Drug Resistant Malaria

Malaria Deaths

The New York Times reports today on the growing resistance to first line antimalarial drug artemisinin in fighting malaria, especially in and around Cambodia:

Combination treatments using artemisinin, an antimalaria drug extracted from a plant used in traditional Chinese medicine, have been hailed in recent years as the biggest hope for eradicating malaria from Africa, where more than 2,000 children die from the disease each day.

Now a series of studies, including one recently published in The New England Journal of Medicine and one due out soon, have cemented a consensus among researchers that artemisinin is losing its potency here and that increased efforts are needed to prevent the drug-resistant malaria from leaving here and spreading across the globe.

Luckily, the Bill and Melinda Gates Foundation is making innovation in malaria vaccines and treatment a priority as reported in Gates’ First Annual Letter:

Today a number of new tools are being developed—better bed nets, better drugs, better insecticides, and a number of vaccine candidates. One of the vaccines will go into the last phase of human trials this year and could be ready for wide use by 2014. None of these tools is perfect. To understand how we should combine them, we brought in an expert in mathematical modeling who is applying a technique called Monte Carlo Simulations. This modeling work, which will show where we can eliminate malaria and where we can just reduce the disease burden, is a wonderful use of advanced mathematics to save lives, and if it goes as well as I expect, we will apply it to other diseases.

Definitely, advances in epidemiological science, vaccine technology, and pharmeceuticals will be crutial to controlling this disease. But, I also think that it is telling that:

The mosquito responsible for transmission of malaria is still endemic in the United States. But modern housing, better access to health care and the use of insecticides have virtually eradicated the disease in wealthier countries.

Once again, poverty is the main structural force shaping the risk of acquiring and dying from malaria. Shouldn’t we address the root cause – inequity – before pumping out technologies? Or, should it be a parallel process?


5 Responses to “Drug Resistant Malaria”

  1. 1 lill January 29, 2009 at 11:20 pm

    I think they can and should be parallel processes, since poor health and poverty are so inextricably linked. If easy, simple-to-deliver vaccines and other technologies can reduce the disease burden of the poor, they will be healthier, and therefore have a better chance at lifting themselves out of poverty. On the other hand, there definitely needs to be attention on reducing structural violence. What’re your ideas for ways to reduce inequity?

  2. 2 topnaman February 1, 2009 at 3:06 pm

    Nice blog,

    I think you fellas might have met my friend Joel Thomas (from UNC)? he came to speak at your conference, representing his group Nourish International.

    Anyways more about this topic here:

  3. 3 Philip Stevens February 10, 2009 at 5:11 am

    If we consider malaria to be a disease of poverty, how can tackling ‘inequity’ be the priority? Surely it should be about reducing absolute rates of poverty, so that living conditions can materially improve?

    Although in this context, it’s rather unclear what you consider ‘inequity’ to be.

  4. 4 Ankur Asthana February 12, 2009 at 11:20 am

    The reason tackling ‘inequities’ is the priority, is because it makes the difference — in a very practical sense — of how poverty can be ended. It means understanding that many of the roots of global poverty today stem from historical and current structures that we in the richest countries continue to benefit from at the expense of the poor (an example: in 2003, the cotton subsidies for approximately 3,000 farmers in the U.S. meant that countries like Mali or Burkina Faso, where up to 40% of exports/10% of GDP was cotton, and where those countries had a comparative advantage, remained stuck in poverty). The sense of inequity creates a sense of duty on our part, and duty demands that we don’t take the easy way out of saying “it’s too expensive to treat people with drug resistant malaria” (like we first did with MDR-TB), but rather respond with the practical solutions that will both end poverty and save lives.

  5. 5 Philip Stevens February 12, 2009 at 12:43 pm

    While developed country agricultual subsidies are certainly abhorrent, we are deluding ourselves if we think that ending those will make anything but a slight difference to poverty rates in LDCs.

    African farmers have to contend with all kinds of destructive policies inflicted by their own governments – quotas, marketing boards, massive taxes on agricultural inputs like fertilisers, and so on. And let’s not forget African governments impose truly mind-boggling tariffs on intra-African trade, making it practically impossible for African farmers to sell to their neighbours.

    Added to this is a widespread absence of easily transferable and secure property rights, making it impossible for farmers to obtain credit and loans for investment in their own businesses. These hurdles mean that western trade policy (while often ridiculous) is really the least of African farmers’ problems.

    Unfortunately Marxist dependency theory has few answers to the problem of poverty. Although it is politically incorrect to say it on a forum like this, the blame for poverty can be layed squarely at the door of incompetent and corrupt government after government.

    They are aided and abetted by western ‘development’ lobby groups who work hard to ensure these abysmal governments are continually propped up by largely unnaccountable transfers of highly fungible foreign aid – which is very rarely used for the humanitarian purpose intended.

    This is the real ‘inequity’.

    On the topic of drug resistant artemisinin – perhaps that’s something to do with the very large quantities of substandard ART that are doing the rounds in Africa and Asia?

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Welcome to the Students for Global Health Equity (SGHE) blog. Published by university students, the SGHE blog seeks to explore news and issues related to global health.

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