BBC: what’s wrong in the Mekong?
The Today programme ran a story this morning on drug resistant malaria growing in south east Asia (around the Mekong delta).
They’re right to highlight the problem, and correctly point out that around half the world’s population are at risk of the disease.
Every thirty seconds a child dies of malaria.
Furthermore, artemisinin is our last defence against malaria – older drugs have succumbed to resistance themselves, and no new drugs appear to be in the pipeline.
So whose fault is this? Is it just one of those things that happen? Predictably, no – it’s worsened by overbearing governments, fetters on liberal institutions and ugly politicisation.
Today’s report mentioned that insecticides now might be brought into the heavily affected areas. These have always provided great protection to the poor from infectious diseases, yet since the ’60s have been vehemently lobbied against by environmentalist group opposed to anything that doesn’t directly spring from the mud. Government bans on DDT and other insecticides continue to thwart the fight against diseases like malaria.
Secondly – fake drugs. These don’t kill a disease parasite sufficiently, so allow it to mutate and become resistant. The Mekong delta is home to some of the highest rates (up to 68% according to one study) of fake malaria drugs in the world.
Funny how it’s also where drug resistant malaria first blossoms.
Governments provoke the existence of fake drugs by imposing high tariffs (and non-tariff barriers) on pharmaceutical goods – this deters high quality drug producers so that they don’t enter the market, leaving a vacuum for counterfeiters to fill.
Action against counterfeiters is often not possible due to flimsy courts where political interference and corruption are commonplace. Where liberal institutions and the rule of law are strong, companies and victims can take action against producers of fake and substandard drugs.
Examples abound of political vested interests in counterfeit products. In China, the second largest supplier of fake drugs in the world, this is very much the case. Li Guorong, the General Manager of China United Intellectual Property Protection Center, says that action against counterfeiting would “destabilize a government where counterfeit factories and warehouses are often owned by local military and political grandees.”
As usual stories like this provoke the “what can government do to help?” reaction. And also as usual, we should instead be acknowledging how big, centralised government is culpable in the first place.
May 29th, 2009 at 5:03 pm
Good points Julian,
Artemisinin-combination therapies are still working well in Africa and there is no sign of resistance … yet. The problem is that standards of treatment and care are very poor in many malarial countries in Africa. In our surveys we have found a huge range of oral artemisinin mono-therapy tablets – as opposed to the recommended combination therapies – on sale in private shops and pharmacies. In January 2006 the WHO called for a halt in the prodcution and sale of the monotherapies – yet this still continues. I recently bought a box of Artemisinin mono-therapy produced by a Belgian company in April 2008. WHO has politely asked companies to stop producing the medicines and has passed a World Health Assembly resolution on this subject – but it seems to have had little impact. One may ask why the European Union – as well as the Governments of China and India – are not doing anything about the companies that keep pumping out these drugs that will undermine the entire class of medicines.
Somewhere between 50% and 70% of people access their medicines through the private sector because there are no public clinics nearby and very often where there is a public clinic, it has no medicines.
The WHO estimates that malaria is over-diagnosed between 30% and 70% of the time, depending on the season. This means that an awful lot of people are treating themselves with drugs that are likely to be monotherapies and could be sub-standard and are also entirely inappropriate.
Improving malaria prevention through better and more widespread Indoor Residual Spraying and the use of bednets would be a good start. If transmission of malaria is reduced, there will be no pressure to drive the the resistant gene through the population. Efforts at improved malaria prevention are paying off, such as through the US President’s Malaria Initiative. Effective malaria control requires man-made chemicals to kill or repel mosquitoes. But, almost unbelievably, the WHO and UNEP are both pushing non-chemical methods of malaria control to replace DDT. Their ideas include planting mosquito repellant trees around houses and using larviverous fish to eat mosquito larvae. The only thing they left out was sitting in a circle and singing kumbayah.
Governments have an important role to play in improving regulations so that the monotherapies are taken off the market. But they can also step up their malaria prevention strategies and take a firm line against the kind of anti-chemicals nonsense that limits the use of effective public health insecticides and does nothing to spur investment in new chemicals for public health.