WHO urges countries to act on new anti-resistance malaria medicines
25 April 2002 - Tackling rising levels of medicine resistance is one of the key challenges to African States in their efforts to control malaria and meet the declared target of saving the lives of half the 800,000 young children who die of the disease every year by 2010.
The cheapest and most readily available medicines are increasingly ineffective. That's why the World Health Organization (WHO) in its programme to Roll Back Malaria is urging countries to switch to a new type of combination therapy when there is strong evidence that existing conventional medicines are no longer working.
The Artemisinin-Based Combination Therapies (ACTs) are derived in part from a Chinese herb and are the most exciting prospect in new malaria treatments. They kill the malaria parasite very fast, allowing the patient to recover rapidly, and with very few side effects.
Because ACTs combine two medicines which work in different ways, it is unlikely that the malaria parasite – which has rapidly developed resistance to other, single treatments – would evolve to resist these medicine combinations.
WHO has just added one of the combination medicines (artemether/lumefantrine) to its Essential Medicines List – a list which prioritises essential medicines for countries.* This medicine, known by the brand name Coartem, is the only medicine which combines an artemisinin and non-artimisinin compound in a single tablet. WHO also recommends other combinations of artemisinin compounds with currently used medicines, such as amodiaquine or sulfadoxine-pyrimethamine, for use where these medicines are still effective.
The Board of the Global Fund to Fight AIDS, TB and Malaria, meeting in New York, have decided to fund proposals to “Roll Back Malaria” in Zanzibar and Zambia. These proposals include purchasing and phasing-in the use of new ACTs.
"We hope that the Fund and other funding mechanisms will be used to purchase ACTs where they are needed to treat malaria and improve the control of the disease in communities at risk," Dr Gro Harlem Brundtland, Director-General of WHO. "WHO has worked with a variety of partners including the manufacturers to reduce the price of ACTs in developing countries. It is important that countries which need ACTs are able to access and use them in a sustainable manner."
For decades, the best known treatment for malaria was chloroquine, an inexpensive medicine that has saved millions of lives. However, in recent years, the malaria parasite has developed resistance to chloroquine and so, in many countries, it is no longer an effective treatment. Many countries in Eastern, Central and Southern Africa are already experiencing high levels of resistance to chloroquine, and resistance is also appearing more and more in West Africa.
As a result, many countries have moved to sulphadoxine-pyrimethamine, known as SP or “Fansidar”, as first line treatment. However, resistance to SP is also spreading.
There is new evidence that the number of child deaths due to malaria has begun to increase as a result of failing medicines and medicines of poor quality. Recent evidence also indicates that, due to rising levels of medicine resistance, almost half of the money spent on anti-malarial medicines is being used to pay for inappropriate treatments. This also highlights the need for more efforts on preventing malaria, using proven cost-effective measures such as insecticide treated bednets.
It takes time to change medicine policy and to implement the change. New sources of materials and financing have to be found, medical personnel trained, and distribution channels ensured. As more countries start deploying these new combination medicines it is expected that their production will be scaled up to meet the demands. Additional safety information on these medicines is now being sought in special groups at risk such as young infants and pregnant women. Improved packaging of these medicines will help to ensure that patients adhere to the full treatment course.
WHO recommends that countries begin the transition as soon as levels of resistance exceed 15% and that the change will be implemented before resistance reaches 25%.
NOTE FOR EDITORS:
* In the current WHO definition. "Essential medicines are those that satisfy the priority health care needs of the population, are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford."