NY Times Editorial – Malaria on the Rise; Lacks Global Lobby

Janu 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. … 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. 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 a
newer 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.

http://www.nytimes.com/2004/01/22/opinion/22THU3.html?ex=1075775234&ei=1&en=9a3841627fc3794c