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.

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.   

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.

WHO must take side of malaria victims

It seems that the World Health Organization (WHO) has finally accepted the quick, simple, cheap and safe solution to fighting malaria: DDT. But Africans still face a battle with environmentalists and trade blocs who oppose this demonized pesticide.

The WHO's Roll Back Malaria (RMB) started in 1998: millions of dollars later, a WHO report admits "malaria has got somewhat worse during this period." The real tragedy is that malaria would have got somewhat better if the WHO had adopted a sensible strategy from the start. Spraying the inside walls of residential buildings with DDT and other insecticides should be central to this. It prevents most mosquitoes from entering dwellings and it repels or kills those insects that do make it inside.

Over the last few decades, however, the WHO and various NGOs have deliberately discouraged the use of DDT, egged on by western environmentalists who claim it is dangerous. However, Namibia, Botswana, Mozambique and SA have experienced tremendous success by using DDT. DDT is what eradicated malaria in the southern US and Mediterranean Europe in the mid-20th century. There has never been any evidence of harm to humans or animals: one of its proponents, J Gordon Edwards, used to eat spoonfuls of it at lectures and he died this year whilst hiking, at 85.

This week the WHO said it would make DDT part of its malaria campaign. But Africa faces still faces numerous hidden barriers, such as NGOs and western governments refusing to fund supplies of DDT or threatening to ban exports from areas where it is used. The European Union threatened Uganda this year with bans on agricultural exports if it started using DDT against malaria, even though such very limited use was allowed by a little-publicized WHO rule and by the 2004 Stockholm Convention on Persistent Organic Pollutants.

These types of barriers will continue to be used against African produce in Europe and the US by governments and environmentalists unless the WHO publicly and noisily takes the side of malaria victims. Africans must demand that RBM's plans include DDT, plus a campaign to counter the opposition of western governments, NGOs, and environmentalist pressure groups. Millions of African lives depend on it.

The real bloodsuckers

Over at the Globalisation Institute, there is some confusion over how EU trade policy is preventing Uganda from taking steps to tackle malaria with DDT.

One of the misconceptions that has been growing is that the EU is forcing developing countries to go without DDT for fighting malaria. It is being claimed that the EU threatened Uganda with sanctions for using DDT against malaria.

Sounds outrageous. But it is just an urban myth. The EU did no such thing.

Unfortunately, that is not the case.  Back in the Spring, EU representatives suggested to Ugandan ministers that if Uganda chooses to use DDT for malaria control, exporters will have to procure expensive equipment to ensure that their products do not contain any amount of residual DDT; otherwise they will face sanctions against their agricultural products.

This negotiating technique is also known as blackmail, because it would render Ugandan agricultural exports uncompetitive.

And seeing as Uganda only plans to use the chemical for Indoor Residual Spraying, it is also completely absurd.

You can read the full story about EU's shameful treatment of Uganda here.

Malaria risk 'depends on house'

According to researchers from the Wellcome Trust, differences in households can account for around a third of the variations in attack rates by malarial mosquitoes.  Dr Ian Hastings of the London School of Hygiene and Tropical Medicine told the BBC:

"We don't yet know exactly what makes the difference between a good or a bad house. But a lot probably depends on whether there is a mosquito-breeding site in the back yard, the quality of the building and whether insecticides or other repellents are used.

"Identifying and improving factors that put some homes at much lower risk than others would go a long way towards relieving the burden of disease in children living under such conditions."

Quite. We've known for a long time that the most effective way of tackling malaria is to spray the insides of houses with DDT.

This helps prevent mosquitoes from entering dwellings and it repels or kills those insects that do make it inside. Because it minimises the chances of humans being bitten, it effectively prevents the transmission of the malarial parasite, making it an excellent tool for preventing the spread of the disease.

India, for example, started a nationwide programme of indoor DDT spraying in the 1950s, which it has continued to this day. Despite the fact that its population has mushroomed to over a billion in this period, deaths from malaria have decreased to a few thousand each year.

What a shame, then, that the WHO's Roll Back Malaria programme has not embraced fully DDT use. Instead, it has fixated on insecticide-treated bednets, which are both difficult to distribute and unreliable.

Let's hope that this bit of new research brings a bit of the focus away from bednets towards making dwellings less mosquitoe-friendly. DDT has got to be a central part of any such strategy.