Geneva, April 25, 2002 — On Africa Malaria Day, as drug resistance sweeps across the continent and ever more African children die of this treatable disease, the World Health Organization (WHO) publicly urges countries to switch to newer more effective medicines. Doctors Without Borders/Médecins Sans Frontières (MSF) welcomes this new policy and calls for increased funds to aid immediate implementation.
Because of growing resistance to classical antimalarials such as chloroquine and Fansidar®, experts now strongly recommend the use of drug combinations containing artemisinin derivatives. These drugs have been used successfully in China for decades and in South East Asia for more than ten years. In 2001, when the South African province KwaZulu Natal changed to artemisinin-based combination treatment (ACT) and introduced prevention measures, malaria deaths were reduced by 87% compared to 2000.
But despite evidence of ACT effectiveness, many countries in East Africa—the region with the highest levels of resistance to common anti-malarials—have switched to other, sub-optimal choices. Until today, one reason was the lack of clear guidance from WHO.
"The international community has been guilty of wilful neglect by stressing prevention while ignoring the fact that current treatment strategies are failing to cure patients," said Dr Bernard Pécoul, director of MSF's Campaign for Access to Essential Medicines. "This new message from WHO is a very positive step forward. Now we challenge WHO to clearly lay out how it plans to support rapid introduction of ACT in countries with high levels of resistance."
A key barrier to switching to ACT is that it is ten to twenty times more expensive than currently used antimalarials. MSF calls on WHO to identify and validate additional and less expensive sources of artemisinin derivatives. MSF also urges governments of endemic countries to increase their funding for malaria and calls on international donors to proactively support change to more effective treatments. This year, Africa Malaria Day coincides with the announcements of the first grants by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Zambia and Zanzibar have both requested funds from the Global Fund to implement ACT.
"When Zambia first decided to change its national protocol to more effective malaria treatment, some donors opposed this more expensive choice," said Dr Jean-Marie Kindermans from Médecins Sans Frontières (MSF). "If Zambia and Zanzibar are granted money, it will be a very positive sign that the Global Fund has endorsed the use of more effective malaria treatment. But we shouldn't forget that there are at least ten other African countries that urgently need financial support to stem mounting resistance and associated mortality."
In projects where MSF is dispensing malaria treatment in Africa, artemisinin-based combinations are beginning to be introduced. ACT is being provided in Congo Brazzaville, Kenya, Liberia, Sierra Leone, Sudan, and Zambia. In addition to improving individuals' treatments, these malaria projects will provide data to assist health authorities in future national implementation.
Artemisinin derivatives are fast-acting and highly potent drugs. When used in combination with a second drug, artemisinin derivatives appear to slow the development of resistance to the second drug. To date, no resistance to artemisinin drugs has been reported.