HEALTH-AFRICA: Donors Must Join Fight against Malaria, Says MSF

By Gustavo Capdevila Reprint | | Print |

Gustavo Capdevila

GENEVA, Feb 14 2002 (IPS) - Doctors without Borders (Médicins Sans Frontières, MSF) warned the health ministers of East African countries Wednesday that the ill-advised changes in malaria treatments could cause fatalities, and urged donor countries to join in “effective, long-term” efforts to fight the disease.

The new malaria treatments should include combinations of drugs that contain derivatives of artemisinin, a pharmaceutical extracted from a plant originating in China, according to a report presented by MSF spokeswoman in Geneva, Ingrid Cox.

Artemisinin possesses qualities that make it a particularly effective drug, because it acts quickly, is potent and complements other types of treatments, says the Paris-based humanitarian organisation.

This medication’s most important trait is its ability to prevent the development of resistance to antimalarial drugs.

The health protocols in East African countries traditionally recommended chloroquine or fansidar for treatment of malaria cases without complications, but the past few years have seen a dramatic increase in parasite resistance to these drugs.

The British science journal “Nature” said last week that there has been a resurgence of malaria worldwide.

Among the causes for this phenomenon, says Nature, is the fact that the parasite that causes the disease has developed drug- resistant strains.

Environmental changes are also a factor because they affect the mosquito population, which are the vectors of the parasite.

There are some 500 million recorded cases of malaria, or nearly 10 percent of the world population, but 90 percent of the ill are found in Africa, where the disease is the principal cause of death among children under age five.

Jean-Marie Kindermans, author of the MSF report, said health experts recommend responding to the new strains of the disease with a combination of drugs that have proven more effective and require shorter treatment times.

However, these combinations, which include artemisinin derivatives, are more costly.

As a result, health ministers are considering protocols based on transition strategies, due to the lack of financial resources and to the fact that donor nations prefer the most economic options.

These malaria policies use drugs that are “the equivalent to giving some patients placebos,” says MSF.

Diane Cheynier, an MSF doctor who works in Burundi, lamented that while appropriate medicine is available, it is not being distributed. “Treatment exists that can prevent people dying unnecessarily,” she said.

“With the help of donors, African governments can avoid the fatal error of going to stopgap, band-aid solutions,” said Cheynier.

Doctors without Borders recognises that the higher cost of more effective drugs is “one of the chief barriers to widespread implementation in the public sector.”

The antimalarial drug combinations currently being administered cost just 25 cents on the dollar per adult dose, while the more effective combinations with artemisinin derivatives cost approximately 1.30 dollars per dose.

The MSF report states that for the five countries studied – Burundi, Kenya, Rwanda, Tanzania and Uganda – the total additional costs required for implementing the more effective drug combinations would be just 19 million dollars a year and would save countless lives.

“The cost of switching to effective combinations rather than combinations which are often no better than placebos is affordable if international donors are willing to help,” stated Kindermans.

Rwanda, with 1.2 million cases of malaria reported each year in a population of 7.2 million, would need an additional 945,000 dollars to introduce the artemisinin-based drug combinations.

For Burundi, with two million malaria cases in a population of 6.5 million, the extra costs would total 1.6 million dollars a year.

But MSF calculates that by 2004 the price of the artemisinin combinations could fall from 1.3 dollars a dose to just 60 cents.

If that forecast holds true, the five countries would need just 6.3 million dollars a year, compared to the 19 million required today.

“As doctors, we seek effective treatments. We cannot continue prescribing antimalarial treatments like fansidar, which we know will not cure the patient,” said Christopher Fournier, head of the MSF programme in Burundi.

Doctors without Borders is calling for antimalarial drugs being produced in Asia today to be made available to the ill in Africa as soon as possible.

Agencies of the United Nations have a role to play, and the World Health Organisation (WHO) must expand its system for prequalifying drugs for HIV/AIDS to include malaria drugs, says MSF.

The humanitarian organisation maintains that donors have the ethical responsibility to ensure that medical treatments are appropriate from the medical standpoint.