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Update on Malaria: Single ‘Magic Bullet’ Approach Failing?

 

 

 

Copyright © Tony Burfield  January 2006

 

 

 

Lee Long-Wok, WHO Director General told drug companies on 19th Jan 2006 that they must not market artemisinin, an active in the quinhao from the Chinese plant Artemisia annua, except in combination with other anti-malaria drugs. Other drugs that are used in combination with artemisinin include lumefantrine, mefloquine, amodiaquine, and sulphadoxine-pyrimehtamine, and attack any parasites which have evaded artemisinin; these are termed Artemisin Combination Therapies or ACT’s. Lee Long-Wok took this step because the marketing of artemisinin as a single “magic bullet”/monotherapy cure is threatening to destroy its effectiveness, as “decreased sensitivity to the drug rises in SE Asia” (Kochi through Boseley, 2006). Manufacturers of artemisinin include Sanofi-Aventis (France), Dafra (Belgium), Novartis & Mepha (Switzerland) & Gulin (China).

 

Previously, in 1998, the WHO predicted that it would be able to halve malaria deaths by 2010, and since 2001, the WHO has recommended ACT’s (only) for countries where resistance occurs. A 2004 paper in the Lancet by Dr Amir Attaran et al. of the Royal Institute of International Affairs (Attaran et al.2004) previously accused the WHO of ‘medical malpractice’ for continuing to fund some African countries using older malarial drugs, rather than ACT’s. Garner & Graves (2005) briefly review the benefits and the hopes for ACT’s, but mention their increased cost - the total cost for required treatments having been put at $300-$500 million per annum (Thayer 2005). In spite of this cost, 50 malaria-prone countries have adopted them (Thayer 2005). 

 

Supply problems with artemisinin are apparent, most of the worlds supply of Artemisia annua leaves being produced in Guangxi & Hunan provinces in China, as well as smaller amounts from Vietnam. Previously the WHO has backed initiatives to grow the herb in Tanzania in an attempt to supply pure arteminisin and dihydro-artemisinin (see http://www.europaworld.org/week128/whobacks9503.htm). 

 

As Cropwatch has previously remarked, the gradual development of resistance to single actives is hardly rocket science, so monotherapy with artemisinin or its derivatives could have anyway only provided a short period of respite against the ravages of the disease. With the development of a malaria vaccine 10 years away (Greenwood 2005), and a new generation of malaria drugs similarly estimated to be 10 years away (Arati Kotchi through Boseley 2006), when the latter newly developed drugs do arrive, the limitations of the “magic bullet” pharmacological science approach could be perhaps better considered and weighted by policy makers in the future

 

 

 

References.

 

Arati Kochi through Boseley S. (2006) “Drug Firms could Destroy Effect of Malaria Pills” Guardian Fri Jan 20th 2006 p18.

 

Attaran A., Barnes K., Curtis C, d'Alessandro U., Fanello C., Galinski M.,  Kokwaro G., Looareesuwan S., Makanga M., Mutabingwa T.  (2004) “WHO, the Global Fund, and medical malpractice in malaria treatment.” Lancet363 (9404), 237-240

 

Garner P & Graves P.M. “The Benefits of Artemisinin Combination Therapy for Malaria Extend Beyond the Individual Patient” PLOS Medicine 2(4), April 2005.

 

Greenwood B.M., Bojang K., Whitty CJ & Targett GA (2005) “Malaria” Lancet 365(9469), 1487-1498.

 

Thayer A.M. (2005) “Fighting Malaria” Chemical & Engineering News 83(43) 69-82.

 

See also:

Anon (2004) “A Feverish Response” Economist Nov 18th 2004.

 

Boseley S. (2005) “Resistance fears as Life-Saver Malaria Drug Loses Potency” Guardian Dec 2nd 2005.