Artemisinin and Malaria

[Guest guest]

Hi all,

 

I remember some articles regarding this but don't remember if this one

was one of them. If it was, sorry!

 

Daniel C. Luthi

 

 

Global fund changes tack on malaria therapy

 

DECLAN BUTLER, Nature 429, 588 (10 June 2004); doi:10.1038/429588a

[PARIS] An outcry from researchers has helped prompt a move to switch

malaria treatment in Africa to a more effective therapy. The drug,

artemisinin, comes from a Chinese herb, and cures 90% of patients in

three days.

But aid donors have shrunk from promoting artemisinin, largely because

it costs at least ten times more than established malaria treatments,

to which the parasite that causes the disease has grown resistant.

At a closed meeting last month, the Geneva-based Global Fund to Fight

AIDS, Tuberculosis and Malaria agreed to instruct African countries to

retrospectively modify all malaria grants awarded to specify only the

newer drug. The move will cost the fund more than a billion dollars

over the next five years, says Vinand Nantulya, one of its senior

officials.

All future funding will stipulate the use of artemisinin. The policy

change is expected to force most countries to change their national

drug policies. " Money talks, " says Allan Schapira, coordinator of

malaria policy and strategy at the Roll Back Malaria team of the World

Health Organization (WHO).

Nantulya admits that the move was given " further impetus " by the

discussion that followed publication of an article in The Lancet in

January in which prominent scientists accused the fund and the WHO of

" malpractice " for bowing to pressure from aid-giving countries. They

also cautioned against the use of out-dated drugs (Lancet 363,

237–240; 2004).

Donors such as the United States and Britain had discouraged African

countries from adopting artemisinin on the grounds that it cost too

much, that data on its effect in children were insufficient, and that

it was not needed in regions where other anti-malaria drugs still

worked, says Amir Attaran of the Royal Institute of International

Affairs in London, and the article's lead author.

In 2002, the WHO recommended artemisinin as the treatment of choice,

but in Africa only Zambia and Zanzibar have adopted it.

The growing resistance of the malaria parasite Plasmodium falciparum

to chloroquine and sulfadoxine–pyrimethamine, the mainstay of

treatments in Africa — where 90% of global malaria deaths occur — has

also damaged the lofty ambitions of the Roll Back Malaria initiative.

This was launched in 1998, with the goal of halving malaria deaths by

2010.

But deaths are up, not down, and mortality rates of treated patients

are doubling in many parts of Africa. John Lidén, a spokesman for the

Global Fund, says that it revisited resistance data from the WHO and

other sources, and that this " composite set " convinced it to act. " We

are results-based, " he says, " and if we find we are paying for

medicines that don't work, we want to pay for those that do. "

The higher cost of artemisinin means that African countries will spend

their revised grants more rapidly than they had intended. The drug

costs about US$2 for each adult treatment, compared with ten cents for

existing drugs. Its price is expected to fall to about $1 with

improvements in production.

Countries might be allowed to apply for further grants in advance to

make up the loss, Lidén says, and donors may be asked to release an

additional $1 billion to pay for the drug. " I appeal to the donor

community to recognize that moving countries to using the right drugs

will require much more money, " says Nantulya, " They must take this

seriously. "