[Effects on Health] $300M Drug Subsidy Needed to Cut Africa Malaria Deaths

from The Voice

BY BOB OSMAN

300.000 lives could be saved by new drugs and change of pricing methods by pharmaceutical companies, says new WHO report

Almost a million African children under the age of five are dying from malaria each year, but as many as 300,000 could be saved if more effective drugs are made available quickly, two new reports have estimated.

The first report, published in the International Journal of Epidemiology, says that the number of deaths among under-fives could be even higher because there is a lack of accurate information about the disease from the more remote but vast areas of the African continent.

The authors of the report also say as a result of the lack of information, previous figures may have under-estimated the number of fatalities because malaria can often be the primary cause of death, along with other diseases, but may be not recorded as such.

But even using the present available data, they say they still estimate nearly all (94%) of the deaths are in the central regions of Africa. Two thirds (68%) of these occur in rural areas, and a quarter (26%) in towns and cities.

The second report, produced in collaboration with the US Institute of Medicine and the World Bank, looks at the impact that new, more effective drugs would have on reducing the death toll from malaria, which is once again endemic in sub-Saharan Africa.

The authors of this study, who used computer models to predict the spread of the disease, say it makes economic sense for the international community to invest around $300 million in new anti-malaria treatments. This kind of subsidy, they argue, could save as many as 25,000 lives every month.

Deaths in Africa from malaria, particularly among children, have been rising steadily since the 1980s, mainly because the disease has developed a resistance to the most commonly used drug, chloroquine. Some recent estimates put the number of malaria cases each year, at more than 600 million, with over three million dying as result.

Although deaths among Africa’s children from vaccine-preventable diseases such as diarrhoea and measles have been greatly reduced, the rising numbers taken by malaria and HIV/AIDS appear to have cancelled out these gains.

According to the World Health Organisation (WHO), malaria in sub- Saharan Africa is also stifling economic growth and condemning millions to poverty.

Even when it spares its victims, malaria still leaves an intolerable economic burden on families. A father or mother, for example, who otherwise would be employed, is forced to look after a sick child and suffers a serious fall in household income.

Fortunately, there are encouraging signs that new drugs derived from a common weed used in Chinese herbal medicine for centuries, could help to dramatically reduce the current unacceptable death toll among children under the age of five.

But unfortunately nature has its own way of thwarting science, even when it is well intentioned and consequently, malaria is not as easy to treat as it might first appear.

Parasites, which carry the malaria infection, have already mutated and are now able to resist the therapeutic benefits of the old drugs.

Experts fear that if the new therapies are not used globally and in a coordinated manner, resistance to these as well, could soon be developed by the ingenious parasites.

Fearing a medical catastrophe in Africa, the US Institute of Medicine commissioned a report from a panel of economists and health professionals to consider the use of the new drugs globally, without resistance developing. They called for immediate action and an international subsidy to purchase the new treatments.

The new combined Artemisinin treatment (ACT) has been proven to be 95% effective against malaria but only if used in combination with another anti-malarial drug. This combination of drugs is crucial if resistance to the treatment is to be kept to a minimum.

Experts say that when artemisinin is used on its own, parasites rapidly develop a resistance to it, but when used in combination with another anti-malarial drug, it is much harder for resistance to develop twice.

The WHO, alarmed that the use of artemisinin on its own could jeopardise the effectiveness of the combined treatments in the future, issued strict guidelines to health organisations and urged pharmaceutical companies to halt the sales of the drug as a single treatment.

In an unprecedented move, the director general of the WHO, Dr Lee Jong-wook, went public in January this year and demanded that drug companies act responsibly. He said: “It is critical that artemisinins be used correctly. We request pharmaceutical companies to immediately stop marketing single-drug artemisinin tablets and instead market artemisinin combination therapies only.”

Dr Arata Kochi, the newly- appointed director of WHO’s malaria department, went even further when he issued this stark warning. “Our biggest concern right now is to treat patients with safe and effective medication and to avoid the emergence of drug resistance. If we lose ACTs, we’ll no longer have a cure for malaria, and it will probably be at least ten years before a new one can be discovered.”

The latest report produced in collaboration with economists from the World Bank, supports this view. Indeed, the authors of this study warn of a grave crisis if the international community does not act quickly.

Their economic model, they say, suggests the longer the full subsidy is delayed, the more costly it becomes to tackle the malaria endemic in the long term. A delay also puts at risk the effectiveness of the combined artemisinin treatments because it allows the spread of resistance through the uncoordinated use of single therapies.

As parasites do not recognise national boundaries, resistance can spread rapidly across borders.

Experts say the only way to deal with the impending crisis is to treat it globally. And the most cost-effective way, they calculate, is to subsidise the price of the combined therapies so they cost the same as the single artemisinin drug.

Only through pricing, can the use of single therapies be eliminated and non-resistance to the more effective combined treatments be assured. But this requires a subsidy of around $300m, sooner rather than later, the study concludes.

Dr Ramanan Laxminarayan, lead author of the report said: “Providing the subsidies is probably the most important thing the world can do for malaria today. I can’t think of another public health programme that could be deployed so rapidly and would save as many lives.”

The Department for International Development says it fully supports the strategy and believes there are sufficient funds available globally to pay for the subsidy.

A spokesman said: “Extra money is always needed in these situations. We have already contributed £259m to a global fund to fight HIV/AIDS and malaria and another £48m to the Roll Back Malaria‚ campaign organised by the WHO.”