Wednesday, December 10, 2003

In Ethiopia's Malaria War, Weapons Are the Issue: "
With a major malaria outbreak sweeping Ethiopia, an international doctors' group working there contends that outdated drugs are being used to fight it and may even worsen the epidemic.

Unicef, the United Nations agency providing the drugs, defended the choices it made in consultation with the Ethiopian government. The older drugs are still effective, it said, and changing policy midepidemic for a health system as battered as Ethiopia's can be disastrous.

But an internal World Health Organization memo from Dec. 3, obtained by The New York Times, disagrees and 'strongly recommends' that a new but more expensive drug be used."

The struggle illustrates problems confronting the makers of world health policy. Drug-resistant strains can evolve faster than new drugs can be discovered, and new cures are inevitably more expensive, forcing choices between costly drugs that work and cheap ones that may not.

The W.H.O. expects Ethiopia's epidemic to spread to 15 million of its 65 million population — triple the normal rate.

The aid group arguing for newer drugs, Doctors Without Borders, says that in the two Ethiopian areas where it runs clinics, up to 60 percent of patients have strains that appear resistant to the first-line treatment that Unicef and Ethiopia picked, a two-drug cocktail of chloroquine and sulfadoxine-pyrimethamine, better known by its initials, SP, or the brand name Fansidar.

The doctors' group said the second-line treatment, hospitalization for five days of quinine, was inaccessible for many patients and hard on malnourished children. Ethiopia is a mountainous country, where many people live far from clinics or are nomadic.

Doctors Without Borders wants to introduce artemisinin, a chemical that Chinese herbalists first derived 30 years ago from the sweet wormwood plant. It has become the latest wonder drug against malaria. But it is relatively expensive. Even at the prices drug companies offer to the poorest countries, cocktails that use it cost $1 to $2.50 an adult treatment. A typical treatment of chloroquine and SP costs about 20 cents.

The artemisinin program also requires taking pills for three days instead of one.

Nonetheless, the W.H.O., which usually provides treatment guidance, strongly endorses artemisinin cocktails, which are being used in several African countries, including Burundi, Liberia and South Africa. Because resistance to chloroquine is widespread, the W.H.O. discourages its use.

Dr. Kevin Marsh, a malaria expert working in Kenya, called chloroquine "a failed drug" and said health authorities were foolish to spend money on it.

Heavy rains this year ended five years of a drought that starved and weakened people in wide swaths of Ethiopia. The rains were accompanied by unusually hot weather that let mosquitoes breed at higher altitudes.

Malaria surged. United Nations relief agencies are calling the outbreak the worst since 1998 and the country's "single biggest health problem."

But malaria death rates in some villages are five times the normal rate, said Dr. Pauline Horrill, an emergency coordinator for Doctors Without Borders.

Across the world, malaria kills three children a minute.…

http://www.nytimes.com/2003/12/09/health/09MALA.html?pagewanted=all&position=

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