Is China denying African children a medicine that would save their lives? The evidence is growing that it is, and this policy must stop.
Public health officers and doctors have a tough time trying to control malaria. Not only do they have to deal with the Anopheles mosquitoes, which are wily beasts to say the least, they have to contend with the malaria parasite, which is constantly outwitting anti-malaria drugs. In recent years however a new and highly effective dual therapy based on an ancient Chinese herbal remedy, known as Artemesinin-based combination therapy (ACT) has changed the face of malaria treatment and holds out great hope for the control of malaria. Unfortunately for malaria control experts, in addition to mosquitoes and parasites, basic economics and politics now stand in the way of progress.
During the Vietnam War, the North Vietnamese appealed to their Chinese allies to find an effective drug against malaria, which was claiming far too many of their troops. The Chinese government obliged and after bio-prospecting a great number of substances hit upon Artemesinin (qinghaosu), which is an extract of an ordinary looking shrub, Artemesia annua. The new drug remained a secret for many years even though there was increasingly widespread resistance to the alternative therapies. During the 1990s some south east Asian countries began to adopt ACTs with great success.
Most African countries, where around 90 percent of the world's malaria cases and deaths occur, were slower to adopt ACTs but have now started to change over to the new drug. Unfortunately funding bodies and the WHO were behind some of the delays in adopting ACTs and this no doubt cost lives. An article in the medical journal Lancet earlier this year accused these agencies of medical malpractice for dragging their feet over ACT adoption and approving the use of ineffectual medicines in Africa.
Since then the Global Fund for AIDS, TB and Malaria has supported the roll out of the new drugs. But since other agencies didn't buy drugs effective demand was low, so supply wasn't increased, and now that demand is high supply has not changed hence the price of artemesinin has gone up.
Apart from the problem of basic economics, according to sources in the WHO, it seems that the Chinese government, once secretive about its new malaria drugs, is actually trying to limit the export of artemesinin seeds. The plant Artemesia annua is not exclusive to China, but the high yielding varieties are and attempts by other countries, such as South Africa, to import seeds have so far been fruitless.
If indeed the Chinese government is attempting to restrict the export of the seeds, it would surely be breaking some fundamental World Trade Organization rules. Breaking WTO rules is unfortunate, but the real outrage is that their actions are condemning thousands of Africans to an early grave. Given the Chinese government's unfortunate record over the SARS outbreak and over the sale of HIV tainted blood, many will not be surprised that they are implicated in yet another healthcare scandal.
This whole debacle highlights some important points about public health and access to medicines that is far too often overlooked. The popular view in the whole access to medicines debate is that drug patents and drug company profits are by and large responsible for the fact that poor Africans can't get treatment. Yet the reality is that in most poor countries it is poverty, a lack of medical infrastructure and a lack of political will to deal with health problems that denies people treatment.
The Swiss pharmaceutical company, Novartis, pioneered ACTs with its single dose combination Coartem. The company is selling the medicine on a non-profit basis and has expended a great deal of time, effort and money to improve treatment in many African countries. Even though the company is large and powerful, it is still subject to the same laws of supply and demand as everyone else and is having difficulty sourcing Artemesinin. This reality however did not stop the medical charity, Medicines Sans Frontiers blaming Novartis for the ACT shortage.
Add to the activist politics the actions, or lack of them, of various UN agencies and malaria control seems a far off goal. Most UN bodies and donor agencies have failed Africa's most vulnerable by ignoring interventions that work, such as effective drugs and indoor spraying of insecticides that protects households from the Anopheles mosquitoes. In 1998 the WHO, UNICEF, the World Bank and various donor agencies launched a new malaria control program, Roll Back Malaria (RBM). The goal was to halve the burden of malaria by 2010. Since then malaria cases have gone up not down and earlier this year the British Medical Journal editorial characterized RBM as "a failing health initiative."
It is time for governments, UN agencies and activists stop blaming the easiest target, the drugs industry, and start to face up to the fundamental barriers to access and deal with the politics that denies people treatment. Tackling China over their apparent reluctance to boost the supply of Artemesinin would be a good first step.
Richard Tren is the director of the South Africa based health advocacy group Africa Fighting Malaria, and Roger Bate is a fellow at the American Enterprise Institute.