WHO urges Africa to use more effective malaria medicines
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《英国医生杂志》
BMJ
Hoping to put an end to criticisms by malaria researchers of its malaria treatment strategy (24 January, p 183), the World Health Organization stated unequivocally last week that African countries experiencing resistance to conventional drugs should switch to using more effective, artemisinin based combination therapies.
"At least one million children die every year in Africa from malaria," said Dr Lee Jong-wook, WHO's director general. "Several million more become seriously ill. In many places, they are still given medicines whose effectiveness is very low, and decreasing. Better treatment is available and must be delivered urgently to the people who need it most."
WHO says that it made its position on artemisinin based combination therapies clear many years ago, but its critics say this policy is simply not being implemented on the ground.
Since April 2001, WHO's official policy has been to recommend that countries that are experiencing resistance to standard drugs—such as chloroquine and sulfadoxine pyrimethamine—should instead use more expensive, but much more effective, artemisinin based combination therapies.
Yet an international group of malaria researchers says that WHO "violates its own policy standard regularly" ( Lancet 2004;363: 237-40). When countries apply to the Global Fund for money to buy malaria drugs, they get technical advice from WHO country representatives. These representatives, says the group, have sometimes given their approval for "applications for ineffective drugs that violate WHO policy."
WHO argues that it can urge countries to adopt artemisinin based combination therapies, but many countries worry about whether they will receive the long term external funding needed to buy these medicines.
"We will continue to strongly advocate for a rapid scale-up of artemisinin based combination therapies," said Dr Jack Chow, assistant director general for HIV/AIDS, tuberculosis, and malaria at WHO. "Some countries are still reluctant to adopt ACT treatment policies because is much more expensive than conventional therapies. Countries feel insecure about the sustainability of donor support as they switch to more costly treatment regimens."
WHO estimates that donor support of an extra $1bn (￡0.6bn; 0.8bn) a year would pay for artemisinin based combination therapies for 60% of people who need them.
Dr Allan Schapira, coordinator of WHO's malaria policy and strategy team, says that WHO "has the right policy" but that now "the international community must put in more money. The ball is in the donors' court." The amount of funding available through the Global Fund, he said, is still "very far from the $1bn figure."
Dr Amir Attaran, associate fellow at the Royal Institute of International Affairs and an out-spoken critic of WHO's malaria strategy, welcomed the organisation's renewed focus on artemisinin based combination therapies.
But to see whether WHO's commitment is genuine, he argued, we need to wait until the results of the fourth round of funding from the Global Fund, when we will see whether more African countries are switching to using artemisinin based combination treatments.(Gavin Yamey)
Hoping to put an end to criticisms by malaria researchers of its malaria treatment strategy (24 January, p 183), the World Health Organization stated unequivocally last week that African countries experiencing resistance to conventional drugs should switch to using more effective, artemisinin based combination therapies.
"At least one million children die every year in Africa from malaria," said Dr Lee Jong-wook, WHO's director general. "Several million more become seriously ill. In many places, they are still given medicines whose effectiveness is very low, and decreasing. Better treatment is available and must be delivered urgently to the people who need it most."
WHO says that it made its position on artemisinin based combination therapies clear many years ago, but its critics say this policy is simply not being implemented on the ground.
Since April 2001, WHO's official policy has been to recommend that countries that are experiencing resistance to standard drugs—such as chloroquine and sulfadoxine pyrimethamine—should instead use more expensive, but much more effective, artemisinin based combination therapies.
Yet an international group of malaria researchers says that WHO "violates its own policy standard regularly" ( Lancet 2004;363: 237-40). When countries apply to the Global Fund for money to buy malaria drugs, they get technical advice from WHO country representatives. These representatives, says the group, have sometimes given their approval for "applications for ineffective drugs that violate WHO policy."
WHO argues that it can urge countries to adopt artemisinin based combination therapies, but many countries worry about whether they will receive the long term external funding needed to buy these medicines.
"We will continue to strongly advocate for a rapid scale-up of artemisinin based combination therapies," said Dr Jack Chow, assistant director general for HIV/AIDS, tuberculosis, and malaria at WHO. "Some countries are still reluctant to adopt ACT treatment policies because is much more expensive than conventional therapies. Countries feel insecure about the sustainability of donor support as they switch to more costly treatment regimens."
WHO estimates that donor support of an extra $1bn (￡0.6bn; 0.8bn) a year would pay for artemisinin based combination therapies for 60% of people who need them.
Dr Allan Schapira, coordinator of WHO's malaria policy and strategy team, says that WHO "has the right policy" but that now "the international community must put in more money. The ball is in the donors' court." The amount of funding available through the Global Fund, he said, is still "very far from the $1bn figure."
Dr Amir Attaran, associate fellow at the Royal Institute of International Affairs and an out-spoken critic of WHO's malaria strategy, welcomed the organisation's renewed focus on artemisinin based combination therapies.
But to see whether WHO's commitment is genuine, he argued, we need to wait until the results of the fourth round of funding from the Global Fund, when we will see whether more African countries are switching to using artemisinin based combination treatments.(Gavin Yamey)