Editorial: How Not to Roll Back Malaria.
Seven years ago, with much fanfare, international health and development agencies unveiled the Roll Back Malaria campaign, which was supposed to cut malaria deaths in half by 2010.
Yet progress has been worse than sluggish: there are actually indications that more people are suffering from malaria now than when the campaign started. This is simply unacceptable. We know what needs to be done to control malaria. What is lacking is the drive and resourcefulness to do it, writes The New York Times in Sundays editorial according to the World Bank press review.
After failed attempts to eradicate malaria, the emphasis today is on control, by spraying insecticides on interior walls and covering sleeping children with insecticide-treated mosquito nets, as well as using drugs to cure the disease. These simple tactics work well, but incredibly, they are not being used at anything near the rate that has been promised.
Most shocking has been a reluctance to use the right drugs. For decades malaria fighters relied on chloroquine, a pill so cheap it is often popped like aspirin at the first sign of high fever. Unfortunately chloroquine and another standard drug have become ineffective in many parts of Africa.
The best treatments are drug combinations whose core ingredient, artemisinin, a plant extract long used in Chinese herbal medicine, is buttressed by an additional medication. Such combination treatments work in the vast majority of cases and have yet to encounter resistance.
But because they cost 10 to 20 times as much as the standard drugs, international agencies have been slow to change. Last year, an article in The Lancet, a British medical journal, accused the World Health Organization and Roll Back Malaria of medical malpractice for providing ineffective drugs to malaria victims. Only then did the effort to provide the new, effective drugs quicken.
Some 33 African countries have now officially adopted combination therapy, but only 11 have begun to roll out the drugs and only a few have done so nationally. While start-up financing is available, many African leaders are reluctant to commit to higher-cost drugs with no assurance that there will be money to continue purchasing them indefinitely.
This is not the fault of selfish pharmaceutical companies. Novartis, which makes the best of the combination drugs, is selling it at cost and has ramped up production greatly despite limited demand.
The company will produce 30 million treatments this year but has received orders for only 13 million. Nevertheless, it plans to produce 100 million treatments next year even without orders.
Novartis should not be expected to take a huge loss for its corporate citizenship. The best and fairest way to get these drugs used would be to guarantee long-term purchases so that timid African leaders will consummate the switch, either to the Novartis product or other combination therapies.
International donors, though increasingly generous, still need to give more. Even with a big increase in financing through the Global Fund to Fight AIDS, Tuberculosis and Malaria, only about 600 million US dollar (3,6 mia. DKR) a year is currently available to meet needs estimated at 3 billion dollar (18 mia. DKR) a year.
Pledges of additional money from the United States, the Group of 8 industrial nations, the World Bank and programs financed by the Gates Foundation should swell the kitty. President Bush is to be commended for proposing to spend 1,2 billion dollar over five years to fight malaria in 15 African countries, much of it for treated nets, indoor spraying and combination drugs.
But two worrisome problems remain. One is that international donors have a history of being more generous with pledges than with money. And even if the money comes, it has to be administered much more effectively than has been the case so far, the New York Times Editorial concludes.
Kilde: www.worldbank.org
