Drug resistance - a global-scale failure

30 Jun 2010
Africa Fighting Malaria
Drug resistance is seriously undermining efforts to cure disease in developing countries, a new report by the Center for Global Development (CGD) warns.

The report argues that although eventual resistance is inevitable, it has been accelerated unnecessarily by careless practices in drug supply and use.

Widespread global drug resistance could have serious consequences for the fight against malaria.

Resistance drives up the cost of curing patients, as second-line drugs are far more expensive than first-line. Increased cost challenges gains in improved drug access.

Currently, WHO recommended treatment for malaria is a third generation treatment, artemisinin-combination therapies (ACTs). Unsubsidized, ACTs are 20 to 40 times more expensive than previous treatment methods of chloroquine and SP.

Furthermore, the report cautions, ACTs are already showing signs of declining efficiency along the Thai-Cambodian border. This is an alarming case of déjà-vu, given that resistance to chloroquine originated in Southeast Asia before spreading to the rest of the world.

According to the report, artemisinin resistance could "precipitate a global health crisis if widespread". Malaria already kills one million children in sub-Saharan Africa every year.

Currently, a new model called the Affordable Medicines Facility - malaria (AMFm) offers a global subsidy to increase access to ACTs. Through doing so, it aims to save lives and combat the spread of artemisinin resistance, which is driven largely by the use of artemisinin monotherapies.

However, it remains unclear whether this policy will provide enough access to successfully save lives while slowing the spread of resistance, or whether it could be applied more widely.

A more comprehensive strategy is needed. The report calls for a "systematic, global response" in order to combat the key drivers of drug resistance: technology gaps, inappropriate behavior and weak health systems.

The report introduces "four practical steps" to achieve this.

Firstly, surveillance must be improved and resistance information shared across networks of laboratories and among all those involved in the global supply chain.

Secondly, public and private sectors must work together to secure the entire drug supply chain - from manufacturer policies to drug dispensing practices.

Thirdly, national and international support is needed to enable national drug regulators to work together to improve the quality of drug supplies. Currently, not enough is being done to combat the use of counterfeit, substandard and ineffective drugs - another key driver of resistance.

Lastly, a web-based marketplace to share research should be developed in order to enhance innovation, foster collaboration and increase investment.

The report calls upon all parties involved - donors, governments, companies, global health institutions and patients themselves to recognize their individual responsibilities and act quickly and aggressively to stop the spread of resistance. Unless they make combating resistance a global health priority, governments and private funders risk seeing their immense efforts to increase access to drugs over the past decade become void.