Analysis
There are many political, medical, social, environmental and economic factors influencing prevalence and treatment options in the developing world. Although the WHO is working at the policy level to prevent and eradicate this disease from both epidemic and endemic areas, infection prevalence remains high in developing countries.
WHO Recommendations: Political and Economic Factors:
Prior to 2005 the World Health Organization recommended chloroquine in the developing world as the primary anti-malarial. However, in 2004, Amir Attaran's article in the Lancet set off international debate. This article severely criticized the World Health Organization and the Global Fund for recommending and funding malaria treatment drugs that were "outdated" such as chloroquine and sulfadoxine-pyrimethamine, when much more effective drugs such as artemisinin class combination treatments existed (Attaran, 2004). The WHO was put in a difficult position, as actual funding fell far short of the world’s needs to make this change. Expenditures for malaria was $600 million, not the $3 billion that was needed to provide artemisinin treatments for the developing world. In addition, the World Bank did not ultimately follow through on its partnership commitment (Lambo, 2004).
Economic Implications Of Treatment Choices:
The most effective anti-malarial to date, ACT, is nearly ten times more expensive than its less effective counterparts due to the herb's long growth period and high demand (Purcell, 2004). When the WHO finally made the switch to recommending ACTs in 2005, there were negative consequences. Because the herb can take up to 11 months to grow and prepare, the stock was initially depleted (Purcell, 2004). Consequently for some regions, as Robert Snow of the Center for Tropical Medicine pointed out, "instead of using a drug with a 30 to 40 percent failure rate, they're using no drug at all" (Snow, Robert. Interview).
In addition, there was disagreement within governments, as they did not want to commit to using a new expensive drug with the risk of funds being withdrawn. However, without accepting the new ACT campaign, many of these countries were left without any drugs at all. However, ACTs also provided advantages to many, such as effectiveness of treatment and lack of resistance to name a few.
Intellectual Property Rights and a Controlled Market:
The WHO currently receives ACT drugs from pharmaceutical Novartis AG of Switzerland. In early March of 2007, the Wall Street Journal reported The WHO's demand that Kunming Pharmaceutical Corp of China desist in its artemisinin production. The WHO cited an increased risk of resistance as its primary reason for this request, angering Chinese business leaders and politicians. They question the fact that a Chinese company is closed out of a profitable market, especially since Chinese scientists originally derived artemisinin (Zaminska & Mackay, 2007).
Political Momentum:
Recently, there has been greater political initiative towards malaria treatment and research. In addition to the WHO Roll Back Malaria partnership, which was launched in 1998, there have been other major movements to address malaria. The United States President’s Malaria Initiative (PMI) was created in 2005 by George Bush who pledged to raise funding for malaria by 1.2 billion over the following five years. The Gates Foundation has begun to support PMI projects to research new vaccines and drugs and improve access to and efficacy of existing drugs (PMI “Grantmaking Priorities”). In addition, there are a number of other private partnerships and organizations involved in similar efforts.
Qualities of a Good New Anti-malarial Drug:
For a new anti-malarial drug to be considered effective and useful on a wide-scale, it must have a number of qualities. The first is efficacy: to what extent does the drug prevent malaria infection and treat malaria parasitic infections? In addition to reducing the duration of malaria and increasing effectiveness, treatment should also contribute to slowing the development of resistance to the anti-malarial drug, such as combination therapy (Anti-malarial Drug Combination Therapy: Report of a WHO Consultation). Often the current effective anti-malarial drugs are given in combination with one another (as discussed above).
Further drug requirements address the fact that some drugs work for a longer period than others since each drug has its own rate of metabolism in the body. Secondly, because many drugs kill the parasite by creating a toxic environment within the cell, the drug must have a low overall level of toxicity for the whole body (Posner, 5/22/07). In addition, before a drug can go on the market, it must go through a number of clinical trials to ensure proper absorption and distribution throughout the body, and easy secretion. If any of these issues are not met, a drug will not be FDA-approved (Posner 5/22/07).