Funds hamper those who need malaria drugs
30 April 2004
NEW YORK - Medicines to fight the rising malaria epidemic do not reach millions who need them because the money and the international commitment to supply the drugs are lacking, experts said at a conference here. Although malaria kills more than a million people a year - most of them African children - national and international policy makers show a "lack of urgency and political will" to use new treatments in the face of drug resistance, conference organizers said in a statement. Sponsors of the two-day symposium, which ends Friday, were Columbia University, UNICEF, the World Health Organization and the medical aid group Doctors Without Borders (MSF). New, highly effective combination therapies cost about $1 per treatment, but that is about 10 times the price of their predecessors, and donations have not kept pace. Some experts say $2 billion or more will be needed for drugs each year, but the two-year-old Global Fund to Fight AIDS, Tuberculosis and Malaria has spent a total of $2.1 billion for all three diseases, with 23 percent, or $491.4 million, going for malaria. Donors need to double or triple their contributions to the Global Fund, said Dr. Jean-Marie Kindermans of MSF, adding that he was "disappointed by discussions with donors" during the conference. With at least 300 million acute cases of malaria every year, experts also cited concerns over long lead times to produce the newer drugs. MSF urged using incentives for manufacturers to avert a shortage and consequent price increases. "One clear barrier that seems to be the most difficult to surmount is the financial barrier," Dr. Ronald Waldman, deputy director of Columbia's Center for Global Health, told journalists Thursday. "Those people in charge of the money are spending it on other places, like Iraq." Waldman said health budgets for developing countries remain constant even as costs increase. It would be "a very bitter pill," he added, if purchasing effective anti-malaria medicines cut into other care. Resistance to two widely used malaria medications, chloroquine and sulfadoxine-pyrimethamine, is on the rise; in some areas, it has reached 80 percent. Death rates are climbing, too, despite WHO's Roll Back Malaria program, launched six years ago to cut deaths from malaria in half by 2010. Combination drug therapies using artemisinin, derived from an Asian plant, and synthetic compounds have proved highly effective against the malaria parasite, which is transmitted by mosquitos. WHO now recommends that all countries experiencing resistance to conventional malaria medicines use combination therapies, preferably including artemisinin derivatives. Dr. Fatomata Nafo-Traore, Roll Back Malaria director, and other conference organizers said an article in the British medical journal The Lancet in January helped spur new tactics. The authors accused WHO, the Global Fund and others of "medical malpractice in malaria treatment" for continuing to use older medicines in areas of high drug resistance. "Thankfully, WHO has (since) been much more aggressive about doing the right thing," Amir Attaran, lead author of the article, told The Associated Press by telephone. "Media pressure has been instrumental where science has not been." Other organizations have not improved their practices, he said, singling out the U.S. Agency for International Development as "the most perfidious" and accusing it of pressuring African governments not to seek funds for ACTs. It could cost $2 billion to $3 billion a year to get ACTs to Africa, but that would be "a huge bargain" because sickness and death from malaria deepen poverty and prevent development, said Attaran, of the Royal Institute of International Affairs in London. Dr. Anne Peterson of USAID defended the agency, saying it is "actively promoting the transition to ACTs, but there isn't enough of the drugs for everybody." It spends its funds on preventing malaria infections and providing technical advice to African governments, rather than buying drugs, she told The AP by telephone. USAID chief Andrew Natsios has said the agency sees ACTs as "the most effective malaria treatment" and will spend $83 million on malaria this year and give $398 million to the Global Fund. Nafo-Traore said the number of countries using or planning to use ACTs has climbed from half a dozen last year to about 30 now. Anti-malaria efforts include preventive measures such as mosquito nets and insecticides, she added. As funding and the ability to supply the drugs improve, WHO expects demand for ACTs to rise to 200 million treatments by the end of 2005 and to 1 billion a year thereafter. "The next step is how to respond to this increase in demand," Nafo-Traore said.