Treating malaria

Vegetable stir fry

Legend has it that the gin and tonic cocktail evolved to provide the administrators of the British Empire with both ethanol and quinine. The former would keep them happy, and the latter would help keep malaria-carrying mosquitos at bay. In the present day, chloroquinine is still a common treatment for malaria. At 20-40 cents a dose, it is dramatically cheaper than the more effective alternative: a drug called artemisinin which is derived from the Artemisia annua shrub. A course of artemisinin treatment costs between $5 and $7 – too much for many people in the developing world.

Also problematic is how using artemisinin-only treatments will rapidly lead to drug resistance in mosquito populations. Mutations that confer advantages against a particular compound are relatively common, and are strongly selected for by evolution once they occur. It is much less likely that a malarial parasite will evolve both resistance to artemisinin and to a drug used in combination before one compound or the other kills it. As such, artemisinin combination therapies (ACTs) are the preferred treatment. These are somewhat more expensive, at $6 to$10 for a course of treatment.

Several organizations are trying to tackle the cost issue. In particular, the World Bank and the Bill and Melinda Gates Foundation are cooperating on a scheme called the Affordable Medicines Facility-malaria (AMFm). Given that malaria continues to kill 1-3 million people per year – and sicken between 400 and 900 million – such efforts are to be applauded and encouraged.

Author: Milan

In the spring of 2005, I graduated from the University of British Columbia with a degree in International Relations and a general focus in the area of environmental politics. In the fall of 2005, I began reading for an M.Phil in IR at Wadham College, Oxford. Outside school, I am very interested in photography, writing, and the outdoors. I am writing this blog to keep in touch with friends and family around the world, provide a more personal view of graduate student life in Oxford, and pass on some lessons I've learned here.

15 thoughts on “Treating malaria”

  1. Artemisin is not that expensive. Some types of drugs are more expensive than others. In Ghana I paid $3 for one kind, although the kind that eventually cleared up the malaria for good was $10.

    I believe most of Sub-Saharan Africa is chloroquine resistant. Quinine can still be effective in some cases though.

    Also, if more people in malaria zones had access to clean water and better nutrition, their chances of surviving would surely go up and their chances of developing “complicated” malaria (malaria and another disease at the same time) would go down. Effective sewage would mean less communicable diseases, and less places for mosquitos to breed too.

  2. Hahaha, Litty!

    Actually did you check out National Geographic’s recent Malaria issue? They made the interesting point that in circumstances where malaria is *almost* eradicated, it can actually be worse than doing nothing, because when adults go for a couple years without malaria they lose all the immunity they’ve built up. So when the malaria makes a comeback they are even more vulnerable.

    Perhaps that means that focusing on infant malaria health is a safer bet, because it protects the fetus and infant from the disease until it is old enough to have the strength to survive it? Also, having immediate and effective access to treatment must make a difference because malaria is more severe according to the parasite load in your blood (as I discovered when I was diagnosed with “double malaria” two years ago). In countries where every dollar counts, people often wait until the situation is very severe before they will pay their hard-earned money to go to a doctor.

    (For example in the Bawku hospital, they often see car accident victims who have waited several days before coming in with a broken leg or arm. The doctor told us that because they wait while the limb becomes gangrenous, a high percentage of their car accident patients end up getting amputations-which could be prevented if they were able to immediately see a doctor. I’ve seen the same thing with people who are very, very sick with malaria, and if you have cerebral malaria you can die within three days meaning that hours count!).

    If seeing a doctor was realistically accessable (say, within a bus ride) and guaranteed free for people below the poverty line, I’m sure many people would improve their preventative health care. With the impact that malaria and HIV/AIDS, as well as other diseases have on the well-being of entire nations, can African countries afford not to provide free universal health care?

  3. Good intentions

    SIR – You fail to properly discuss malaria drug quality (“Money v mosquito”, November 3rd). Substandard drugs (as opposed to outright fakes) contain some active ingredient, making them likelier to pass basic pharmacological tests. But while fakes might kill individuals, substandard drugs can drive parasite resistance and could doom a whole class of drugs, as well as not cure the patient. A subsidy is welcome, but will increase incentives for manufacturers of substandard and fake drugs alike. Strengthening regulatory controls in developing countries is vital. Before launching a full-scale subsidy, pilot programmes to test the market, such as that being run in Tanzania by the Clinton Foundation, should be closely analysed first.

    Richard Tren


    Africa Fighting Malaria

    Washington, DC

  4. A dying mosquito exclaimed,
    “A chemist has poisoned my brain!”
    The cause of his sorrow
    Was para-dichloro-

  5. Malaria
    Resisting arrest

    May 15th 2008 | NEW YORK AND RIO DE JANEIRO
    From The Economist print edition
    Fighting malarial drug resistance

    WILL the world lose another miracle cure? Fifty years ago chloroquine seemed to be an unbeatable malaria remedy. But as the popularity spread of this synthetic form of quinine (a tree extract), the biological backlash began in the form of drug resistance. Today it is not recommended even for use in Africa, which suffers most of the world’s malarial deaths.

    In the past few years artemisinin, derived from Artemisia annua, a bush common in China, seemed equally promising. Alarmingly, though, signs of resistance to it have started to appear in South-East Asia. A large part of the reason for the build-up of resistance is the use of the drug by itself, as a monotherapy, rather than in combination with another drug. Experts agree that the use of Artemisinin Combination Therapies (ACTs) can greatly delay drug resistance in Africa. The World Health Organisation recommends their use. The leading ACT today is Coartem, which combines artemether, a derivative of the Chinese drug, with lumifantrine, another anti-malarial remedy.

  6. Malaria parasites ‘resist drugs’

    International scientists say they have found the first evidence of resistance to the world’s most effective drug for treating malaria.

    They say the trend in western Cambodia has to be urgently contained because full-blown resistance would be a global health catastrophe.

    The artemesinin family of drugs is the world’s front-line defence against the most prevalent and deadly form of malaria.

    Two teams of scientists, working on separate clinical trials, have reported seeing the disturbing evidence that the drugs are becoming much less effective.

    There is particular concern because previous generations of malaria drugs have been undermined by resistance which started in this way, in this part of the world, our correspondent reports.

  7. Gates says malaria vaccine may be ready in three years

    By Tom Hagler
    BBC News

    Microsoft founder Bill Gates has told the BBC that a vaccine for malaria could be just three years away.

    Mr Gates is a key campaigner against the disease which kills a million people a year, most of them children.

    Since it was formed, his foundation has spent billions of dollars in the fight against malaria.

    Just like smallpox, Mr Gates believes the disease can be eradicated. As yet, there is no vaccine, but, Mr Gates says, a breakthrough is near.

    “We have a vaccine that’s in the last trial phase – called phase three. A partially effective vaccine could even be available within three years, but a […] fully effective vaccine will take five to 10 years,” he told the BBC World Service’s World Today programme.

  8. A Saskatoon-based team at the National Research Council has isolated genes in the sweet wormwood plant that produce the compound artemisinin, a key malaria antidote. The genes can then be added to yeast, producing the compound much more quickly, a process being worked on by scientists at the University of California, Berkeley.
    “The problem is that the plant has a one-year life cycle between the demand and the supply,” said Patrick Covello, the lead NRC researcher on the project. “You had costs going from a few hundred dollars a kilogram to a thousand, then back down to a few hundred.”
    Growing artemisinin in yeast, however, can be done within weeks, providing a more reliable source. Pharmaceutical company Sanofi-Aventis has agreed to produce drugs using the technology and distribute them, not for profit, in the developing world starting next year.
    Scientists at Harvard University, meanwhile, have made progress toward solving one of the greatest problems in the treatment of the disease: its ability to rapidly build up resistance to medications. Last week, the team announced it had uncovered genes that may be involved in creating drug-resistant versions of the parasite. Finding these genes is the first step toward developing drugs that can neutralize their power.

  9. Malaria
    Not swatted yet
    A new vaccine is one step towards a distant goal

    MAN has vanquished only one disease, smallpox. In 2007 Bill Gates set out to eradicate another, malaria. The World Health Organisation (WHO) was soon rallying its troops to the cause and a flood of money followed. $612m went to research in 2009 alone. This week the Bill & Melinda Gates Foundation trumpeted another announcement: results from a phase III trial (the more extensive process of testing drugs in people) of a malaria vaccine called RTS,S. This is the world’s most advanced vaccine for malaria and the results, published in the New England Journal of Medicine, were encouraging.

    It is an important step in combating a disease that still kills more than 700,000 people a year and debilitates millions more. But it is also a reminder of how much work remains to be done.

    Mr Gates is only malaria’s latest adversary. The parasite has plagued man for millennia. Chinese texts from 2700BC describe plants to treat its fevers. More recently, in 1955, the WHO embarked on its first malaria-eradication effort. But transmission rates in Africa seemed intractable. After 14 years the WHO gave up. The last time the world tried to eliminate malaria, some scientists lament, the world eliminated malariologists.

  10. Malaria deaths hugely underestimated – Lancet study
    By Neil Bowdler
    Science and health reporter, BBC News

    Worldwide malaria deaths may be almost twice as high as previously estimated, a study reports.

    The research, published in the British medical journal the Lancet, suggests 1.24 million people died from the mosquito-borne disease in 2010.

    This compares to a World Health Organisation (WHO) estimate for 2010 of 655,000 deaths.

    But both the new study and the WHO indicate global death rates are now falling.
    Continue reading the main story
    “Start Quote

    What we now know is that we’re actually able to turn off malaria using existing methods”

    Richard Horton Editor, The Lancet

    The research was funded by the Bill and Melinda Gates Foundation. It used new data and new computer modelling to build a historical database for malaria between 1980 and 2010.

    The conclusion was that worldwide deaths had risen from 995,000 in 1980 to a peak of 1.82 million in 2004, before falling to 1.24 million in 2010.

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