Progress
The total number of malaria infections worldwide is greater and more widespread than what epidemiologists predicted when they took stock of the situation few years ago. Malaria continues decimate populations of Africa. The persistent morbidity and mortality from malaria is a multi-faceted challenge with far reaching problems such as increased drug resistance in the parasite Plasmodium falciparum, poverty that exacerbates health problems, and inconsistent and politicized efforts to irradiate the disease. With global temperature change threatening to increase the number of mosquitoes, the urgency for malaria vector control and disease treatment only increases.
On its face progress has been good. Efforts to treat and prevent infection and death have made inroads on many fronts. multiple fronts. The parasite was sequenced several years ago and there is a lot of research funding dedicated to finding better drugs, methods for prevention and vaccines. But although there is an excellent array of promising technologies there is a lack of consensus about the use of existing technologies. Available methods for mosquito control are not employed because of science, politics, economic development and research funding quagmires. There are competing agendas between all parties; researchers, pharmaceutical companies, government agencies and public health experts. On one hand the competition between various parties is helpful for assuring success via one method or another, but it also interferes with actual treatments for people who live in the malaria infected areas.
Politics
Various players all sincerely want to see malaria irradiated but can't cease bickering about the solutions. For example, bed nets have long offered a promising low tech method of malaria control. Permethrin impregnated bed nets are cheap and and easy to distribute and studies have shown that they can decrease deaths by 20%. However for several reasons, only one in 20 children uses the nets. Typical to many efforts, funding is often scarce or erratic. Political stalling in distributing available funds is typical when aid is tied to policies that recipient countries don't agree with.
As if these problems weren't challenge enough, the bed net advocates seems to be directly at odds with the DDT advocates. The DDT contingent argues that spraying will irradiate mosquitoes. DDT is endorsed by the the military and others. Defenders of DDT disparage the proposals for bed nets. Reason magazine disparaged bed nets in a recent article because "bed nets protect only at night". The truth is that mosquitoes are actually only a threat at night. Incorrect politically motivated ideas like this interfere with finding a solution to the problem.
Qinghao Shortage?
Another example of complications with available technologies involves the artemisinin derived drug Coartem. In 2001, the WHO approved use of this drug from Novartis. The drug combines an artemisinin derivative harvested from the qinghao plant indigenous to China, with a second drug - lumefantrine. The artemisinin combination therapies (ACT) have proven to be the most effective treatment, as older treatments are increasingly ineffective against drug resistant strains. As a result reliable artemisinin sources are high in demand.
Today, for the second year in a row, Novartis, the sole producer of the drug, reported that its supply of Coartem will not meet its production goals. This year the company will only supply 13 million doses, instead of an estimated 30 million needed. Novartis says it received too few orders in time to produce the quantity needed, and also that it has had have problems obtaining the plant, because Tonhe, a Chinese company contracted to supply the qinghao, can't acquire the plants it promised because farmers are selling their crops to better paying local Chinese companies.
Unfortunately Novartis ran into the same shortages last year. At the time, they were chided by the World Health Organization (WHO) for the mishap). In a letter to the editor in response to an article about the dispute a Novartis VP and General Manager of Malaria Initiatives wrote to the Financial Times.:
"Sir, Contrary to the headline on your recent report "Finance Dispute Halts New Malaria Treatment Project (February 19), our partnership with the [WHO]...continues to move forward rapidly...In response to recent exponential increases in demand, Novartis has rapidly scaled up production capacity and expects to be able to produce 30m Coartem treatments this year...." (March 3, 2005)
But when the time came, Novartis again failed to deliver for unknown reasons. Sanofi-Aventis has recently announced plans to produce a artemisinin based treatment next year in a joint research and development agreement with the Drugs for Neglected Diseases Initiative (DNDi), a research group based in Geneva. Hopefully the added competition will change the dynamics of production, although if there is a shortage of the plant needed, arguably more competition won't solve the problem.
Vaccine
Almost everyone agrees that infection by Plasmodium falciparum will be easiest to prevent with a vaccination, yet this too remains an elusive goal. A study last year in Mozambique done by University of Barcelona and GlaxoSmithKline showed good initial results. Another study done by Oxford looked promising but fell through last year -- to their credit Oxford group has published a follow-up study about the failure.
While vaccines are the ultimate solution, we are a world of limited resources and ever burgeoning populations of people and infectious diseases. Are we attached to the idea that no disease can be controlled without a vaccine, even as malaria and other diseases could be controlled with other available technology? Vaccines attempt to circumvent politics and competing ideologies This works as long as vaccine development doesn't get stuck in the very same political quagmires.
Acronym Required previously wrote about new schemes for vaccine funding here, and writes frequently about public health.
