Averting a malaria disaster in Africa--where does the buck stop?
The serious threat posed by the spread of drug-resistant malaria in Africa has been widely acknowledged. Chloroquine resistance is now almost universal, and resistance to the successor drug, sulfadoxine-pyrimethamine (SP), is growing rapidly. Combination therapy has been suggested as being an available and potentially lasting solution to this impending crisis. However, the current cost of combination therapy, and especially that of artemisinin combination therapy (ACT), is potentially a serious drawback, even if a significant part of its cost is passed on to the end-user. If the question of cost is not successfully addressed this could lead to adverse results from the deployment of combination therapy as first-line treatment. These adverse effects range from an increase in potentially fatal delays in infected individuals presenting to medical services, to exclusion of the poorest malaria sufferers from receiving treatment altogether. Urgent steps are needed to reduce the cost of combination therapy to the end-user in a sustainable way if it is to be usable, and some possible approaches are discussed.
Gates Malaria Partnership, London School of Hygiene and Tropical Medicine, 50 Bedford Square, London WC1B 3DP, England. c.whitty@lshtm.ac.uk
Christopher J M
CJ
Whitty
Richard
R
Allan
Virginia
V
Wiseman
Sam
S
Ochola
Maria Veronicah
MV
Nakyanzi-Mugisha
Benjamin
B
Vonhm
Mahemba
M
Mwita
Constantin
C
Miaka
Aggrey
A
Oloo
Zul
Z
Premji
Craig
C
Burgess
Theonest K
TK
Mutabingwa
D000349:Africa / Q000453:epidemiology; D000818:Animals; D000962:Antimalarials / Q000191:economics / Q000494:pharmacology* / Q000627:therapeutic use; D037621:Artemisinins / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D004196:Disease Outbreaks / Q000517:prevention & control*; D016527:Drug Costs; D018432:Drug Resistance, Multiple; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D010963:Plasmodium falciparum / Q000187:drug effects*
D000962:Antimalarials; D037621:Artemisinins