The Editors

There is another killer disease besides AIDS, but it receives far less attention in the wealthy nations of the Northmalaria. Malaria has been almost completely eliminated in the United States and other developed countries. It is often included among the so-called neglected diseases, neglected in the sense that although it is curable, adequate resources for preventing and curing it remain in short supply, largely because of indifference on the part of first-world governments and the major pharmaceutical companies.

Yet every year malaria kills over one million men, women and children, most of them in sub-Saharan Africa. In Chad it is the principal cause of death, ahead even of AIDS. Children are the most severely affected. They are at special risk because they have not had time to acquire the level of partial immunity that can keep the disease from becoming life-threatening. As a result, 1,000 children, mostly from poor rural areas, die of malaria every day.

Greatly compounding the problems of illness and death caused by malaria is the growing ineffectiveness of the traditional medications that are still used in a number of the most seriously affected African nations. Both chloroquine and sulfadoxine-pyrmethamine (commonly called SP) have long been employed together as the first line of treatment. But increasing levels of resistance have rendered both chloroquine and SP virtually useless in many parts of Africa.

Over the past decade, however, ACTan artemisinin-based combination therapyhas emerged as a new form of treatment that has proven effective in countries particularly hard hit by epidemics of malaria. Derived from the sweet wormwood plant, artemisinin has served as a medication in China for 2,000 years. When used in conjunction with other anti-malarials developed over the past three decades, it has proven successful in southeast Asia. ACT has been used with impressive results in a number of African nations by medical groups like the Nobel Prize-winning Doctors Without Borders. In Burundi, after a five-year drought followed by heavy rains and unusually hot weather, the mosquito population proliferated. Many people fell ill when the mosquito carrying the especially deadly parasite Plasmodium falciparum infected thousands. But after the government of Burundi decided late in 2002 to adopt ACT as the first line of treatment, in combination with other anti-malarials, the toll of illness and death began to drop.

As of now, however, only half a dozen African countries have actively promoted the switch from the earlier, largely ineffective therapies to the artemisinin-based protocol. A primary reason for this is the expense. While chloroquine costs only pennies per patient, ACT costs an average of $1.50 or more per adult and 40 cents per child. Small though these sums may seem, for desperately poor families they can represent insurmountable barriers, unless rich countries contribute more to funding organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria. Created in 2001 by U.N. Secretary General Kofi Annan, the fund makes grants to front-line health providers in poor countries combating these three deadly diseases. But donations have fallen far short of what is needed. The Gates Foundation, a major donor in the fight against malaria, has estimated that $2 billion would be needed to control the disease.

But even relatively simple prevention methods could reduce the infection rate: for example, the use of insecticide-treated mosquito nets. According to Unicef, however, only 15 percent of children have access to nets, and only 2 percent of these are treated with insecticides. Complicating prevention efforts are the civil wars that periodically wrack many African nations. Made refugees in their own countries by these conflicts, people have no choice but to live a nomadic existence, which may entail sleeping outdoors. Similar conflicts make it difficult for aid workers to reach those in need of anti-malarial and other life-saving medications.

Humanitarian health organizations like Doctors Without Borders believe that it is not only cost considerations that pose barriers to the wider use of proven, albeit more expensive, anti-malarials like ACT. There has also been a lack of political will on the part of international donor countries and governments in malaria-stricken regions to make this potentially life-saving switch. Also to blame is the for-profit pharmaceutical industry. With malaria all but eradicated in wealthy countries, this industry is carrying on virtually no research into treatment. A strange kind of indifference thus sets in when it comes to addressing this and other neglected diseases, like sleeping sicknessdiseases that continue to claim needlessly the lives of millions every year. Indifference of this kind lies at the heart of the lack of political will that is allowing diseases like malaria to ravage some of the world’s poorest and neediest populations.

Comments

Mary Kay Louchart | 2/9/2007 - 3:53pm
I was gripped by the editorial about malaria (5/10). I was in Uganda in December 2003 with the Grail as they celebrated 50 years of struggle and work and life and celebration in that country. I visited our dispensaries and health units and felt so very helpless—with so little they could do so much. Truthfully, with so little money, they do so much. But when I was taking my weekly malaria pill, I felt guilty that so many folks are dying of such an easily curable disease, while—as you say in your editorial—in “our” countries, it is wiped out. Where is our understanding of caring for our brothers and sisters?

I have photos of empty medicine cabinets in Mushanga and a dispensary building that is waiting for medicines and a nurse. But there is no money. I really don’t know how my Grail sisters manage, except that when there isn’t a drought, they can live off the land. Uganda has rich soil. My sisters in Mushanga told me that each month they get money for drugs, but these are depleted by mid-month. They receive very little in the way of financial contributions from the patients, and their counseling of AIDS patients—which is growing daily—is totally free.

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