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The WTO and Access to Essential Medicines: Recent Agreements , New Assignments  - Dr Roger Bate & Richard Tren
Roger Bate and Richard Tren discuss the recent WTO agreement on TRIPS and public health and recommend that the WTO now turn its attention towards removing import tariffs on medicines and medical devices, which have been shown to reduce access to medicines and medical care.

Brazil's AIDS Program - A Costly Success  - Richard Tren & Roger Bate
Richard Tren & Roger Bate comment on Brazil's AIDS Treatment program which has achieved some notable successes, but potentially reduces research into new AIDS medicines and could result in large long term costs down the line.

AFM testimony to the US Senate Committee on Environment & Public Works  - Roger Bate & Richard Tren
Download the testimony given by AFM's Roger Bate and Richard Tren to the US Senate's Committee on Environment and Public Works. The hearing, chaired by Sen. Inhofe (R, OK) was set up to look at the role of science and environmental policy - what better case study than DDT?

An Immesurable Crisis? A Criticism of the Millennium Development Goals and Why They Cannot Be Measured  - Prof. Amir Attaran
Prof. Amir Attaran evaluates the Millennium Development Goals and criticises them for being unmeasurable and therefore largely meaningless. He also criticises the UN for failing to discuss the measurement of these goals at the September 2005 UN meeting on the MDGs.

State in Fear - Zimbabwe's Tragedy is Africa's Shame  - Archbishop Pius Ncube, Dr Roger Bate & Richard Tren
Catholic Archbishop of Bulawayo Pius Ncube, Dr Roger Bate and Richard Tren report on the horrific abuses of human rights by Mugabe's police and military. The authors call on the G8 leaders to exert pressure on African leaders, such as President Mbeki, to condemn Mugabe's regime and support the return of peace and democracy in Zimbabwe.

AFM's Comment on the WHA Malaria Resolution  - AFM
The World Health Assembly recently passed a resolution on malaria control. The WHO and UNICEF also recently published their World Malaria Report. AFM comments here on some aspects of the resolution and report.

Senate Hearings on USAID  -
The Senate Hearings on USAID's involvement in malaria control led to significant challenges to the agency's activities. Download the testimonies from USAID, Senator Sam Brownback, Professor Amir Attaran and AFM's Dr Roger Bate here.

Eliminate Neglected Diseases Act of 2005  -
Senator Sam Brownback's Eliminate Neglected Diseases Act of 2005 has been dropped in the US Senate. Read the Act and supporting documents here.

Taxed to Death  - Roger Bate, Richard Tren and Jasson Urbach
AFM publishes a working paper on the degree to which import tariffs, taxes and bureaucratic procedures block access to essential medicines in poor countries. See the latest version of this ongoing study here.

Despotism & Disease  - Richard Tren & Roger Bate
Africa Fighting Malaria report on the destruction of the Zimbabwean healthcare sector and the probable impacts on the entire region. Download the pdf version of this report here.

Ugandan Study Highlights Best Drug Combinations for Treating Malaria in Africa  - The Lancet
Results of a randomised trial from Uganda in this week’s issue of THE LANCET suggest that the drug combination of amodiaquine and sulfadoxine-pyrimethamine might offer the optimal treatment for malaria in terms of efficacy and cost-effectiveness in this region. The study also shows that the drug combination of chloroquine and sulfadoxine-pyrimethamine—the recommended first-line treatment in Uganda—is far less effective than other drug combinations.

Climate Change and Malaria  - Indur Goklany - with response from Sir David King
Indur Goklany offers some fascinating insights into climate change, malaria, poverty and development. Sir David King, the UK Government's chief scientific adviser gives a predicable response.

The Real Obstacles to Sound Treatment of AIDS in Poor Countries  - Roger Bate & Richard Tren
Writing for the American Enterprise Institute's Health Policy Outlook, Bate and Tren explore some of the reasons for low drug access in poor countries. Despite promises of cheap or free antiretroviral drugs, Bate and Tren argue that access to treatment in poor countries is abysmally low because of a lack of infrastructure, political indifference, excessive bureaucracy and taxes and tariffs.

South Africa's War Against Malaria - Lessons for the Developing World  - Richard Tren & Roger Bate
The Cato Institute published Richard Tren and Roger Bate's analysis of South Africa's recent history with malaria control. They argue that its policy on DDT use and Artemesinin based combination therapy provide excellent examples for other malarial countries.

SA's Leading Malaria Researchers Support DDT Use  -
South Africa’s leading malaria control experts, researchers and doctors support and endorse the use of the insecticide DDT to control malaria. Their statement is released in light of recent claims that DDT is harmful to human health and should be removed from South Africa’s malaria control programme.

South African Malaria Data  - SA Dept of Health
November 2003 - the malaria statistics show that malaria is still well under control in South Africa. A recent epidemic in the Limpopo Province was primarily caused by late spraying and poor case management.

South Africa Malaria Data  - SA Dept of Health
The latest data on malaria cases and deaths from South Africa show that the country's policy of indoor residual spraying with DDT (among other insecticides) and the use of artemesinin based combination therapy is working. KwaZulu Natal, traditionally the province with the worst malaria and the centre of the recent epidemic has only recorded 1 malaria death this year!

South Africa Malaria Statistics  - Dept of Health
The 11th Dept of Health Malaria Update shows the latest number of confirmed cases and deaths from malaria in the three malarial provinces of South Africa.

Saving Lives Today and Tomorrow  - Dr. Roger Bate
This paper analyses trends in drug development using data from the drug industry association, the Pharmaceutical Research and Manufacturers of America (PhRMA). Worryingly, the findings suggest that far fewer AIDS drugs are in development compared to several years ago, and at a time when drug development for other communicable diseases is increasing. There are several probable explanations for this phenomenon, but the least benign is the likelihood that continual pressure group and media attacks on the industry over pricing of drugs in Africa has reduced incentives for development of new AIDS medicines

South African Malaria Update  - SA Dept of Health
The latest malaria update from the Directorate of Communicable Diseases.

Home The Journal Current Issue Correspondence
Volume 362, Number 9378 12 July 2003

Correspondence

Counterfeit artesunate antimalarials in southeast Asia

Sir--Artesunate is the key antimalarial drug in the treatment of multidrug-resistant Plasmodium falciparum malaria in mainland southeast Asia. In China, Burma (Myanmar), Laos, Cambodia, and Vietnam it is widely available through the private sector. Widespread criminal production and distribution of counterfeit artesunate tablets in this region has resulted in the deaths of many people who would otherwise have survived their malaria infection. The spurious artesunate tablets contain no active drug. They are labelled to resemble a product, manufactured by Guilin Pharmaceutical Company, Guilin, People's Republic of China, that is the most commonly available brand of artesunate.1,2

In 2000-01, 38% of shop-bought oral artesunate sampled in Vietnam, Cambodia, Laos, and Burma, did not contain the active drug. However, the appearance of the packaging allowed detection of counterfeit tablets, which could be confirmed by the Fast-Red dye test.3 Some blisterpacks containing the fake tablets bore a poor, easily recognisable, copy of the genuine hologram.

During a more recent larger survey of fake antimalarials in this region, we noticed two new sophisticated fake hologram styles on artesunate blisterpacks in southern Laos and northern Cambodia (see www.shoklo-unit.com/fakeas2.pdf for photographs). High-performance liquid chromatography confirmed the absence of artesunate. The main distinguishing features of the first new counterfeit, from the genuine product are a different mountain silhouette and the absence of the legend Guilin Pharma written on the hologram. This can just be seen with the naked eye as a pale strip. The printing on the counterfeit blisterpack is less clear than that on the genuine product and all four samples collected were printed with the code 00902 and manufacture and expiry dates of 09/00 and 09/03.

Blisterpacks with a second fake hologram style, bought in southern Laos in 2003, are indistinguishable from the genuine hologram, apart from the absence of the microscopic legend Guilin Pharma. The samples collected have the code 010901 with manufacture and expiry dates of 09/01 and 09/04. Artesunate was collected from 22 pharmacies in southern Laos, of which 19 offered only counterfeit drug, all of which were labelled as made by Guilin Pharma.

Since these new counterfeits are so convincing, they are probably escaping detection elsewhere in Asia and could be disseminated to other continents. In Cambodia, a poster and television campaign warning the public of the existence of fake artesunate and informing them how to identify such tablets seems to have driven the trade in counterfeit artesunate underground.1 Health personnel will find the latest counterfeits much more difficult to identify, because they differ from the genuine product only in subtle characteristics.

Earlier reports1,2 of the scale of the problem seem to have had little effect and research on fake drugs seems to be an example of applied health research with minimum effect on health policy. International organisations, including WHO, have done little to counter this lethal trade. This inaction is partly because of the lack of resources available for the regulation and policing of the drug supply in tropical countries, the secrecy of the pharmaceutical industry, possible links between the counterfeiters and officials in the producing countries, and because the effects of fake antimalarials are disguised in the unrecognised deaths of the rural poor.4,5 Such failure to act contrasts with the recent rapid mobilisation of public-health resources to counter severe acute respiratory syndrome in the same region. We believe that urgent action is needed to find, prosecute, and close down the factories, collect and incinerate all suspect artesunate, prosecute the shops selling it, warn the public, and ensure that inexpensive quality-assured antimalarial drugs are made readily available. We gratefully acknowledge all who have helped with collecting drug samples and for the help of Shunmay Yeung. This work was part of the Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Programme funded by the Wellcome Trust, UK.

Paul N Newton, Arjen Dondorp, Michael Green, Mayfong Mayxay, *Nicholas J White


*Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand (AD, NJW); Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, UK (PNN, AD, NJW); Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Lao PDR (PNN, MM, NJW); and Division of Parasitic Diseases, CDC, Atlanta, Georgia, USA (MG) (e-mail:fnnjw@diamond.mahidol.ac.th)

1 Rozendaal J. Fake antimalarials circulating in Cambodia. Bull Mekong Malaria Forum 2000; 7: 62-68. [PubMed]

2 Newton PN, Proux S, Green M, et al. Fake artesunate in southeast Asia. Lancet 2001; 357: 1948-50. [Text]

3 Green MD, Mount DL, Wirtz RA. Authentication of artemether, artesunate and dihydroartemisinin antimalarial tablets using a simple colorimetric method. Trop Med Int Health 2001; 6: 980-82. [PubMed]

4 Cockburn R. Crime, fear and silence: making public the fake pharmaceutical drug racket. Proceedings of the First Global Forum on Pharmaceutical Anti-Counterfeiting. Geneva, Switzerland, Sept, 2002.

5 Newton PN, Rozendaal J, Green M, White NJ. Murder by fake drugs--time for international action. BMJ 2002; 324: 800-01. [PubMed]
The Lancet