HEALTH: Ethiopia Blasts MSF For Advocating Alternative Malaria Treatment

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Sonny Inbaraj

ADDIS ABABA, Dec 28 2003 (IPS) - Ethiopia’s health ministry and the aid agency Medecins Sans Frontiers are at loggerheads over the use of a cocktail of drugs for malaria treatment in an epidemic that is threatening 15 million Ethiopians.

Health Minister Kebede Tadesse accused the aid agency, or MSF, of embarking on a concerted campaign of misinformation and peddling “new and uncalled for drugs and treatment regimes”.

“We would like to point out that any health authority of a sovereign and democratic country, however poor and short of essential resources it may be, is duty bound to strictly follow the rules and regulations set by its government,” Tadesse told a news conference in Addis Ababa this week.

“It would also be expected to have in place an independent body to regulate the quality, rational use and the manner in which new drugs and medical supplies are introduced to the community,” he added.

Tadesse said it was unbecoming of MSF to try to disrupt such norms and good standards of ethical practice.

MSF is urging the Ethiopian government to implement a new treatment involving a combination of drugs that have been given preliminary approval by the World Health Organization (WHO).

According to the MSF, the combination treatment should be used now because an increasing number of malaria victims were developing resistance to treatment by conventional drugs.

“We are seeing patients who have been treated but still displaying the same malaria symptoms. When they are diagnosed, they are still testing positive,” said Annick Hamel, MSF spokesperson in Ethiopia.

“If there is a high-level of resistance we could assume that the best available treatment is not being used,” added Hamel.

The 24th African Health Science Congress, held in Addis Ababa in September, expressed concern over the prevalence of malaria in Ethiopia.

“Traditional approaches to malaria control, such as spraying are not sustainable and resistance has developed to most existing anti-malaria medications,” said the congress statement.

But the Ethiopian ministry of health has already started a study on alternative drug treatments called Artemisinin Combination Therapies or ACT. The ACT pilot study results, according to Health Minister Tadesse, are expected to be announced next month.

“ACT follows the recommendation of WHO as well as internationally accepted standards of the introduction of new drugs and we are doing it ethically,” said Tadesse.

“You cannot introduce a drug because somebody is dying. You don’t introduce a new drug because there is an epidemic. We cannot test it on dying people. This is unethical,” stressed the minister.

According to latest figures issued by the Health Ministry, 45.6 million Ethiopians are living in areas where malaria could occur, out of a population of 70 million, and 15 million people are in direct threat of the disease.

Malaria is the leading cause of mortality in children under five, and the third killer disease in Ethiopia. Five million cases are reported annually and the ministry expects a three-fold increase during the epidemic.

Bjorn Ljungqvist, Ethiopia representative of the United Nations Children’s Fund (UNICEF), said malaria cases were rising sharply in the Oromia, Amhara and Southern Nations regions of Ethiopia.

“We’re trying to get better data on the mortality rates but all indications from the data we have from the Oromia, Amhara and Southern Nations regions shows that there is a malaria increase in epidemic proportions in many areas,” he said.

“But we don’t really know how many are actually succumbing to the disease.

We are now getting figures, but it’s just bits and pieces here and there,” added Ljungqvist.

Yohannes Hailemichael, head of the Wollega Health Bureau in the Oromia region, told Radio Ethiopia recently that malaria was spreading alarmingly in his area.

“Unless the current situation is given immediate attention by the concerned bodies, a good number of people will die,” Hailemichael said.

UNICEF and WHO are supplying anti-malarial drugs to the Ethiopian government in response to the current malaria epidemic.

Presently four different drugs are being used in the country and they include oral and intravenous quinine, suphadoxine-pyrimethamine or Fansidar, Chloroquine and Primaquine.

But UNICEF is concerned about the cost factor in using ACT as an alternative drug therapy. In October, the United Nations launched an appeal for 5.8 million dollars to help fight the epidemic but is still facing a million dollar shortfall.

“Alternative drug therapies, like ACT, can cost up to 10 times more and because of potential limitations in use for some populations, like very young children and pregnant women, may not be used outside of supervised settings,” said a UNICEF statement.

“In the context of the current epidemic in Ethiopia, that translates into an additional cost of 22 to 30 million dollars for drugs for 15 million estimated cases of malaria, which is not affordable with available resources,” added the statement.

In addition, said UNICEF, there was not enough manufactured ACT available to meet the current demand of the epidemic.