Letter to Roll Back Malaria regarding guidelines for 2004-08

Roll Back Malaria's guidelines set to reverse more than five 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. November 28, 2003 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