A new, highly-effective anti-malaria treatment will soon be made available in countries where the parasitic illness is endemic. A great deal of controversy has surrounded the planned distribution of the drug, which is made from an ancient Chinese herb.
Artemisinin is a compound made from the 2000-year-old Chinese herb, sweet wormwood. It has been shown to be 97 percent effective in treating malaria, but until now, artemisinin has not been included in the cache of drugs promoted by the World Health Organization (WHO) as part of its anti-malaria campaign, known as Rollback Malaria.
Amir Attaran is an Associate Fellow at the Royal Institute of International Affairs in London. ?The program is a total abyssmal, egregious, failure,? he said.
An estimated 300 million people are infected with malaria each year, most of them in Africa. Of these, one million people die, mostly children. Dr. Attaran said that the children who don't die are often left physically or mentally handicapped.
In an article published earlier this year in the journal the Lancet, Dr. Attaran charges the WHO and the Global Fund have continued to promote the use of cholorquine and other ineffective, old line drugs to treat malaria.
The international health agencies have argued that artimisinin is 10-20 times more expensive than chloroquine. But the Royal Institute's Amir Attaran believes that's no excuse.
?It's available as a generic,? he added. ?It's available at no profit from a brand name company. It's not a patent issue; it's a money issue. If you want to ask who there is to blame, and for those of you who are well connected who would like to work with me on changing this, we could literally save a few hundred thousand children next year if we change the behavior of three agencies.?
In addition to the World Health Organization and the Global Fund, Dr. Attaran points a finger at UNICEF.
Allan Schapira is Coordinator of WHO's Rollback Malaria program in Geneva. Dr. Schapira said that the world health body has moved cautiously on artemisinin because it had to make sure the herbal derivative was safe to use in children.
?We have not been reluctant,? he said. ?We have not been out too early either, because it's not our job to be super enthusiastic on the basis of a rumor. We have to convene groups of experts which can provide recommendations on the basis of evidence.?
Dr. Schapira says Rollback Malaria has a $15 million fund to fight malaria. He says that's a tiny fraction of the $2 billion that's needed to fight the tropical disease in Africa alone.
Dr. Schapira said that the rest of the money has to come from rich donor countries like the United States and Great Britain through the Global Fund.
Critics say the richer countries have preferred to spend money on less expensive, but ineffective anti-malarial drug, such as cholorquine, than pay for expensive new treatments like artemisinin. The same goes for providing funds for a well-known malaria prevention strategy, insecticide impregnated bed nets
?It is the reluctance of some donors to give sufficient support to the countries; donors which have and, I'm not against social marketing, but they have to exaggerated extent, believed that only marketing and social marketing approaches get all children in a few years under insecticide-treated bed nets. And that's not possible given how poor people are.? Mr. Schapira said.
In 2001, the World Health Organization hosted a technical meeting at which there was general agreement that artemisinin is the future drug of choice to treat malaria. The proposed treatment is a cocktail of artemisinin and another, older anti-malaria drug, a strategy that should keep artemisisinin from become useless against the parasitic illness.
Dennis Carroll is a consultant to the U.S. Agency for International Development, USAID, one of the agencies that has come under fire for not doing enough to eradicate malaria.
Last month, the United Nations agreed that funds for anti-malaria efforts be redirected from old, ineffective drugs toward the purchase of artimisinin in 25 African countries.
?I think it is clearly going to signal that the international community has a responsibility and has the resources to make smart investments to defray the costs of these drugs,? said Mr. Carroll.
The World Health Organization estimates 100 million doses of artimisinin will be needed by the end of 2005, at a cost of $450 million. Meanwhile, a report on funding proposals by the U.S. National Academy of Sciences is due to be released at the beginning of June.