Malaria on the Rise
January 22, 2004
Malaria, a disease forgotten in wealthy countries, is advancing, killing a million people or more a year, at least 700,000 of them African children. In many nations, some people spend several months a year ill from malaria, a toll that cripples African economies. One reason for malaria's resurgence is that it has evolved to resist the two standard treatments. In East Africa, chloroquine, the most widely used drug, fails two-thirds of the time, and anewer treatment is useless in nearly half of the cases.
A better treatment exists, but the world is adopting it far too slowly. It is a two-drug therapy that includes artemisinin, a Chinese plant used against malaria in herbal form for thousands of years. The combination therapy works 95 percent of the time, prevents disease transmission to others and is slow to provoke resistance.Yet only 6 of the 42 African nations with endemic malaria - whose decisions are heavily constrained by outsiders - have changed drugs. For two years, Doctors Without Borders has been arguing that the global malaria establishment, especially influential donors like the United States Agency for International Development, has been dragging its feet. An article published last week in the medical journal The Lancet provides evidence that international health organizations are pushing countries to continue to use
drugs they know do not work.
The main reason is cost. A chloroquine dose costs a few pennies. The best price available for the artemisinin-based combination therapy is 40 cents for a child's treatment and $1.50 for an adult's. That may not sound like much. But until recently, poor countries bore the cost of drugs themselves. Many sick people cannot pay 40 cents. Wealthy countries are going to have to pay for the more expensive drugs. The Global Fund to Fight AIDS, Tuberculosis and Malaria is now doing this, but the fund has very little money. Changing drugs requires countries to adapt health care services and find ways to get people to finish a three-day treatment. Countries will not switch unless they are sure of steady financing for the new drugs. The underlying problem is that most people who die of malaria are poor rural children, and the disease has been eradicated in most wealthy nations. The lack of a global lobby against malaria has brought the world to the sad, absurd point where organizations dedicated to saving lives are pushing drugs that they know will allow children to
die.
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