This diary provides an update for liberals and progressives on the state of the world in malaria. I'll provide some background and commentary on two recent and very important developments. The first is a vote at the Global Fund on the Affordable Medicines Facility for Malaria (AMFm). The second is a summary of an article published this week in the Lancet, a team of researchers published a paper in The Lancet that takes a hard look at the current state of malaria control in Africa.
Why should liberals and progressives care about malaria? Here's my short list:
*Malaria causes about 500 million clinical episodes each year.
*About 1 million of our fellow humans die of it each year. About 90% of the victims live in Africa, and about 90% of those victims are children.
*Malaria in pregnancy contributes to low birth weights, which are a risk factor for infant mortality.
*US Leadership in malaria control would help to restore our tarnished image abroad.
For more information and background, also see the diary by UN Dispatcher (that was rescued by taylormattd). Follow me after the fold.
AMFm From the News of the Week in the November 20, 2008 issue of Science (Account required)is
this report about a vote at the Global Fund that would make it the new host to the Affordable Medicines Facility for Malaria.
Background: Chloroquine has been used to treat malaria in Africa since around 1946. In 1978, chloroquine resistant parasites were imported into Africa from southeast Asia, and by the late 80s, chloroquine was failing. Most governments and the WHO failed to respond to the growing crisis, so that by the end of the 90s, chloroquine was still the first-line drug in most African countries. Some governments switched to Fansidar (sulfadoxine-pyramethamine), but the parasites had already evolved resistance, and Fansidar was also failing.
Meanwhile, an old Chinese herbal (dating from two thousand years ago) remedy was being developed into a new class of drugs, called artemsinins, derived from a plant Artemesia annua. The drug has been used in China and southeast Asia for as long as 20 years. This is an extremely good drug for treating malaria. It provides nearly instant relief because it kills the parasites very fast. Artemisinin-based drugs save lifes, but how long will we have them?
Some visionaries recognized a need for a proactive policy to delay the emergence of resistance. An institute of medicine committee was convened in 2004, chaired by a Nobel Prize winning economist named Kenneth Arrow (Stanford University), to look at ways to delay the emergence of artemisinin resistance. The IOM committee recommended a global subsidy for artemisinin combination therapies (ACTs) to drive down the price of the drugs and to drive out the use of artemisinin. The logic is that if you pair artemisinin-class drugs with another drug that has an independent mode of action, a mutant would have to be resistant to both drugs to avoid elimination. The subsidy would delay the emergence of resistance and create a global public good, the extended useful life of artemisinins. After four years, the subsidy is now a financial mechanism called Affordable Medicines Mechanism for Malaria (AMFm)now has a home at the Global Fund.
AMFm is not universally loved. Representatives of the US position at the President's Malaria Initiative have raised several objections (i.e. it's expensive, it's never been tried before, people will be using drugs without supervision, etc.). Most of those objections were raised in the original IOM report. They're right about one of these. Nothing like this has ever been tried before. It's a visionary move. I think it opens up all sorts of opportunities to make and enforce good drug policy.
Bednets The use of insecticide-treated bed nets (ITNs) to protect children from malaria has risen six-fold in the past seven years, according to research funded by the Wellcome Trust. Despite this success, however, 90 million children still do not have access to this simple protective tool, and remain at risk from the life-threatening disease.
For over 15 years it has been known that sleeping under a net treated with an insecticide can substantially reduce the chances of a young African child dying. When African heads of state met in 2000, the Abuja Declaration stated that they would work towards protecting 60% of their vulnerable populations with insecticide treated nets. Now, a study published in the Lancet today highlights what has been achieved since this historic declaration.
Kenyan and British scientists have published data from 40 African countries which shows that at the time of the Abuja meeting in 2000 just over 3% of Africa’s young children were protected by a treated mosquito net. Seven years later this increased to only 18.5%. In 2007 90 million children have not yet received this simple protective tool, and remain at risk from life-threatening malaria. Most of these children live in only seven African countries; one country in particular stands out – a quarter of all African children living without nets are Nigerian.
The authors report that bed net use increases faster in countries that distribute them free of charge compared to countries that make people to pay for them. Usage rises to an average of 25% when they are given free, but is much lower at 4% when people have to pay for them.