MSF calls on African governments, WHO to switch to newer, more expensive treatment for severe malaria

Nearly 200,000 deaths from severe malaria could be averted if African governments replaced the low-cost antimalarial quinine with the more expensive but more effective drug artesunate, according to a report (.pdf) released Tuesday by Medicins Sans Frontieres (MSF), Reuters reports (Kelland, 4/19).

The report, "based on a review of the latest scientific evidence, coupled with information from MSF's malaria programmes across Africa," describes the benefits of switching treatment plans for severe malaria, according to an MSF press release (4/19).

Compared to quinine, which "has to be given three times a day in a slow intravenous drip that takes four hours," artesunate "can be given in just four minutes, by giving a patient an intravenous or intramuscular injection," improving patient outcomes and freeing up medical staff, a second MSF press release notes. The release describes recent findings that artesunate is more effective at preventing deaths from severe malaria in children (4/19). Similar findings also have been found in adults (Kaiser Daily Global Health Policy Report, 3/16).

Based on such evidence, "MSF called on African governments, the WHO and international aid donors to back an immediate global switch to artesunate for severe malaria," Reuters continues, adding that artesunate is roughly three times as expensive as quinine (4/19). In the report, MSF writes, "The cost of making the switch is well within reach of the international community. To treat all cases of severe malaria worldwide with artesunate instead of quinine represents an additional annual drug cost of $31.8 million and a total drug cost of $49.2 million in order to save around 195,000 lives each year" (undated).

"The WHO has said it will issue new guidelines soon recommending artesunate for treating severe malaria in children in Africa, but MSF said the United Nations health body also needed to develop a plan to help countries make this switch," the news service adds (4/19).

"We've been here before - when WHO changed its treatment recommendations for simple malaria in 2001 it took years for countries to actually make the switch, and shockingly, in some countries the far inferior drugs are still being used ten years on," said Martin De Smet, who coordinates MSF's malaria work, according to the MSF release. "With severe malaria, WHO needs to make sure that the change is much less sluggish, so lives can be saved immediately. There's simply no excuse not to make the switch now," De Smet added. The MSF report offers several recommendations for translating policy into practice (4/19).

In related news, IRIN examines the struggle to contain resistance to the antimalarial drug artemisinin along the Thai-Myanmar border. The article describes several factors contributing to the rise of drug resistance, including limited access to effective artemisinin combination therapies (ACTs), poor health facilities and ongoing security problems in the region (4/19).