistance has already happened partly to all the drugs that we've had. So that's why we need to have more, but I don't think we need to wait."

Nick White says there are no excuses for not using the new artemisinin combination drugs, which will be widely available and cheap.