Malaria Drug's Value Hurt by Packaging Policy

Health experts say that the most effective drug for malaria may be undermined by drug company practices. The drug is often packaged and purchased as a single dose. But people need to take the drug for several days.

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The World Health Organization is calling on international drug companies to stop selling a common malaria treatment on its own. It warns that malaria could become resistant to the drug and, as a result, the most effective treatment now available will be lost. NPR's Brenda Wilson has more. BRENDA WILSON reporting:

Over the last quarter of a century, one malaria drug after another has been lost to resistance because all the drugs were used alone. Scientists now know that the more drugs that are used to fight malaria, the more difficult it is for the parasite to become resistant. That's why they now recommend using some of the older anti-malarials with a newer group of drugs, the artemisinin compounds. But W-H-O says 18 companies have been selling single tablets of the drug, risking the loss of the current, most effective treatment for malaria.

Tropical medicine professor, Nick White, from Mahidol University in Bangkok, Thailand, says there are no new promising therapies on the horizon.

Professor NICHOLAS WHITE (Faculty of Tropical Medicine, Mahidol University): If that happens, malaria could become incurable within a decade. That would be incurable not only for the hundreds of millions of African, Asian, and Latin American children who will become sick with the disease each year, but also incurable for the millions of northern hemisphere business people and tourists who travel to these regions.

WILSON: W-H-O estimates that there are up to 500-million cases of malaria in the world each year. Though it's still a serious problem in parts of Southeast Asia, most are in Africa. And that is where W-H-O's Andrea Bosman says the 18 companies selling single or mono-therapy malaria treatments based on artemisinin operate.

Dr. ANDREA BOSMAN (World Health Organization): The companies are relatively small, but quite dynamic in terms of marketing strategies and presence in the African countries. And they are able, generally, also to adapt and modify product for Malaysians according to the availability of rheumatic supplies. And they basically exploiting the weak regulatory system that we have in these countries.

WILSON: Until recently, artemisinin was expensive compared to other treatments, but as funding to fight infectious diseases became more available in recent years, more countries began adapting artemisinin as the standard treatment. As procurement increased, so did the risk of resistance. Though artemisinin costs more than the old drugs, Bosman says patients buy it because it's quick-acting.

Dr. BOSMAN: They may buy, out of pocket money, just what they need maybe for one or two days. So, easily, they provide it. The pharmacies will cut and give them just the limited number of pills that they need. So, this is a big problem, because clearly it's an incomplete treatment. They will not be totally cured and, over time, this will certainly bring the resistance.

WILSON: W-H-O says there are already hopeful signs that companies will comply. Sanofi-Aventis, a French company, has said that it will phase out selling single tablets of artemisinin. But another company, the India-based Cipla, says it will continue to provide single pills to government.

Amar Lulla, Cipla's managing director, says many countries add artemisinin to other medicines that they already have.

Dr. AMAR LULLA (Managing Director, Cipla, Inc.): Possibly, these are being used, the single tablets of artemisinin, to make a kit. When the artemisinin tablets are sold as such, it's not necessarily to conclude that they're being used alone; maybe they are being used in combination. So, to those countries who are using in combination, if you don't give them artemisinin tablets in single artemisinin tablets, then they would be deprived of those, you know.

WILSON: But W-H-O says this is simply a ruse to circumvent its guidelines, which these companies have ignored for five years. It's given them three months to discontinue selling single pills before seeking stricter import controls on the companies and the countries where they market the drugs.

Brenda Wilson, NPR News, Washington.

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