Coming into the immigration office in Bukavu, Democratic Republic of Congo, one is welcomed by a 2008 calendar that features chloroquine products made by Pharmakina, a company that has set up production in DRC. Another copy of the calendar is seen in the provincial office of the national AIDS coordinating agency. According to the company “PHARMAKINA combats malaria supplying drugs of natural origin. PHARMAKINA cultivates 1,200 hectares of quinquina that guarantees the stocks of barks for a LONG-TERM production.”
While it is admirable that local botanical production is being promoted, the sale of chloroquine when drug resistance is rendering this anti-malaria drug useless in most of Africa is questionable. [see comment for correction] The East African Network for Monitoring Antimalarial Treatment observed that “Between 1998 and 2001, Kenya, Uganda, Tanzania, Zanzibar, Rwanda and Burundi changed antimalarial drug policy, in the face of widespread chloroquine resistance.” Specifically in DRC researchers reported that CQ is no longer efficacious in the treatment of malaria.
Furthermore DRC’s malaria grant from the Global Fund remarks on the change of national malaria drug policy to use artesunate-amodiaquine as first line treatment. The August 2007 progress report on that grant observed that there was, “Concern with the impact of the switch from chloroquine to ACTs on the program’s Phase 2 targets on the Principal Recipient’s ability to purchase sufficient drugs to enable it to reach targets and the CCMâ€™s proposal in the Phase 2 request to reduce the program’s timeline from 5 to 4 years.” Maybe this is why CQ is still popular?
Local production of malaria drugs does have the potential to reduce costs and increase access. Just as Pharmakina is promoting local cultivation of quinine, other companies and countries are promoting growing of artemisinin. The principle is the same, but the drugs are not. The challenge is producing the most efficacious drugs that come in combination form. Following WHO malaria treatment guidelines is a good place to start.