Malaria drug need is ignored

Africans still rely on inferior therapy
Nairobi, Feb. 14 - Until being overtaken by AIDS in recent years, malaria killed more Africans than anything else. Its thrashing fevers remain the leading cause of death for the continent's children; as many as 1.8 million of them succumb to malaria each year. Yet while Western governments have been pressured into providing costly and complicated drugs to treat AIDS, a simple, effective and relatively inexpensive new malaria treatment has been largely ignored by African governments and the Western donors that often fund their health programs, an aid agency charged today. Medecins Sans Frontieres (MSF) , the Paris-based humanitarian organization that spearheaded the campaign to make AIDS drugs available in Africa, said that hundreds of thousands of malaria patients might be saved by a new generation of Chinese-made treatments. But even at $1.30 per treatment, the new medicine is regarded as too expensive by one of the wealthiest donors, the U.S. Agency for International Development (USAID), according to the advocates. "The only ones we've heard fighting against it is USAID," Daniel Berman of MSF said at a news conference today. The private aid agency, which won the 1999 Nobel Peace Prize, also lambasted the World Health Organization for failing to promote the new medicines, known as artemisinin derivatives. Instead, the U.N. body, chartered to assist the poorest nations on health matters, has emphasized preventing the mosquito-borne disease through the use of mosquito nets, "because bed nets are not controversial," Berman said. The controversy is purely financial. The new, more effective drugs are expensive by African standards, and the people who would benefit by them are too poor to buy them, making it impossible to generate the economies of scale that eventually would bring prices down. No patent or other trade barriers stand in the way of mass distribution, as was the case with AIDS drugs. And in Western terms, the cost is small: $19 million a year would pay for treatment in five East African countries, according to MSF. Yet in countries where USAID funds drug purchases, such as Congo, U.S. officials continue to recommend less effective drugs, citing their own budget constraints, Berman said. "In a meeting with us in Washington, USAID said, 'We're not going to recommend a drug we can't pay for.' " A U.S. official in Nairobi defended the policy. "Sometimes the perfect is the enemy of the good," said the official, speaking on condition of anonymity. "State of the art is fine, but poor people tend not to be able to afford it." The consequences are dire. Without the extra $1.05 that might save a child's life, African health ministries continue to prescribe cheaper but increasingly less potent treatments that were developed 50 to 75 years ago. Those drugs, chloroquine and Fansidar, cost just 25 cents. The initial effectiveness of those drugs against the parasite that causes malaria has greatly diminished over the years. As generations of patients have used the drugs improperly, taking only one or two pills rather than a full course, generations of the parasite have developed a resistance to the compounds. Today, in the East African nation of Tanzania, chloroquine has no impact on between 28 percent and 72 percent of malaria cases, according to statistics gathered by Medecins Sans Frontieres (MSF) , and 15 percent to 34 percent of cases prove resistant to Fansidar. Other countries in the region report similar resistance rates - almost always well above the 25 percent threshold that the World Health Organization says should prompt health ministries to recommend another drug. But health ministries say they cannot afford to recommend the new drug. They cite annual health budgets that seldom reach above $20 per capita, making prohibitive the $1.30 needed to supply the drug in the government clinics that the great majority of impoverished Africans rely upon. Instead, the health officials, who are meeting in Nairobi this week, reluctantly approve national protocols calling for a combination of chloroquine and Fansidar. © 2002 The Washington Post Company