Widespread use of a new fast-acting and potent treatment for malaria is finally on the horizon in Africa, where malaria is the number one killer of children. But the international medical humanitarian organization Médecins Sans Frontières (MSF) warns that artemisinin-based combination therapy - or ACT - will only be accessible to all in need if immediate action is taken to finance scale-up of production of the drugs.
"ACT is really a cause for hope in Africa - more and more countries with extremely high rates of resistance to old malaria treatments are starting to use it with excellent results," said Dr. Jean-Marie Kindermans, one of MSF's principal malaria experts.
"But donors and producers need to take action to avert a major supply crisis of ACT. Since the key ingredient of the combinations is extracted from plants, only firm orders now will enable enough plants to be ready for the huge expected increases in demand next year."
Artemisinin-based combination therapy has been used in Asia for more than 10 years but is new to Africa. It is a critical element of the World Health Organization's strategy to Roll Back Malaria on the continent. Fourteen African countries have now officially switched their malaria treatment protocols to ACT and five (South Africa, Burundi, Comoros, Zambia and Tanzania) are already using them in their public health facilities. Many other countries are reviewing their policy with a view to switching to ACT.
In October 2002, MSF decided to use ACT wherever possible and now estimates that about 50% of patients treated by MSF are receiving ACT. MSF treats an average of 3,000 people with malaria each day in Africa, amounting to more than 1.1 million cases per year.
"We are seeing with our own eyes the difference these drugs make," says Dominique Fouché, who is coordinating MSF's malaria program in Makamba, Burundi, one of the African countries which has just switched to ACTs. "Our patients are getting better more quickly and fewer are returning with life-threatening recurrences of symptoms. We are confident that as the national program rolls out in Burundi we are going to see childhood and adult malaria deaths drop."
WHO estimates that 132 million treatments will be needed in 2005, of which 92 million are for Africa. To avoid acute shortages of ACT, international donors must immediately stimulate production of Artemisia annua, the plant extract. The next chance to increase cultivation is the planting session which begins in December 2004, so notice to farmers to start cultivation has to be given soon.
The lack of research and development into malaria must also be addressed. An average of just US$42 was spent on research for every malaria death, and yet fixed-dose combinations and new drugs are still desperately needed. Solving these challenges will require far more commitment than the international community has shown up until now, MSF warns.