MALARIA: drug resistance

The World Health Organisation, governments, and non-profit groups are not paying enough attention to the dangers of drug-resistant drugs, a report from the Centre for Global Development has warned.
According to the report, laudable efforts to increase access to drugs in the developing world are hardly accompanied by measures to protect the continued effectiveness of drug treatment.
It called on the distributing agency to “strenuously enforce quality standards throughout the supply chain, ensure that adequate knowledge is gathered about the effectiveness of the medicines they are providing, and use their purchasing power to drive drug quality standards throughout the supply chain.”
The report, which was released on Tuesday, added that children in the developing world die every year from drug-resistant strains of malaria, tuberculosis, AIDS, and other diseases.
It also revealed that more than 40 percent of children worldwide live in malaria endemic countries, while malaria kills almost 1 million children under the age of five in sub-Saharan Africa alone annually.
Many of the drug distribution programmes may be driving drug resistance and endangering the lives they are meant to save, according to the report from the Centre for Global Development.
“We are rapidly losing our ability to cure an alarming number of the most serious and common diseases of the developing world because of an invisible adversary: drug resistance. Resistance is inevitable - but careless practices in drug supply and use are hastening it unnecessarily.
“Without an immediate global effort to safeguard lasting treatment effectiveness, drug resistance will quickly become a widespread threat, claiming lives, raising the cost of curing patients, and making future generations increasingly vulnerable to deadly diseases that were easily cured in the past, ” said the Centre’s Rachel Nugent, who led the group that wrote the report.
High cost
Since 2006, donors have spent more than 1.5 billion dollars on specialised drugs to treat resistant bacteria and viruses, and this could worsen the report cautions.
The Centre’s report looks for even broader action, urging WHO to lead others, including pharmaceutical companies, governments, philanthropies that buy and distribute medicines, hospitals, healthcare providers, pharmacies and patients.
The report finds clear links between increased drug availability and resistance. For instance, in countries with the highest use of antibiotics, 75 to 90 percent of Streptococcus pneumoniae strains are drug-resistant, it found.
“Poor quality drugs, counterfeit drugs, incomplete use of drugs, and other factors all contribute to the problem, and this problem will worsen as drug access programs succeed,” it cautions.
“The number of people being treated for HIV/AIDS, for example, increased 10-fold between 2002 and 2007; there was an 8-fold rise in deliveries of (drugs) for malaria treatment between 2005 and 2006.
“And the Stop TB Partnership’s Global Drug Facility has expanded access to drugs for TB patients, offering nearly 14 million patient treatments in 93 countries since 2001,” it added.
Child’s health impact
The long-term effects of malaria on a child’s health and development are often insufficiently recognised and poorly managed, the report identifies.
“A severe form of the disease, cerebral malaria, kills 10-20 percent of those children it affects, while an additional 7 percent are left with permanent neurological problems, including blindness, epilepsy, and speech and learning difficulties.
“Chloroquine was an effective first-line malaria treatment for more than 50 years, but when resistance rates became unacceptably high in the mid-1990s, SP became the only affordable, effective alternative with limited side effects,” it stated.
Mrs. Nugent, who is also the deputy director of global health, while commenting on drug resistance and the administering of bad malaria pills in some Africa countries, told journalists in February 2010, that, “there are many cases of malaria that are being only partially treated, and that just guarantees acceleration of artemisinin drug resistance.”
The result of a study conducted in Africa then revealed that high rates of the most effective type of malaria-fighting drugs sold in three African countries are poor quality - including nearly half the pills sampled in Senegal.
The group, however, highlighted the need for governments to “have a responsibility to provide regulation and oversight of drug licensing, manufacturing distribution, and use, as well as to properly support laboratory facilities and surveillance systems, in order to detect and monitor drug efficacy.”
Patients, prescribers, and dispensers were all advised to gain greater awareness of the personal and social costs of drug resistance, and employ far greater diligence in appropriately using drugs.
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