Recent aggressive measures against the anopheles mosquito, sanitation measures, earlier and more accurate diagnostic techniques, and more efficient medication delivery through improved infrastructures has led to a decline in malaria deaths in sub-Saharan Africa, from over 1 million annually to the recently-estimated 600,000 (still a catastrophe). Various agencies of the U.S. government have played crucial roles in financing the miraculous change in prognosis for malaria in Africa, starting with the PMI (President s malaria initiative) of Pres. GW Bush. Currently, the U.S. Agency for International Development (USAID) is in charge of these programs, in cooperation with the Global Fund to Fight AIDS, Tuberculosis and Malaria an initiative set up by the United Nations and Western governments that spends one-third of its budget on malaria control.
One of the key improvements responsible for this salutary change is the prevention of resistance to anti-malarial drugs by using adequate doses of the best treatment, artemesinin-based combination therapy (ACT). One of the most effective and commonly used such ACTs is Coartem, made by Novartis and either given away in Africa, or sold at a deep discount. However, the increasing problem of drug diversion (theft) is causing widespread resistance to the drug, according to an investigative report in the Wall Street Journal story. When the drug is stolen and shipped from the east African nations where it is legally marketed (e.g.,Tanzania), to the west (Angola), deterioration occurs. If the activity of the drug is impaired, ineffective dosages will produce resistant strains of the plasmodium, the parasitic protozoa which is the infectious agent of malaria. The same criminals who steal and re-sell the drugs at huge mark-ups also make counterfeit medications resembling the real thing, with the same result: ineffective (or absent) active ingredients, fatal results of inadequate therapy for the patient, and resistant organisms for the region.
ACSH s Dr. Gilbert Ross, who has studied the problem of malaria in Africa and the various approaches to its prevention and treatment, including the increasing use of DDT, and the problem of counterfeit and sub-standard medications, had this comment: Smugglers and crooks are going to do what they do that s the way of the world, worse perhaps in the poorer countries with little effective enforcement. However, the key part of this story is the implication that public officials in some of these countries are complicit in the diversion of desperately-needed treatments. Hopefully, now that the Inspector-general of USAID has gotten involved, the culprits, both traffickers and government officials, will be rooted out and the delivery of effective antimalarial drugs will continue to stem the epidemic of malaria.