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Access to Effective Malaria Treatment for Africa Threatened by Potential Drug Shortages

25.04.04

Africa Malaria Day - Widespread use of a new fast-acting and potent treatment for malaria is finally on the horizon in Africa, where malaria is the number one killer of children. But the international medical humanitarian organisation Médecins Sans Frontières (Doctors Without Borders) warns that artemisinin-based combination therapy or ACT will only be accessible to all in need if immediate action is taken to finance scale-up of production of the drugs.

“ACT is really a cause for hope in Africa – more and more countries with extremely high rates of resistance to old malaria treatments are starting to use it with excellent results,” said Dr. Jean-Marie Kindermans, one of Médecins Sans Frontières’ principal malaria experts. “But donors and producers need to take action to avert a major supply crisis of ACT. Since the key ingredient of the combinations is extracted from plants, only firm orders now will enable enough plants to be ready for the huge expected increases in demand next year.”

Artemisinin-based combination therapy has been used in Asia for more than 10 years but is new to Africa. It is a critical element of the World Health Organisation’s strategy to Roll Back Malaria on the continent. Fourteen African countries have now officially switched their malaria treatment protocols to ACT and five (South Africa, Burundi, Comoros, Zambia and Tanzania) are already using them in their public health facilities. Many other countries are reviewing their policy with a view to switching to ACT. Africa is burdened by 90% of the world’s 300-500 million cases of malaria every year.

Médecins Sans Frontières treats an average of 3,000 people with malaria each day in Africa, amounting to more than 1.1 million cases per year. “We are seeing with our own eyes the difference these drugs make,” says Dominique Fouché, who is coordinating Médecins Sans Frontières’ malaria program in Makamba, Burundi, one of the African countries which has just switched to ACTs. “Our patients are getting better more quickly and fewer are returning with life-threatening recurrences of symptoms. We are confident that as the national program rolls out in Burundi we are going to see childhood and adult malaria deaths drop.”

WHO estimates that 132 million treatments will be needed in 2005, of which 92 million are for Africa. To avoid acute shortages of ACT, international donors must immediately stimulate production of Artemisia annua, the plant extract. The next chance to increase cultivation is the planting season which begins in December 2004, so notice to farmers to start cultivation has to be given soon.

Most of the cultivation of artemisia annua occurs in China and Vietnam. According to Australian doctor Alyosha Jacobson who has recently returned from working in malaria for Médecins Sans Frontières in Ethiopia, there is a need for the Australian government to become involved. “Médecins Sans Frontières would encourage the Australian Government to develop a malaria policy for its overseas aid program in support of the most effective antimalarials (ACT),” he said. “As most artemisinin production is in Asia, Australia could also play a crucial role in providing financial and technical support in building regional capacity to produce this essential drug.”