[afro-nets] Need for Effective Malaria Treatment

[Claudio Schuftan <claudio@hcmc.netnam.vn>]

More than 600 Million People Urgently Need Effective Malaria
Treatment to Prevent Unacceptably High Death Rates
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Geneva - More than 600 million people, most of them children
living in sub-Saharan Africa, face the daily threat of death
from malaria because new, effective treatments are not available
where they live. Existing, cheaper medicines, which have been
used for many years, are no longer effective in most places be-
cause the malaria parasite has developed resistance to them.

"At least one million children die every year in Africa from ma-
laria. Several million more become seriously ill. In many
places, they are still given medicines whose effectiveness is
very low and decreasing," said Dr Lee Jong-wook, Director-
General of the World Health Organization (WHO). "Better treat-
ment is available and must be delivered urgently to the people
who need it most."

Artemisinin-based combination therapies (ACTs) provide a highly
effective new medicine to treat malaria for the first time in
more than 20 years. But despite some progress, the new treatment
has not become available as widely or as quickly as it needs to.

Since April 2001, WHO has strongly recommended that countries
where there is resistance to conventional treatments should
switch to ACTs. However, at around US$ 2 for an adult dose, ACTs
cost 10-20 times as much as the old monotherapies such as
chloroquine. For most countries in Africa, external funding will
be required.

In 2002, the Global Fund to Fight AIDS, TB and Malaria started
to make significant funds available to countries in need. Since
then, six countries in Africa have started using ACTs: Burundi,
Mozambique, Senegal, South Africa, Zambia, and Zanzibar.

In the past 12 months, an additional nine countries in Africa
have adopted ACTs in their antimalarial treatment policies: Be-
nin, Cameroon, Comoros, Gabon, Ghana, Equatorial Guinea, Kenya,
Sao Tome and Principe, and the United Republic of Tanzania. Oth-
ers are likely to follow suit this year. Outside Africa, 14 ma-
laria endemic countries have adopted an ACT policy.

Throughout this process, WHO has provided technical advice and
support to ministries of health on all aspects of national
treatment policy change, including monitoring the therapeutic
efficacy of medicines, as well as implementation.

"We will continue to strongly advocate for rapid scale-up of
ACTs," said Dr Jack Chow, Assistant Director-General for
HIV/AIDS, Tuberculosis and Malaria at WHO. "Some countries are
still reluctant to adopt ACT treatment policies because it is
much more expensive than conventional therapies. Countries feel
insecure about the sustainability of donor support as they
switch to more costly treatment regimes. However, the progress
we have witnessed over the last 12 months is remarkable in terms
of its speed and the number of countries changing their poli-
cies."

WHO estimates that the global demand for ACTs will soar from
about 20 million per year currently to between 130-220 million
adult treatments in 2005. In the following years and at the cur-
rent price, about US$ 1 billion per year will be required to
provide 60% of the population in need with ACTs. Much of this
money will have to come from donor countries and funding insti-
tutions such as the Global Fund.

Together with Roll Back Malaria (RBM) partners, WHO works for
lower prices to reduce the cost of making quality ACT products
available to the poor. "While private-public cooperation can be
instrumental, we have learnt that it is wrong to wait for the
prices to go down," said Dr Fatoumata Nafo-Traoré, Director of
WHO's Roll Back Malaria Department. "Increased demand is the
main factor that will drive down prices."

WHO's renewed call for a more rapid change to ACTs comes as the
world commemorates Africa Malaria Day. This year's theme is
"children for children to roll back malaria". Young children un-
der five are the main victims of malaria. They have a right to
be protected, but in reality they do not have access to life-
saving treatment because their parents are poor.

Increased access to effective medicines, together with the im-
proved use of technology to prevent malaria transmission, could
enable much better progress towards the RBM targets, set by Af-
rican leaders in 2000 [1]. In the area of prevention, WHO also
notes important technological progress since 1998, despite in-
adequate funding. According to the Africa Malaria Report 2003,
about 15% of African children slept under mosquito nets and 2%
under insecticide-treated nets, which are known to be highly ef-
fective. Although these rates are far from satisfactory, the
adoption of mosquito nets throughout Africa reflects a profound,
even if incipient, change in behaviour and attitude. Such prac-
tice was unknown to most rural African populations until the
late 1990s.

"This is a significant improvement," says Dr Nafo-Traoré. "How-
ever, we are still far from reaching our reduction targets, be-
cause the fight against malaria has been so dreadfully under-
funded." The situation has improved considerably since the emer-
gence of the Global Fund, but not enough. Until and unless most
people can afford to buy their own bednets and pay for their own
treatment, substantial public funding will continue to be
needed."

--
[1] Four years ago, 44 Heads of State and Government from the 50
malaria-affected countries in Africa came together in Abuja, Ni-
geria, to set ambitious targets to reduce the malaria burden by
the end of 2005. They committed themselves to work to improve
access to affordable and appropriate treatment for at least 60%
of those suffering from malaria. In the area of prevention, they
agreed that at least 60% of those at risk of malaria should be
protected by insecticide-treated mosquito nets and other commu-
nity preventive measures, and that at least 60% of pregnant
women should have access to intermittent preventive treatment.