Malaria Keeps Killing Millions

Jasson Urbach | 16 May 2008
Malaria continues to be a serious concern. It affects more than 100 countries and about 40percent of the world's population.

It causes between 300 and 500 million infections and about a million deaths each year. It is estimated that malaria kills a child every 30 seconds in spite of the disease being entirely preventable and curable.

At the eighth World Health Assembly meeting in 1955, it was resolved to begin a worldwide eradication campaign of malaria.

Though the campaign was eventually abandoned and considered a failure, it registered resounding successes in eradicating malaria from large regions across the globe. The successful application of insecticides and the effectiveness of antimalarial treatments formed the cornerstones of the programme.

But because the malaria parasite is constantly evolving to try and outsmart the human race, our ability to control the parasite hangs in a precarious balance.

Chloroquine, along with many other mono-therapy antimalarial drugs, has been rendered completely resistant for a number of years and though the World Health Organisation (WHO) was slow to adapt, it eventually changed its policy about producing mono-therapy drugs. In January 2006 the WHO appealed to pharmaceutical manufacturers to cease production of the drugs.

As a result of wide-scale resistance, scientists developed new drugs called artemisinin-based combination therapies to stay a step ahead of the parasite. But because of the unscrupulous behaviour of some pharmaceutical companies that are producing fake or substandard drugs that raise the probability of resistance building up, we could potentially lose a very valuable tool in the fight against malaria.

Africa Fighting Malaria (AFM), along with Amir Attaran from Canada's University of Ottawa, released a report this week published in the Public Library of Science journal PLoS ONE.

Entitled Antimalarial Drug Quality in the Most Severely Malarious Parts of Africa - A Six Country Study, it reports on tests AFM conducted to check the efficacy of drugs collected in Ghana, Nigeria, Tanzania, Rwanda, Kenya and Uganda.

More than 200 samples of antimalarial treatments were collected and tested to see if they met international standards. The results were alarming. Overall, 35percent of the samples were substandard and failed the test. This means that one in three patients are unlikely to be cured.

It was also found that 33percent of the treatments tested were artemisinin mono-therapy drugs - 42percent of these failed the test. At least 78percent of the mono-therapy drugs collected were manufactured after the WHO appealed for mono-therapy production to stop.

Sub-standard drugs as opposed to outright fakes are also of particular concern. In addition to affecting a patient's health, they increase the probability of parasites building up resistance to quality drugs. This has the potential of rendering a whole class of drugs useless, with serious long-term implications to fight the disease.

It is unfortunate that large multilateral donors actively support and encourage the domestic production of antimalarial drugs.

Local production of drugs sounds appealing because it has the potential to lower transport costs, provide local jobs, increase expertise and cut dependence on foreign suppliers. But apart from the potential for the production of fake or substandard drugs, local manufacturers might not be as efficient as established manufacturers that are already supplying the market on a no-profit and no-loss basis.

In order to support inefficient and sub-standard home industries, a government might protect locals from foreign competition by imposing high tariffs on imported pharmaceuticals. At the same time, the government might offer tax incentives and subsidies to local companies. These constrict the supply of imported drugs without necessarily increasing local supply appreciably.

Despite international donor communities' best intentions to increase access to medicines in developing countries through the development of local manufacturing facilities, they should be cautious in their prescriptions, particularly if the wider policy environment is not conducive to the development of local facilities.

Taxes and tariffs must be eliminated and strict regulatory standards adopted to clamp down on fake and substandard drugs.