Number One Killer of Children in Africa Too Expensive to Treat Effectively?

Report Released by MSF Debunks Malaria Treatment Myth

February 13, 2002, Nairobi — As East African countries are about to change national malaria treatment protocols and the East African Network for Monitoring Antimalarial Treatment (EANMAT) meets in Nairobi to discuss rising resistance to malaria treatments, Doctors Without Borders/Médecins Sans Frontières (MSF) today releases a report in the hope of averting a fatal choice.

In recent years, increasing parasite resistance has rendered antimalarial drugs such as chloroquine and Fansidar® virtually useless in many parts of East Africa. Malaria experts agree that in order to offer patients effective treatment and prevent further spread of resistance, protocols should include drug combinations with the highly potent drugs known as artemisinin derivatives.

However, because of a lack of resources and donor preference for cheap solutions, many health ministries are considering changing protocols to transition strategies, using combinations of drugs that will be equivalent to giving some patients placebos. This decision is a matter of life and death in a disease that kills between 1.3 and 1.8 million African children a year.

"Knowing more effective drugs are available and not being able to give them to my patients has been so difficult," said Dr. Diane Cheynier who works in an MSF malaria program in Burundi. "Treatment exists that can prevent people from dying unnecessarily. With the help of donors, African governments can avoid the fatal error of going to stop-gap, band-aid solutions."

In MSF's report, increased costs of more effective drugs are pinpointed as one of the chief barriers to widespread implementation in the public sector. Current drug combinations cost just US$0.25 per adult dose while more effective combinations with artemisinin derivatives cost approximately US$1.30. The MSF report, however, shows that for all of Burundi, Kenya, Rwanda, Tanzania, and Uganda combined, the additional cost to implement the more effective treatment combinations would only amount to US$19 million. But even at this price, for African governments to make the political decision to implement effective long-term strategies in the treatment of malaria, they will need the support of donors.

"We believe that the report released today destroys one of the key myths blocking the introduction of treatment that has been highly recommended by leading malaria experts," said Dr. Jean-Marie Kindermans of MSF and author of the report. "The cost of switching to effective combinations rather than combinations which are often no better than placebos is affordable if international donors are willing to help."

Artemisinin derivatives, which are extracted from a Chinese plant and have been used in Asia for more than ten years, have attributes that make them especially effective against malaria and are therefore viewed as essential elements of effective combinations. They are fast-acting, highly potent, and complementary to other classes of treatment. When used in combination with a second drug, artemisinin derivatives appear to slow the development of resistance to the second drug. For this reason, experts predict that artemisinin-containing combinations would continue to be effective in the long term. To date, no resistance to artemisinin drugs has been reported.

The full report "Changing national malaria treatment protocols in Africa: What is the cost and who will pay?" can be found on the MSF Access to Essential Medicines Campaign web site, www.accessmed-msf.org.