HEALTH-AFRICA: WHO Urges Switch in Malaria Treatments

By Gustavo Capdevila Reprint | | Print |

Gustavo Capdevila

GENEVA, Apr 25 2002 (IPS) - The World Health Organisation (WHO) recommended Thursday that African countries speed up implementation of a new, more effective therapy to fight malaria, a disease that has developed resistance to conventional medicines.

The WHO position, announced on Africa Malaria Day, echoes the demands of humanitarian organisations – like Médicins Sans Frontières (Doctors without Borders) – for urgent action in adopting new malaria treatments.

Kamini Mendis, WHO adviser on treatment access, said this UN agency recognises that “the current drugs used to treat malaria are no longer working.”

The malaria parasite’s resistance to the two most widely used drugs presents a serious challenge for African countries. One of the medications, cloroquine, saved millions of lives over decades, and the other, sulfadoxine-pyrimethamine (SP, also known as Fansidar), is more recent in malaria treatment.

This resistance threatens to frustrate the African countries’ objective, declared in 2000 in Abuja, of halving the number of children who die of this disease within the next 10 years. The malaria death rate for minors in Africa currently stands at 800,000 annually.

In some countries, the death rate of children is increasing, mainly due to the problem of drug resistance, said Mendis.

To combat the advance of malaria, the WHO, through its “Roll Back Malaria” programme, is urging countries to modify treatments and to switch to what is known as combination therapy, which contains artemisinin, derived from a Chinese herb.

Artemisinin-Based Combination Therapies (ACTs) eliminate the malaria parasite very quickly, which permits the patient’s rapid recovery, and has very few side effects.

The Paris-based Médicins Sans Frontières (MSF) applauded the new WHO malaria policy and urged the designation of more resources for the immediate implementation of the disease-fighting campaign.

MSF issued an urgent call in February for African countries to make appropriate changes in therapies for treating malaria, a disease that affects 500 million people, more than eight percent of the world population.

Africa holds 90 percent of the world’s cases of the disease, the leading cause of death among children under five on that continent.

Bernard Pécoul, head of the MSF campaign for access to essential medicines, says the message sent Thursday by the WHO “is a very positive step.”

He added that MSF now challenges the WHO to outline a plan for supporting the immediate introduction of the artemisinin-based therapies in countries where malaria presents the highest levels of resistance to other treatments.

The international community is guilty of “wilful negligence”, said Pécoul, for having placed emphasis on prevention while ignoring the failure of current treatments to cure infected patients.

MSF reported that, in spite of the proven effectiveness of ACTs, many countries in East Africa, the region with highest resistance to conventional malaria medications, opted to introduce other variations of lesser efficacy.

One of the reasons for this, according to the humanitarian non- governmental organisation, has been the absence of clear guidelines from the WHO.

UN agency official Mendis told a press conference in Geneva Thursday that the decision to switch to the combination therapies had been taken by WHO experts in early 2001.

But implementation was delayed because policy change involving medicines or treatment for a disease like malaria requires the countries to take part in a “huge and complex process,” she said.

There is an inevitable delay, “mainly because financial difficulties mean that countries are reluctant to make the change,” said Mendis.

The problem will not be solved only with the treatment changes recommended by the WHO, as most African countries will require financial help to cover the larger expenditures for the new medicines.

The costs of the conventional drugs, cloroquine or sulfadox, are around six to seven cents on the dollar per adult patient. Meanwhile, the ACTs cost 1.5 to 2.5 dollars per patient.

Given the social characteristics of people with malaria, who are generally among the poorest sectors of society, these figures represent an enormous challenge, said Andrea Bosman, another WHO official.

“But this is the way forward”, she said. The costs for the malaria drugs are high, “but still much cheaper than many other treatments for other diseases.”

Mendis announced that the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria has decided to fund the dissemination of ACTs in Zanzibar (Tanzania) and Zambia.

In a message aimed at donor countries, Jean-Marie Kindermans, of MSF, stressed that at least 10 other African nations need financial support to halt the increasing resistance to malaria, which is associated with higher mortality rates.

The new ACTs are currently seeing only incipient application, covering just one percent of the infected population in Africa.

The artemisinin-derived drugs are more widely used in Southeast Asian countries, such as Vietnam, Thailand, China, Myanmar, where ACTs implementation began in the late 1970s and 1980s.

In South America, where the malaria parasite’s resistance to the older treatments is as high as in Asia, experts are studying the possibility of introducing ACTs to confront the disease.

In Central America, however, treatment with cloroquine is still producing satisfactory results.