Posts or Comments 18 April 2024

Monthly Archive for "March 2007"

Funding &Policy Bill Brieger | 22 Mar 2007

Malaria AID: Do No Harm

In a working paper for the Center for Global Development, Nancy Birdsall challenges some of the basic assumptions of development aid/assistance.  She identifies 24 African countries that are ‘aid-dependent’, deriving more that 10% of their gross national income from international assistance.  The results of this situation need to be monitored, according to the working paper, so that aid providers ‘do no harm.  Problems of aid potentially include poaching of skilled workers by aid agencies, decreased government accountability when income comes from non-indigenous sources and even macroeconomic effects like pressure on currency appreciation.

What does this have to do with malaria?  Obviously national malaria programs are receiving aid in a variety of forms from large scale efforts like the Global Fund to fight AIDS, TB and Malaria, the President’s Malaria Initiative and the World Bank Booster program.  Following the White House Summit on Malaria, many organizations from traditional development NGOs to sports groups have jumped on the bandwagon to assist in the fight against malaria.  Financial aid for malaria, though still far from what is needed to control the disease, has increased by leaps and bounds.  Besides providing bed nets and malaria medicines, what else is this aid doing?


Ideally assistance from sources like GFATM should be used to supplement or compliment national malaria control program efforts. Unfortunately, one often sees that the only resources going to buy Artemisinin-based Combination Therapy (ACT) drugs or Long-Lasting Insecticide-treated Nets are in fact donor funds.  Visits to district health facility medical stores may show a large supply of nets in stock. Many may have been given out to children under five years of age in conjunction with a recent measles campaign. The remainder might be sent to antenatal clinics to give to pregnant women.  When asked what will happen when the stock of donated nets is finished – i.e. what to do next year when there are a new set of pregnant women and a new set of infants in need of nets, the health staff can’t answer. Districts do not have in their budget funds for serious malaria control, and thus the short term gifts are not backed by a commitment to long term sustainability.

What about ACTs? Most aid is used to buy and give ACTs free to children under five years of age. What happens to older children and adults who have malaria?  Again, district health departments often have not planned in a comprehensive way to provide up-to-date malaria treatment for the population, but just rely on the targeted donations for a specific age group. Embarrassed health workers have been known to give two packets of the child medicines to adult clients in need.  Furthermore, if the grant or program has targeted only 20% or 50% of children under five, when the ACTs on hand finish after a few months, there are none available even to treat the children until the next year’s donor supplies arrive.

In many cases therefore, donor supported malaria programs are not really strengthening and supplementing a local program. They are simply providing a stopgap for a portion of the population for a few short years.  Malaria aid without national and district political commitment in endemic countries and comprehensive forecasting and planning is not going to save lives in the long run.

Policy &Treatment Bill Brieger | 07 Mar 2007

Monotherapy Artemisinin Issue Not Resolved

United Press International reports that Kunming Pharmaceutical Corp. maintains that its monotherapy artemisinin product is safe despite WHO trying to clamp down on sales and distribution of monotherapy malaria drugs in order to prevent resistance.  Although Ferreira et al. (2007) note that African surveys have observed that the overall susceptibility to artemisinin derivatives is relatively high they found potential opportunities for resistance to develop and therefore recommend, “Close monitoring of local parasite susceptibility and of putative genetic modulators of drug responses should carry on in view of protecting the long-term efficacy of ACT.”


There is no point waiting until full blown resistance develops before taking action, hence WHO’s call for eliminating monotherapy artemisinin drugs before it is too late.  In stark terms WHO’s malaria chief, Arata Kochi, says, “If we lose artemisinin, we are dead, basically.”

In addition to the natural development of resistance over time one finds human induced problems. Atemnkeng et al., (2007) warn that, “Counterfeit or substandard artemisinin-derivative drugs are being sold in parts of Africa, presenting a potential route for resistance development in the future.”

Ultimately the will and ability to preserve our pharmaceutical arsenal against malaria rest with national governments who set malaria drug policies and guidelines and whose various food and drug regulatory agencies approve which malaria drugs are sold and dispensed.  Mugittu et al. (2006) commend preventive policies. Even though resistance to artemisinin has not yet been selected in Tanzania, they commend the Ministry of Health for making the decision to adopt artemether+lumefantrine as first-line malaria treatment. Governments in endemic countries like that of Tanzania need to step forward and protect their populations against drug-resistant malaria.