Campaign for Fighting Diseases Blog

Substandard malaria drugs rife in Africa

Shocking new statistics reveal that 35% of antimalarial drugs in Africa fail basic quality tests.

The report in PLoS One, a scientific and medical research peer-reviewed journal, is based on a recent study of drugs purchased in six major African cities.

The survey found substandard drugs to be rife – the drugs accelerate parasite resistance and thus threaten to cause a major health crisis for the 700 million people at risk from malaria.

The Global Fund itself may be exacerbating the problem by a policy under which poor countries can purchase untested drugs.

A decentralized network of drug testing facilities is urgently required and could be funded by a fraction of the current budget for fighting malaria.

World Malaria Day – the experts speak

More welcome publicity today for malaria, a disease which according to the WHO still kills more than a million people every year.

In the UK the BBC’s Today Programme featured Professor Chris Whitty, a trustee of the aid agency Merlin.

Professor Whitty made the point that conflicts can exacerbate effects of malaria. He explained that war typically causes a breakdown in health services and makes spraying (‘indoor residual spraying', IRS) far more difficult.

Asked whether global warming caused malaria and threatened to bring it back to Europe, Professor Whitty responded ‘I don’t think global warming would cause it … it’s not really because of global warming’.

This echoes the arguments provided by expert on insect-borne diseases Paul Reiter regarding the fallacy of global warming-induced malaria.

The BBC’s website also includes an article featuring contributors from Merlin. They make the same points about conflict causing a breakdown in health services, a decline in spraying and often resulting in large numbers of people being exposed to malaria near breeding sites. They also note the futility of bed-nets in such circumstances:

‘But nets don't work so well if, like many displaced people, you have no bed, and no home’

Note: If you want to listen, the interview was broadcast around 6:55am.

Let's talk about drugs on World Malaria Day

Over at The American, CFD contributor Dr Roger Bate has an interesting article for World Malaria Day. 

While he notes that increased funding and coordination amongst global agencies has improved the quality of malaria treatment, there are still many companies going against WHO advice and selling artemisinin monotherapies in Africa. These monotherapies raise the risk of the malarial parasite developing drug resistance.

Meanwhile, the suppliers of high quality artemisinin combination therapies are having their lives made difficult by the WHO's insistence on forecasting 'need' rather than actual demand.  WHO figures out how many people 'need' treatment in an ideal world, and these figures provide the basis upon which manufacturers produce the drugs.

The only problem is, 'need' is not the same as real demand: as a result of weak health infrastructure, only a fraction of the 'needed' drugs manufactured get to patients.  This results in a massive waste of drugs and loss of money, as for example when Novartis and Sanofi-Aventis had to destroy drugs that had been overproduced.  This undermines the incentives for companies to invest their precious capital in malaria drugs.

World Malaria Day is a good time to raise these issues.  Unless the economics are correct, the private  sector will lose interest in the disease, which will be a disaster for malaria sufferers everywhere.   

Soviet medicine rises from the grave

In ten days time, the World Health Organization's IGWG will get together to finalise its Plan of Action on IP and health.  When I last checked, talk of a 'Medical Research and Development Treaty' was still in the document.

Today my colleague Paul Howard (from the Manhattan Institute) and myself have an op-ed explaining why this treaty will actually undermine drug research. 

One would have thought the Soviet Union had provided ample evidence of why centralised planning can never work: yet twenty years on from the collapse of Soviet communism we find ourselves still having to explain why such ideas are bad.

Markets for organs?

Waiting lists and death are too often the outcomes for people suffering from End Stage Renal Disease (ESRD). Sadly, this familiar story occurs in virtually every country across the world.

In the US alone 73,000 people are waiting for a kidney donation and the waiting list is growing. Since 1999, 30,000 people have died whilst waiting for a kidney that never arrived.

These figures are reported by Benjamin E. Hippen, MD, a nephrologist (kidney expert), member of leading transplantation organisations and associate editor of the American Journal of Transplantation.

His report is available here and remarkably notes that Iran is the world’s only country to have eliminated waiting lists. This has been achieved via a kidney vendor program, made possible through the legalisation of kidney vending.

The program allows vendors to approach a not-for-profit body, Dialysis and Transplant Patients Association (DATPA), which matches them with recipients. Vendors are compensated by the government, receive health insurance and additional funds from either recipients or charities funding recipients. Vendors are assessed with non-remunerated donors and the operation vetoed if the vendor is found to be medically unsuitable.

Whilst noting problems within the system, Hippen notes that the involvement of an intermediary not-for-profit organisation and other means of legal framework mitigate concerns about organ donation.

This scheme could work in other countries which have organ shortages, thus reducing waiting lists, saving lives and eliminating illegal organ trafficking.

Malaria: bed-nets won’t ‘end killer disease’

Last night Prime Minister Gordon Brown pledged Britain would supply 20 million bed-nets to aid the fight against malaria.

Appearing on U.S. show ‘American Idol’, he urged governments and donors to supply aid for 120 million bed-nets to be supplied to malaria-hit countries.

Is this the best way to deal with malaria and thus should governments be channelling vast amounts of aid at bed-nets? Are bed-nets really the way to ‘end this killer disease’?

Research suggests not. In Chapter 6 of ‘Fighting the Diseases of Poverty’* authors such as Jason Urbach from Africa Fighting Malaria argue there are far more effective means of fighting malaria.

UN-led programmes against malaria have failed due to the withdrawal of DDT for indoor residual spraying and are overstating the value of bed-nets. Bed-nets require regular retreatment, do not guarantee protection and are often simply not used.

Furthermore, a chapter in a report from the Civil Society Coalition of Climate Change (pages 28-36) examines the causes of malaria and means of prevention.

The chapter is written by Paul Reiter, Director of the Insects and Infectious Diseases Unit of the Institut Pasteur and global consultant on insect-borne diseases. Reiter covers the conditions in which malaria thrives, mainly relating to agricultural and economic development (rather than, as often misconceived, climate change).

* Fighting the Diseases of Poverty can be purchased here.

More spin from UNAIDS

This week the Commission on AIDS in Asia released its prediction that, without additional action, AIDS deaths in Asia could rise from 440,000 each year currently to nearly 500,000 annually by 2020, and total infections could double from 4.9 million to 10 million.

Our friend Prof Jim Chin, author of the AIDS pandemic: the collision of epidemiology and political correctness, has some stern words about this report on his website.  Prof Chin is particularly aggrieved by the report's claim that "regionally, AIDS is estimated to be the single largest cause of death and morbidity due to disease for adults age 15-44 years."  In reality, in Asia, AIDS wasn't even in the top 10 killers in 2001.

By the way, Prof Chin is discussing his new CFD paper at a lunchtime event on 22nd May in Geneva. Please email if you want more information.

Trade is good for your health, especially if you are poor

Anti-globalists frequently complain that increasing international trade is bad for the poor, as it leaves them at the mercy of international competition and ruthless multinationals.

New findings suggests that increased trade is actually very good for the poor, in particular their health.  Over at the Free Market Foundation, economist Jasson Urbach reports on this evidence that trade improves health through the twin mechanisms of economic growth and technology transfer.

I wrote a study on this theme a couple of years ago. I made the point that the massive increases in global life expectancy that characterised the 20th century were largely down to increased trade - this period saw the global spread of health knowledge such as sanitation, as well as technologies such as vaccinations and antibiotics.

The benefits of the FDA's fast-track ARV approval

Four years ago, the FDA announced it would test and certify as a true generic, for free, any ARV manufactured by a foreign company.  This fast-track certification asks a copy drug to prove that it is bioequivalent to the original drug.  If a copy drug is not bioequivalent, it may act on the body in subtly different ways, increasing the chances of clinical failure and viral mutation.

The FDA announced this fast-track offer at the same time as the WHO's infamous de-listing of 18 ARVs from its prequalification programme in May 2004. The prequalification programme, incidentally, is not a regulatory programme and does not require the same high standards as the FDA. 

This sets a double standard:  drugs approved by WHO prequalification are not demonstrably bioequivalent, and would therefore not be used in developed countries.  So, patients receive these drugs because they are poor rather than because they are sick.

As this briefing note over at the CFD shows, the FDA fast-track approval scheme has gone some way to rectifying this double standard. 

Wealth and health

The BBC covers today a new report from British pressure group, Save the Children, which claims that economic growth does not necessarily translate into a healthier population.

The report cites examples such as India, which still suffers high rates of child mortality despite having undergone a prolonged period of economic growth.

This report is saying nothing new. Reading between the lines, it is a fairly standard call for governments to redistribute wealth and intervene more heavily in the economy, in order to iron out the inequalities which they perceive to perpetuate ill health.

However, economic growth certainly does improve health of the individuals who are able to benefit from it, not least because it enables people to afford better sanitation and living conditions, which are key to addressing a large part of the disease burden in less developed countries. 

The point is not everyone is able to share in economic growth, largely because of counterproductive governance.  For example, if the poor do not have property rights, it makes it impossible for them to borrow capital to invest in their own businesses and education and climb up the economic ladder.  Meanwhile, the poorest countries erect massive, costly regulatory obstacles to entrepreneurship, meaning that only the politically well-connected and rich can start businesses and create wealth.  And so on.

Save the Children are right to point out that the poor are still suffering unacceptably poor health as a result of poverty.  Their diagnosis is way off the mark, because the redistributory measures they advocate would stifle economic growth and cut off the one mechanism that is vital for improving health.

It would be more constructive for Save the Children to talk about empowering the poor instead of clobbering the rich.

What is the rationale behind spending 0.7% of GDP on aid?

Last week I spoke at the New Zealand launch of Fighting the Diseases of Poverty in Wellington.  The event was superbly hosted by the New Zealand Business Round Table, and the discussant was Dr Peter Adams, head of NZAID. 

One comment from the audience urged the NZ government to reach the UN target of spending 0.7% of its GDP on aid by 2015.

However, I'm not sure what the empirical basis is for this target. Can aid not achieve its purposes at 0.75% of GDP, or even 0.1%?  To me, the figure seems to have been somewhat arbitrarily settled upon by aid campaigners, without real reference to the documented evidence on the relationship between aid and economic growth.

Perhaps aid campaigners are worried about their own future funding, as many of the biggest (such as Oxfam) derive a huge part of their budget from government.