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30.08.2008 Health

High Quality Anti-Malaria Drugs Will Significantly Reduce Malaria Related Deaths in Africa

By PanAfrican Visions
High Quality Anti-Malaria Drugs Will Significantly Reduce Malaria Related Deaths in Africa
30.08.2008 LISTEN

Richard Trent Chairman Board of Africa Fighting Malaria

By Ajong Mbapndah L

Prior to the discovery of HIV/AIDS it was one of the greatest killers in Africa. Malaria, the killer disease in question has continued to take a huge toll on human life in Africa. Despite the huge number of malaria related deaths, it does not appear to benefit from the kind of attention and focus as HIV/AIDS. As the countdown to the new millennium narrowed down, all sorts of slogans were used to raise hopes in Africans. Health for all by the year 2000 was one of the most conspicuous, yet almost a decade into the 21st century, malaria related deaths are still very rampant with Africa hardest hit. One of the groups leading a relentless crusade to turn the tide is Africa Fighting Malaria (AFM), a health advocacy group based in South Africa and the USA.With a mission to make malaria control more transaparent, responsive and effective, AFM is today leading the first grass roots project dedicated to buying high quality malaria drugs for African children and testing markets in Africa to publicize the prevalence of fake sub standard malaria drugs.


Richard Trent from South Africa has been Director of AFM since inception in 2000 and in 2006, he was appointed Chairman of the AFM Board. Interviewed by Ajong Mbapndah L for Pan African Visions, he sheds more light on the grass roots project of the AFM, dubbed the march of Washingtons, global response to the threats posed by malaria, the role of the World Health Organisation and more.

PAV: What motivated the creation of Africa fighting malaria and how will you rate your success in fighting malaria this far?

Richard Trent: AFM came together during the negations around the Stockholm Convention on Persistent Organic Pollutants in the late 1990s. We teamed up with a network of malaria scientists and public health experts to argue against the proposed global ban on DDT. Many of us had worked in malarial countries and seen how effective DDT was in controlling malarial mosquitoes. Despite its reputation, this chemical is not harmful to humans or the environment. Fortunately, we were successful in securing a public health exemption for DDT, and Africa Fighting Malaria was formally incepted as a not-for-profit group in South Africa in 2000. Since then we have continued to campaign for evidence-based, comprehensive malaria control programs. Overall malaria control is improving in many countries and more and more countries are adopting ambitious and comprehensive approaches which include more than just distributing insecticide treated nets. With many countries expanding and re-starting indoor spraying programs with insecticides, improving diagnosis and treatment progress is being made. AFM's success has been in policy change and in ensuring more transparent and accountable malaria control programs. USAID's lead malaria program, the President's Malaria Initiative (PMI) is leading the way with comprehensive and transparent programs and AFM can claim some success in driving through policy changes in the US.

PAV: Why the March of Washingtons and how is it going to impact on the fight against malaria in Africa?

Richard Trent: Access to malaria treatment in Africa is impeded by poor infrastructure and a lack of high quality drugs. AFM's own analysis recently found that 35% of antimalarials sold in six major African cities failed basic quality control tests. In fact, the World Health Organization estimates that 200,000 malaria-related deaths could be avoided each year if antimalarial drugs were of a high quality and properly administered. The March of Washingtons is the first grassroots project dedicated to buying high quality antimalarial drugs for African children and testing markets in Africa to publicize the prevalence of fake and substandard malaria drugs.

PAV: Africa is a broad continent what mechanisms do you have in place to ensure that your activities cover the length and breadth of the continent?

Richard Trent: Our goal is to start small. Once we have raised sufficient funds, our first drug distribution will piggyback on existing donor campaigns – in other words, we will start by helping to fill the gaps. Our drug testing projects use mobile lab technology and can be conducted in the field. We have a growing presence in key African regions where fake and substandard drugs are a problem, and we will continue to make random collections on an ongoing basis. There is a growing momentum among African governments, western donors and public health agencies to fight malaria, primarily by distributing long-lasting insecticidal nets. This is welcome, but we are hoping to refocus efforts on access to safe and effective malaria treatment.

PAV: May we know some statistics in you possession on the situation of malaria in Africa today?

Richard Trent: Unfortunately the capacity to accurately measure the malaria burden does not yet exist in Africa. The World Health Organization estimates that over a million people succumb to the disease around the world each year, though the majority of deaths are still among African children under age five. There have been some notable successes. The Lubombo Spatial Development Initiative is a cross-border project between the states of South Africa, Swaziland and Mozambique to control malaria using highly effective artemisinin-based combination therapy drugs (ACTs), indoor residual spraying with insecticides, and long-lasting insecticidal nets (LLINs). [http://www.ajtmh.org/cgi/content/full/76/1/42] This initiative brought malaria cases down significantly in all three countries where it was run. Zanzibar has also developed a comprehensive program, and brought malaria prevalence to less one percent on the island. [http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040309&ct=1] And the World Health Organization recently published a report showing ACTs and LLINs have helped reduce malaria in Zambia, Ethiopia, Ghana and Rwanda. [http://www.who.int/malaria/docs/ReportGFImpactMalaria.pdf]

PAV: Malaria was a known killer long before the emergence of HIV/AIDS but has failed to receive the same global attention and resources as HIV, why is it so?

Richard Trent: Unlike HIV/AIDS, malaria has no natural constituency in the west – meaning that most western voters and activists aren't actually affected by the disease. There is increasing recognition that the diseases are related and feed off of each other in the field, and thanks to organizations like the Global Fund to Fight AIDS, TB and Malaria, more people are coming together to face these diseases in complementary ways. Luckily some great African advocates for malaria control, such as Yvonne Chaka Chaka are helping to raise the profile of malaria around the world and this really helps to sustain funding and programs.

PAV: You posit that fake and sub standard drugs malaria drugs are a big problem in Africa, who bears the blame for this?

Richard Trent: Well first of all drug counterfeiters are criminals and their intention is to make money by passing off chalk or some other substance as a medicine. This activity kills and the criminals are to blame. Now of course the criminal justice system of any country must deal with these criminals and prosecute them to the full extent of the law – and we believe that they should be treated as harshly as possible. Not only are they stealing money from people that have very little, but they are ensuring that a child will die – this amounts to theft and murder.

As for the sub-standard medicines, this is a complex area. We believe that if a company is unable to produce a good quality medicine it should be shut down and the regulators should take responsibility for ensuring that bad quality products are removed from the market. Generally local businesses that produce any number of products try to put pressure on governments to favour local producers and to keep out foreign imports – and the market for malaria drugs is no different. So we see local producers being favoured, even though they may be unable to produce a high quality product. Often an imported medicine is not only cheaper, but better. That is not to say that local producers are incapable of producing a high quality product, but if they have to rely on tariffs, trade barriers or political favours to sell their product, the likelihood is that they can't compete on quality or price adequately. In this case, the politicians and bureaucrats that keep out imports are to blame. Unfortunately some agencies, such as the Global Fund for AIDS, TB and Malaria includes a whole host of malaria medicines on their list of products that can be procured that have never been tested by a stringent regulatory authority or the World Health Organziation. We clearly think this should stop and we must have better leadership from international organizations when it comes to drug quality.

So there are many that are to blame for poor drug quality and for fakes – and there is no single solution – but governments of malarial countries can be more firm about insisting on high quality products from donor agencies and they can and should improve their oversight of the drugs market, doing random quality tests at ports of entry and at pharmacies.

PAV: In your opinion has the World Health Organization been paying sufficient attention to the threats posed by malaria, what recommendations will you make to them?

Richard Trent: The World Health Organisation. Lately though, that leadership has improved dramatically and with For many years malaria was a forgotten disease and there wasn't very good leadership from the Roll Back Malaria partnership we now see a great deal of progress globally in scaling up malaria control and improving treatment.

When it comes to malaria treatment, the WHO has shown good leadership and in 2006 it issued new antimalarial treatment guidelines for the first time in 20 years. The WHO and other agencies are also working hard to improve malaria treatment and ensure that drugs are of high quality. WHO also has a project to clamp down on fake drug producers and to put these criminals in jail.

There is always a great deal that UN agencies could be doing – one area that needs to be addressed is the issue of insecticide resistance and new insecticides. With diseases such as malaria that are transmitted by mosquitoes, we need insecticides. Unfortunately there have been no new insecticides developed. Unlike the leadership shown for the development of new malaria medicines and a malaria vaccine, there is no real drive from UN agencies or governments for new, much needed, public health insecticides. As resistance to insecticides increases the need for new products will be ever more acute. This is an area that WHO must address urgently.

PAV: After the March of Washingtons what other programmes does the AFM have in mind?

Richard Trent:AFM continues to promote increased transparency and accountability in all spending of public funds on malaria control. We believe that it isn't enough just to spend more money on malaria control, we must measure success better and ensure that taxpayers money is spent in the most effective way.

We are currently working hard to oppose proposed European Union legislation that would see the number of insecticides for agriculture dramatically reduced – this will have knock on effects for malaria control. The public health market for insecticides is a small fraction of the total market for agriculture, so if the agricultural market is closed down it will be financially unviable to produce chemicals for malaria control. The unintended consequences of EU moves to protect people in Europe from the very small risks from insecticides means that people in poor countries will face higher risks from mosquitoes – with increased incidences of disease and death. We can't allow that to happen!

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