Africa's Plans for New Malaria Drug Meet US Resistance

June 20, 2002
By Donald McNeil Jr
The New York Times

Geneva - With resistance to old malaria drugs spreading, African officials want to start using a relatively new Chinese remedy so powerful that some experts consider it a miracle drug. Because more than 2,000 African children die of malaria each day, doctors there are clamoring for the drug, and the World Health Organization recommends it.

But the US generally opposes using it in Africa yet. An adviser to USAID in Washington, Dennis Carroll, said the medicine, artemisinin, probably represented "the best long-term option." But, he added, the drug is expensive and hard for poorly educated people to take correctly. It needs, he said, more testing in infants and is "not ready for prime time."

Other experts say delays will cost too many lives because the drugs now in use are rapidly losing their effectiveness.
Artemisinin was first refined 30 years ago in China from the qinghaosu plant, used in fever remedies for 2,000 years. The raw material comes from China and Vietnam, although the source plant, Artemisia annua, known as sweet wormwood or Chinese wormwood, grows wild even in the US.

In Vietnam, according to WHO, the death toll from an epidemic was reduced 97 percent from 1992 to 1997 using bed nets, indoor DDT spraying and artemisinin. In a study under way in rural South Africa, malaria deaths dropped 87 percent in a year.

"It really is a marvelous drug," said Dr David Nabarro, executive director in the director-general's office at WHO. "It's not only a treatment, but the treated person then contains a sterile form of the malaria. So it reduces the intensity of the epidemic."
Many African countries want to switch to it now, arguing that resistance to chloroquine and sulfadoxine-pyrimethamine, the usual front-line drugs, is rapidly spreading.

Most of those countries cannot buy drugs without help from donors or World Bank loans. Some public health officers complain that USAID quietly pressures them not even to request artemisinin.

Carroll denied the pressure but said the agency believed that artemisinin had not been tested enough on infants and that sulfadoxine/pyrimethamine had some years of usefulness left. For that reason, the agency officially suggests saving artemisinin for cases not helped by first-line drugs.

That infuriates malaria specialists like Dr Fred Binka, a professor of epidemiology at the University of Ghana. "In poor countries like ours, children have only one chance. They struggle just to visit a health service, and if they get the wrong drug the first time, they are then found dead," he said.

Dr Bernard Pecoul, director of the Medecins Sans Frontieres campaign for cheaper medicines, called the US position "frankly, very difficult to understand." But senior WHO officials are careful to say just that the US is "sounding useful notes of caution," in the words of Dr David Alnwick, manager of the agency's Roll Back Malaria project.