Fake
or poor quality malaria drugs are boosting resistance in parts of southeast
Asia, a problem that is likely to worsen unless tighter regulations are
adopted, US experts said Monday.
"The malaria parasite has a history of
adapting to drugs and adapting to insecticides," Regina Rabinovich,
director of infectious diseases at the Bill and Melinda Gates Foundation, told
a hearing of US lawmakers.
"Drug resistance to the most effective
drug available, artemisinin-based combination therapy, is developing and has
been recognised in southeast Asia."
Last month, the World Health Organization said
resistance to artemisinin appeared to be spreading in the region from the
Cambodia-Thailand border, where it was first detected in 2009, and possibly
moving into Myanmar.
Half of the world's population is exposed to
the mosquito-borne disease which kills 860,000 people every year, according to
the WHO.
According to Roger Bate of the American
Enterprise Institute, research has shown that about half the malaria drugs that
failed quality control tests also contained some artemisinin.
"So they are directly contributing to
resistance," he told lawmakers at the House subcommitee on Africa, Global
Health, and Human Rights.
"Resistance is being noticed on the Thai,
Cambodian, Burmese borders and resistance is likely to increase," he said.
"Fake and substandard antimalarial
medications are a significant and probably growing problem."
While the actual number of poor quality drugs
in circulation is unknown, "it is certainly not a negligible amount,"
he added, and the problem is festering because these medications are not
illegal in the countries affected.
"Simply getting the medical regulatory
authorities to control what is on the market for anti malarials I think is
important," said Bate.
The sale and use of monotherapies, which
contain just one active agent, have long been known to contribute to
resistance. Experts favour combination therapies which last longer.
Bate said that coordinated action to get
monotherapies off the market in Africa has shown some success, "but some
companies in China, India and Vietnam are still producing them and this is a
major contribution to resistance."
In addition to tougher regulations,
researchers need to focus on developing new drugs against malaria, and consider
making sure they cannot be sold or distributed as monotherapies, the panelists
urged.
"The goal now going forward is the new
drugs we develop need to be made as fixed dose combinations immediately, and
never be sold or available as single entities," said Dennis Schmatz,
president of Medicines for Malaria Venture North America, Inc.
"And that will definitely extend the life
of any of those new drugs we develop going forward."
Rabinovich echoed that point, saying that the
drugs of today will not be effective tomorrow.
"Research and development is essential
because the preventive and curative tools that are available today and are so
effective at controlling malaria are not sufficient to control malaria in the
long term or for eradication due in part to the development of
resistance," she said.
Kerry Sheridan
AFP
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