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New Malaria Medicines Slow to Arrive in Africa - 2004-01-10


An average of 3,000 people in Africa die of malaria every day. And drug-resistant strains threaten to take that toll even higher. A study in the British medical journal The Lancet shows a new drug may help turn the tide in Africa. But the drug has been slow to arrive.

Malaria is a fact of everyday life in much of Africa. Even top health experts, like Hassan Mshinda, are not immune from it. The director of Tanzania's Ifakara Health Research and Development Center says he has struggled with the disease all his life.

"Of course, yes, several bouts of malaria since I was very young," he said. "And my children are also getting malaria. So this is the problem which we have been experiencing for many, many years."

Chloroquine has been the anti-malaria drug of choice in Africa for decades. But the malaria parasite has developed immunity to chloroquine, and Mr. Mshinda says that's rendered the drug all but useless.

"More than 50 percent of children who were treated with chloroquine, they came back with malaria symptoms within the first two weeks," said Hassan Mshinda. "And that has actually made us rethink, what is the purpose of treating people who come are coming back again."

Chloroquine-resistant malaria is spreading across the African continent. But Mr. Mshinda's institute is conducting studies on a new group of medicines that are promising to turn back malaria's advance. Drugs based on a 2,000-year-old Chinese herbal remedy called artemisinin have been used successfully against the disease in Asia for more than a decade. A recent study in the British medical journal The Lancet shows an artemisinin drug has worked extremely well in clinical trials in several African countries as well.

But the new drugs are expensive. Malaria expert Peter Bloland, from the U.S. Centers for Disease Control and Prevention, compares them to a dose of chloroquine, which only costs about 10 to 20 cents.

"The new drugs, the cheapest of the new drugs that contain artemisinin compounds, cost anywhere from $1.20 to $2.40 per adult treatment dose," he said. "So we're talking orders of magnitude more cost associated with each treatment."

The World Health Organization strongly recommends that countries with drug-resistant malaria switch to the new medicines. But health ministries in Ethiopia, Nigeria, and elsewhere are still buying chloroquine, even when resistance is on the rise. According to Jon Liden of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, cost is a factor for many cash-strapped developing countries.

"Countries have policies based on what is sustainable, what they can afford to buy in the long term," he said. "And several countries would be reluctant to change their policies unless they are very certain that these medicines will be available for five, 10, 15 years from now, and be effective for five, 10, 15 years from now."

Mr. Liden says the Global Fund can provide countries with the financing they need to make the change. But the organization is still subsidizing health ministries that buy chloroquine. Daniel Berman, of the activist group Doctors Without Borders, says that's irresponsible.

"We simply need the WHO recommendations to be implemented," he said. "And that means that the Global Fund needs to say no to funding drugs that we know are not going to work. And the WHO needs to play a stronger role in advising and helping countries to choose the right drugs."

The Global Fund's Mr. Liden says chloroquine still works on some forms of malaria. And he says the fund does not tell countries what drugs to buy.

And that's as it should be, according to WHO drug policy expert Piero Olliaro, the responsibility to change drugs should lie with national health ministries. But he says some African ministries are reluctant to start the complex and expensive bureaucratic process of changing from old, familiar chloroquine.

"Of course there are huge implications when you change from one drug to another, and from one policy to another," Mr. Olliaro said. "It is a very complicated issue, takes time, costs money. But this should not prevent us from changing when it is so required."

Some countries, like Tanzania, Zambia, and Burundi, have started the process of changing their malaria drug policy. Ifakarah director Hassan Mshinda says Tanzania is conducting innovative clinical trials under real-world conditions.

"If we want to see changes in a real life situation, we have to test our tools in a real life situation," he said. "It's only then, after testing in effectiveness, one can develop a policy."

If Tanzania decides to change to artemisinins, it will need financial help from international donors. Some critics question whether the Global Fund can afford to buy artemisinin drugs for every country that needs them. But with more money and the will to change, Africans may get new malaria drugs in the new year.

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