Malaria on the Rise
January 22, 2004
Malaria, a disease forgotten in wealthy countries, is advancing,
killing a million people or more a year, at least 700,000 of
them African children. In many nations, some people spend sev-
eral months a year ill from malaria, a toll that cripples Afri-
can economies. One reason for malaria's resurgence is that it
has evolved to resist the two standard treatments. In East Af-
rica, chloroquine, the most widely used drug, fails two-thirds
of the time, and a newer treatment is useless in nearly half of
A better treatment exists, but the world is adopting it far too
slowly. It is a two-drug therapy that includes artemisinin, a
Chinese plant used against malaria in herbal form for thousands
of years. The combination therapy works 95 percent of the time,
prevents disease transmission to others and is slow to provoke
Yet only 6 of the 42 African nations with endemic malaria -
whose decisions are heavily constrained by outsiders - have
changed drugs. For two years, Doctors Without Borders has been
arguing that the global malaria establishment, especially influ-
ential donors like the United States Agency for International
Development, has been dragging its feet. An article published
last week in the medical journal The Lancet provides evidence
that international health organizations are pushing countries to
continue to use drugs they know do not work.
The main reason is cost. A chloroquine dose costs a few pennies.
The best price available for the artemisinin-based combination
therapy is 40 cents for a child's treatment and $1.50 for an
adult's. That may not sound like much. But until recently, poor
countries bore the cost of drugs themselves. Many sick people
cannot pay 40 cents.
Wealthy countries are going to have to pay for the more expen-
sive drugs. The Global Fund to Fight AIDS, Tuberculosis and Ma-
laria is now doing this, but the fund has very little money.
Changing drugs requires countries to adapt health care services
and find ways to get people to finish a three-day treatment.
Countries will not switch unless they are sure of steady financ-
ing for the new drugs.
The underlying problem is that most people who die of malaria
are poor rural children, and the disease has been eradicated in
most wealthy nations. The lack of a global lobby against malaria
has brought the world to the sad, absurd point where organiza-
tions dedicated to saving lives are pushing drugs that they know
will allow children to die.