May 13, 2010
Despite the existence of effective treatments, malaria kills a million people every year, primarily small children. It s critical that malaria infections are treated immediately with effective drugs because children can die from a serious case of malaria in a matter of a few days. However, in many malaria endemic regions, the only access to malaria drugs is through local, private, small-scale vendors. Accessing malaria drugs in a timely manner is challenging in communities that are poorly served by the market for effective antimalarials or long distances from the drug suppliers. For those who can access drugs in the private market, the drugs that are cheapest and easiest to obtain are often older drugs that have been made obsolete by resistance. For example, chloroquine is one of the cheapest available drugs, but it is no longer reliably effective against the P. Falciparum malaria parasite in most parts of the world. In Africa, it fails to clear parasites over 40% of the time and in Asia and South America it is even less effective (1). Those who buy chloroquine because it is cheap and easy to find are at risk of treatment failure during the critical 2-3 day window where a child’s death can be prevented. Alternatively, more expensive artemisinin monotherapies are available for purchase; although these are less likely to fail than chloroquine, using artemisinin as a monotherapy makes it very easy for resistance to artemisinin to evolve very quickly so the use of monotherapies is a significant public health problem. This is why drugs that combine artemisinin with other antimalarial agents to form a combination therapy are most recommended Artemisinin-based combination therapies (ACTs).
Resistance to artemisinins is quickly becoming a serious problem, and it is important to take steps to maintain the drug s effectiveness. Towards this end, CDDEP researchers contributed to the Affordable Medicines Facility for Malaria (AMFm) a financing mechanism that creates a global subsidy for the therapeutically effective and less resistance-prone artemisinin combination therapies (ACTs). AMFm will subsidize ACTs at the very top of the private market supply chain so that when the drugs reach the consumer the costs of ACTs will have dropped from US$6-10 per treatment to US$0.20-0.50 and they will be able to outsell the less effective and resistance-causing drugs . Last July, the Global Fund to Fight Aids, Tuberculosis and Malaria adopted AMFm model and agreed to be the funder (2).
Update:
However, this solution does not take into account a ubiquitous problem in the developing countries with a serious malaria burden counterfeit malaria drugs. Counterfeit drugs, at best, can be medically useless, and, at worst, can be toxic or can exacerbate drug resistance when they contain diluted amounts of real drugs. A recent Bloomberg article highlighted an innovative approach to combating the problem of counterfeit malaria drugs in Africa that utilizes existing and widely available technology cell phones. Beginning in December, the Ghanaian non-profit mPedigree will introduce a system that will add unique medication ID codes to malaria medication packages. Patients can scratch-off a panel to reveal the code and then can text it to a verification hotline, which will respond with a NO or OK indicating the drug s validity and also confirming the name, expiration date and other information. The text messages will be free to send and receive so it will not be a problem to borrow friends’ and family members’ cell phones to use the system. The system has been tested in trials and pilot programs since 2008, and, starting in December 2010, the codes will initially be rolled out in Ghana on 125,000 malaria medication packages. This easy-to-use feature would only add a few cents to the cost of the drugs and can go a long way in preventing the sale and use of fake drugs. It is exciting to see innovative solutions to public health problems come to fruition and hopefully the implementation of this technology this year will be a great success. As fake drugs become less common in developing countries, many deaths from treatment failure will be avoided and the problem of resistance to antimalarials will have one less contributing cause.
[Bloomberg via Aidwatchers]
Image Credit: Flickr:whiteafrican
