Dear Dr. Nafo-Traoré,
To: Dr. Fatoumata Nafo-Traoré Executive Secretary Roll Back Malaria Partnership cc: Dr. Yves Bergevin Roll Back Malaria Secretariat
As experts and health workers committed to improve health care in the developing world, we are extremely concerned and alarmed by the newly released draft Roll Back Malaria (RBM) guidelines for 2004-08, which represent a major backward step in malaria control. Malaria is killing up to two million people every year, most of whom are children in Africa.
Despite best efforts to date, global control of this lethal disease has failed, and infection and death rates are rising. Effective malaria control requires effective prevention and treatment programmes. While the international community is putting significant efforts to improve prevention measures, treatment is becoming increasingly difficult because of loss of inexpensive drugs (chloroquine and sulfadoxine-pyrimethamine [SP]) to resistance.
These drugs simply do not work now in much of the malaria affected world. In 2001, the World Health Organization (WHO) took the lead in acknowledging the need to bring effective treatments to those affected by epidemics of this devastating disease, advocating the use of artemisinin-based combination therapy (ACT). It was also recommended that any country changing national antimalarial drug policy should change to ACTs.
It is well established that ACTs are the most rapidly and reliably effective antimalarial drugs. Increased use of ACTs has led to a fall in drug prices; today it cost less than $US1 to save the life of a child with malaria using these drugs. However, chloroquine and SP continue to be provided by donors and still recommended in many African countries, leading to avoidable death and wasted resources. These ineffective drugs are often the only available antimalarials. There is an urgent and pressing need to increase the availability of ACTs to replace these failing drugs.
The new RBM strategy sacrifices life-saving treatment to narrow cost-effectiveness considerations, and chooses instead to focus mainly on prevention of malaria. Emphasizing prevention alone for such a common killing disease will certainly not "roll back malaria". It is widely accepted in the field of HIV/AIDS that there are medical, macro-economic, social, moral, and ethical imperatives to provide life-extending treatment to the 6 million people who are in need. Why is malaria, which is so much easier to treat, any different? RBM's guidelines set to reverse more than 5 years of consultation and expert opinion in the field of global control of malaria.
We believe that "Rolling Back Malaria" is possible with effective vector control and effective treatment, and that it is not the time to abandon this important initiative. We call on the WHO for an urgent and complete rethinking of the RBM 2004-08 strategy based on a comprehensive review of available evidence and genuine expert field experience. If RBM is truly committed to reducing the number of deaths from malaria as soon as possible, it should strive to provide technical support to assist countries to implement effective diagnostic tools and widespread ACT use now, and push for increased donor money to support this.
Sincerely,
Dr Abdullah Ali
Malaria Programme Manager Zanzibar
Dr. Fred Binka
School of Public Health, University of Ghana Ghana
Prof. Philippe Brasseur
Institut de Recherche pour le Développement Senegal
Professor Oumar Gaye
Coordinator of the RAOTAP1/WAMTN West African antimalarial treatment network Senegal
Dr. F. K. Kato
Senior Medical Officer, Malaria Control Programme, Ministry of Health – Kampala Uganda.
Dr T.K. Mutabingwa
Chairman of EANMAT Tanzania
Prof. Robert Snow
Head Malaria Public Health Group KEMRI/Wellcome Trust Collaborative Program Kenya
Dr. François Nosten
Director SMRU Shoklo Malaria Research Unit Thailand
Prof. Nick White
Wellcome Trust Mahidol University Oxford Tropical Medicine Research Programme Faculty of Tropical Medicine - Mahidol University, Bangkok Thailand
Prof. Barry R. Bloom, PhD
Dean, Harvard School of Public Health Professor of Immunology and Infectious Diseases Harvard University USA
Prof. Carol Hopkins Sibley
Professor of Genome Sciences University of Washington- Seattle USA
Allan Rosenfield,
MD Dean, Mailman School of Public Health DeLamar Professor of Public Health Columbia University USA
Ron Waldman, MD, MPH
Center for Global Health and Economic Development Mailman School of Public Health Columbia University USA
Prof. Dyann Wirth, Ph.D.
Professor, Infectious Diseases, Department of Immunology and Infectious Diseases Harvard University School of Publich Health Director, Harvard Malaria Initiative Harvard University USA
Prof. Dr. Marleen Boelaert
Public Health Department Prince Léopold Tropical Medicine Institute - Antwerpen Belgium
Docteur Paolo Chiodini
Responsable des projets CUAMM Italy
Prof. Umberto D'Alessandro
Head Epidemiology Unit, Dept Parasitology Institute Tropical Medicine - Antwerp, Belgium
Pr Martin Danis
Parasitology, University Hospital Pitié-Salpêtrière, Pierre et Marie Curie-Paris 6 University France
Dr Cristiana De Lorenzi
Alisei Italy
Dr. Pierre Druilhe
Head of the BioMedical parasitology Unit Institut Pasteur France
Suzanne Fustukian
Lecturer, Centre for International Health Studies Queen Margaret University College – Edinburgh United Kingdom
Prof. Massimo Galli
Director of the Infectious Diseases Institute University of Milan Italy
Dr Philippe J Guerin
Scientific Director Epicentre - Paris France
Dr. Christa Hook
Malaria expert, Médecins Sans Frontières United Kingdom
Prof. Giuseppe Ippolito
Scientific Director of the National Institute of Infectious Diseases Lazzaro Spallanzani, Rome Italy
Dr. Jean-Marie Kindermans
Malaria Access Campaign Médecins Sans Frontières Belgium
Dr. Marina Madeo
Health Department coordinator ONG COOPI Italy
Prof. Mauro Moroni
Coordinator Infectious diseases department L. Sacco Hospital, Milan Italy
Dr. Bernard Pécoul
Director Access to medicines campaign Médecins Sans Frontières Switzerland
Dr. W. M. Watkins
Wellcome Trust Fellow, Department of Pharmacology & Therapeutics, University of Liverpool United Kingdom
Prof. Nick Anstey
Head, International Health Program Menzies School of Health Research, Darwin, Australia
Dr. Dave Durrheim, MPH&TM, DrPH
Associate Professor James Cook University Head of School of Public Health and Tropical Medicine and Director of the Anton Breinl Centre of Public Health and Tropical Medicine Australia
Dr Ric Price
Senior Researcher - Menzies School of Health Research, Darwin, Australia
Dr A.Talisuna
Ministry of Health Member of the EANMAT secretariat Uganda
Dr Karen I Barnes
University of Cape Town Division of Pharmacology South Africa
Arjen M Dondorp, MD, PhD
Deputy Director Wellcome Trust Unit Bangkok Wellcome-Mahidol University-Oxford Tropical Medicine Research Programme Faculty of Tropical Medicine - Bangkok Thailand
Dr Francis N Muu
MBChB, MMed (Paed), MSc (Community Health) National Health Coordinator World Vision Kenya Nairobi, Kenya