[ppi] [ppiindia] Switch to herbal malaria drug is on

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http://www.iht.com/articles/519087.html

Switch to herbal malaria drug is on 
Donald G. McNeil Jr./NYT NYT Monday, May 10, 2004

After years of hesitation, world health agencies are racing to acquire 100 
million doses of a Chinese herbal drug that has proved strikingly effective 
against malaria, one of the leading killers of the poor. 
.
The drug, artemisinin, is a compound based on qinghaosu, or sweet wormwood. 
First isolated in 1965 by Chinese military researchers, it cut the death rate 
by 97 percent in a malaria epidemic in Vietnam in the early 1990s. 
.
It is rapidly replacing quinine derivatives and later drugs that the disease 
has outwitted by evolving resistant strains. This time, to prevent artemisinin 
from suffering the same fate, it will be given as part of multiple-drug 
cocktails as AIDS drugs are. 
.
Until recently, big donors like the United States and Britain have opposed its 
use on a wide scale, saying it is too expensive, has not been tested enough on 
children and is not needed in areas where other malaria drugs still worked. 
Unicef, the United Nations Fund for Children, which procures drugs for the 
world's poorest countries, opposed its use during an Ethiopian epidemic last 
year, saying there was too little supply and switching drugs in mid-outbreak 
would cause confusion. 
.
Now virtually all donors, Unicef and the World Bank have embraced it. The new 
Global Fund for AIDS, Tuberculosis and Malaria has given 11 countries grants to 
buy artemisinin and has instructed 34 others to drop requests for two older 
drugs, chloroquine and sulfadoxine-pyrimethamine, and switch to the new one. 
.
"We want countries to move very rapidly to use it as first-line treatment," 
said Dr. Vinand Nantulya, the fund's malaria adviser. The fund expects to spend 
$450 million on the drugs over the next five years, he said. 
.
The World Health Organization, a U.N. agency based in Geneva, estimates that 
100 million doses will be needed by late 2005. 
.
Malaria causes about 300 million illnesses a year, and at least 1 million 
deaths - 90 percent of them in Africa, and most of them children under 5. 
Despite more than a century of eradication efforts, the disease is endemic from 
the Mekong Delta in Vietnam to the Amazon basin in Brazil, and particularly bad 
across central Africa, from the cane fields of Mozambique to the oases of 
Somalia to the rubber plantations of Liberia. 
.
Like many tropical disease drugs, artemisinin is a fruit of military research. 
Chinese scientists first isolated it in 1965 while seeking a new antimalarial 
for Vietnamese troops fighting U.S. forces, said Dr. Nelson Tan, medical 
director of Holley Pharmaceuticals, which makes it in Chongqing, China. Another 
antimalarial still in use, mefloquine, was isolated at the Walter Reed Army 
Institute of Research in 1963 for U.S. troops in the same jungles. Under the 
name Lariam, it is still issued to troops and sold to travelers. 
.
Artemisinin quickly cures fevers and also rapidly lowers blood-parasite levels, 
which can keep small outbreaks in heavily mosquito-infested areas from 
spreading into epidemics. 
.
Two years ago, Dr. Dennis Carroll, a health adviser to the United States Agency 
for International Development, said artemisinin was "not ready for prime time." 
On April 30, at a malaria conference in New York, he led a session on ways to 
induce farmers to plant more wormwood. 
.
While denying that the U.S. had ever opposed artemisinin in principle, Carroll 
said more evidence had emerged that it was safe and older drugs were not 
working. Also, the creation of the Global Fund sped up grants for it. Dr. 
Stewart Tyson, a health expert in Britain's foreign aid agency, said his 
agency's mind was changed by its experience in Uganda, where resistance to 
older drugs climbed from 6 percent in 2000 to 31 percent in some areas in 2003. 
.
The price of artemisinin cocktails has fallen from $2 per treatment to 90 cents 
or less as more companies in China, India and Vietnam have begun making them. 
Older drugs cost only 20 cents. Novartis, the Swiss drug giant, sells its 
artemisinin-lumefantrine mix, Co-artem, to poor countries for 10 cents less 
than it costs to make, a company official said. The same drug, under the name 
Riamet, is sold to European travelers for about $20. 
.
As a plant material, artemisinin cannot be patented, said Dr. Allan Schapira, a 
policy specialist for the WHO's Roll Back Malaria campaign. 
.
Though it grows wild even in the United States, artemesia is cultivated only in 
China, Vietnam and at pilot projects in Tanzania and India. It is planted in 
December and needs eight months to mature, and drug companies want firm orders 
from donors before they try to triple production. 
.
Even if enough artemisinin can be made, obstacles will arise, experts warned. 
For example, said Dr. Kopano Mukelabai, a Unicef malaria specialist, 
shopkeepers will have to be trained not to sell patients one or two pills if 
they lack the money for a full course of 12. 
.
And what Richard Allan, director of the Mentor Initiative, a public health 
group that fights malaria epidemics, called "the love of chloroquine" will have 
to be broken. That quinine derivative, in use since the 1950s, is now virtually 
useless against parasites, but poor people still buy it because it's cheap and 
lowers fever as aspirin does. 
.
The New York Times 

[Non-text portions of this message have been removed]



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