News outlets examine reaction to WHO plan to contain drug-resistant malaria

Jan 14 2011

In follow-up coverage of the WHO's announcement Wednesday of a plan to contain the spread of artemisinin-resistant malaria, news outlets examined the scope of the problem, reactions to the plan and speculations of how the anticipated $175 million annual cost would be funded.

At issue is "[a]n artemisinin-resistant parasite [that first] emerged in areas along the Cambodia-Thailand border in mid 2000, and is [now] suspected of having spread to other areas in Cambodia, Myanmar, Thailand and Vietnam," swissinfo.ch reports. Because "[t]he Mekong Delta region is where chloroquine first began to fail in the 1950s before it moved westwards and lost effectiveness in Africa," experts worry "the same could happen with arteminisim, the most potent drug available against malaria, especially when used in artemisinin combination therapy (ACT)," according to the news service (Bradley, 1/13).

"ACTs are the gold standard. They are the most effective treatment for falciparum malaria, the most deadly form of malaria," WHO Director-General Margaret Chan said in a speech during the launch of the plan in Geneva, Switzerland, Reuters reports (Nebehay, 1/12).

"At the moment, no other class of drugs is available to replace artemisinin, and none are near the end of the development pipeline. Scientists worry that if resistant parasites make their way to Africa, where the vast majority of malaria cases occur, mortality will soar," Science's "ScienceInsider" blog writes (Enserink, 1/12).

"Over the past several decades, we have lost one front-line antimalarial after another as resistance has developed, become established, and then rapidly spread internationally, rendering these drugs useless," Chan said, according to a WHO transcript of her speech. "Today, in launching this global plan, WHO, together with Roll Back Malaria partners, is attempting to break this historical pattern. We are calling on the international community to take advantage of an unprecedented window of opportunity" (1/12).

As part of the plan, "[t]he WHO, which said last month the world could stop malaria deaths by 2015 with massive investment, called for faster research and development of new anti-malarial drugs," Reuters reports. The article includes reaction to the plan form Nicholas White, professor of Tropical Medicine at Mahidol University in Bangkok, who the news service writes is "widely credited with helping to first identify the resistant form." White "called the WHO plan 'somewhat anodyne.'  … 'What seems to be lacking is a sense of urgency. People talk in terms of years. I think we should be thinking in terms of months. Time is crucial,' he said," according to Reuters.

Currently, "[s]ome 5 million compounds are being screened as potential anti-malarials, 20,000 of which show promise, according to Dr. David Reddy, the new CEO of the Medicines for Malaria Venture, a public-private drugs partnership," Reuters adds (1/12).

"The Global Plan for Artemisinin Resistance Containment (GPARC) doesn't contain detailed strategies; it's billed as a 'call to action and a high-level plan of attack,'" with the idea being "to enlist governments, international agencies, nongovernmental organizations, funders, scientists, and industry in a multipronged approach," ScienceInsider continues (1/12).

According to ScienceInsider, "[m]ost of the $175 million needed has yet to be found, says Robert Newman, head of the WHO Global Malaria Programme. But donors like the Bill & Melinda Gates Foundation, the U.S. President's Malaria Initiative, and the Wellcome Trust - all of which were present at the launch - are interested, he says. … Part of the money can also be 'wrangled out of existing programs,' such as the Global Fund, Newman adds. Given the high stakes, the price tag is 'pretty modest,' he says." The blog also highlights how the U.K. Department for International Development has said it will support a project to improve artemisinin-resistance surveillance and mapping and notes the reaction to the plan from scientists, including Christopher Plowe, a malaria specialist at the University of Maryland School of Medicine in Baltimore (1/12).

swissinfo.ch includes comments by Newman, who pointed to recent progress in malaria prevention programs. "We have made tremendous progress over the past decade in the fight against malaria," Newman said. "But 781,000 [deaths from malaria each year] is still an unacceptably high number for a disease that is entirely preventable and treatable. That number needs to go to zero," he said.

The news service notes that "[a]nnual malaria funding has risen to $1.8 billion, resulting in a rapid increase in malaria-control prevention via the availability of long-lasting insecticide-treated mosquito nets, targeted indoor spraying and modest increases in access to ACTs. … But the money still falls short of the projected $6 billion needed annually for global malaria control, said Newman. He added that over the next five years gains needed to be maintained in vector control - 350 million insecticide-treated mosquito nets in Africa - while seeking progress in areas lagging behind like universal diagnostic testing of all suspected cases," the news service writes (1/12).