Over the last year, there has been much debate about prevention and treatment of malaria, an insidious infectious disease afflicting some 500 million people each year.
More than 1 million yearly die of malaria in Africa; the victims are primarily young children. This disease leads to a loss of $12 billion a year in Africa’s gross domestic product.
While much malaria dialogue has centered on using insecticide-treated bed nets and indoor spraying of insecticides to kill malaria-carrying mosquitoes, not as much public discourse has focused on the increasingly drug-resistant malaria parasite itself. Since the 1950s, there has been a relatively stable pool of antimalarial drugs. But within the last decade, the malaria parasite has adapted to many drugs, rendering the drugs weak or ineffective. This increase in resistance creates more pressure on the international community to find stronger treatments to fight new malaria strains.
One such treatment derives from the Artemisia plant, a Chinese herb that, until recently, was harvested mainly in China and Vietnam. Recent clinical data indicate artemisinin-based combination therapy, or ACT, is hugely effective against new malaria strains, with virtually no side effects. The drug is taken orally over three days and very rapidly eliminates the parasite from the body, wiping out malaria’s flulike symptoms such as fever, headache, nausea and chills.
Today, there is widespread international consensus that ACTs should be the new front-line drug of choice against malaria. A little more than two years ago, at the behest of the U.S. Agency for International Development, the Institute of Medicine convened an expert study committee to explore the economic landscape of antimalarial drugs, particularly ACTs. Published in July 2004, the final report is helping galvanize more policy discussion on how to rapidly produce and distribute artemisinin combination therapy.
Since 2001, 40 countries — including 20 African nations — have switched from old malaria drugs to the artemisinin combination therapy. This is an extraordinarily important step, as the herb itself takes seven to nine months to grow. An estimated 15 million malaria cases were treated with ACTs in 2003, and demand for artemisinin drugs will rise to an estimated 150 million cases by 2007.
To help meet this increased demand, USAID and its partners in the Roll Back Malaria initiative have agreed with agricultural producers in East Africa, helping farmers cultivate Artemisia plants. We hope and expect this partnership will produce enough artemisinin for 20 million to 40 million pediatric doses, greatly increasing the drug availability by the end of 2005.
Other vehicles like the Global Fund to Fight AIDS, Tuberculosis and Malaria are important partners. The Global Fund’s unique mechanism as a public-private partnership adds more resources to the malaria pot, with an expected $900 million in two-year grants earmarked for the disease. The U.S. government is proud to have made almost a third of all contributions to the Global Fund. In addition, USAID’s malaria budget has more than quadrupled in the last seven years, from $22 million in fiscal 1998 to roughly $90 million in fiscal 2005.
No doubt, the international community should note the progress to date. But we are still too far from the finish line to consider this work complete. To the contrary, our efforts must outpace the rapid advance of drug-resistant malaria strains so we can release millions, particularly children, from its determined grip. Too many lives are at stake and time is of the essence to permit any delay on quickly moving with this effective new treatment. Collectively, we must gather all our will and resources to stop the spread of this deadly disease.
Kent R. Hill is Bureau for Global Health acting assistant administrator in the U.S. Agency for International Development.
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