Paul Kirk
As South Africa braces itself for a malaria epidemic, health experts are warning that a run on anti-malaria drugs may leave people defenceless against the killer disease.
It emerged this week that pharmacies across the country are reporting fast- shrinking supplies of over-the-counter anti-malaria drugs, with several outlets in malaria hot spots having already depleted their stocks.
The annual incidence of malaria in South Africa stayed below 12 000 until 1995, when it began to climb. In three of the last four years, the number of malaria cases has exceeded 25 000.
This year, the incidence of the disease has soared. In the first nine months of 1999, the national Department of Health recorded more than 42 000 cases of malaria, including outbreaks in areas that have been malaria-free for years.
Last year at least 10 cases of malaria were reported in Gauteng. This year the figure is expected to skyrocket.
Not surprisingly, anti-malaria drugs are selling like hot cakes, and are running low – a situation that could coincide with the first real epidemic of the new millennium.
Dr Andrew Jamieson of British Airways Travel Clinics says: “The situation is not good when it comes to anti-malaria medications. Chemists are hamstrung.
“The two most widely recommended and by far most effective drugs they can give out without a prescription are meflian [equivalent to Lariam] and doxicyclene. Many pharmacies have run out of them or are experiencing shortages. The result of this is that, unless the patient has a prescription, they cannot be supplied with malaria prophylaxis.”
The possibility of those living in non- malarial areas being infected on a large scale is enough to give health workers nightmares.
“Mosquitoes are not born with malaria. They pass it on after biting an infected person. If a person from, say, Cape Town becomes infected with malaria as he could not obtain prophylaxis, then he may very well take the malaria to Cape Town and start an epidemic there. It is not a pleasant thought.”
Jamieson says parts of Gauteng, especially the north of Pretoria, recorded malaria incidents last year, and it would be a “fair prediction” that the area would suffer more severe outbreaks this year. Nine out of the 15 pharmacies contacted at random by the Mail & Guardian say they have run out of over- the-counter malaria prophylaxis.
Jamieson says he has also received a number of reports of rural clinics running out of intravenous quinine – the most effective treatment for malaria.
“If travellers are going into malarial areas they should get hold of malaria prophylaxis well in advance of their departure,” he says. “Many of the small clinics and hospitals will run out of medicines to treat malaria once it is contracted.”
Because of South Africa’s porous borders, many clinics in border areas treat foreigners who come into South Africa in search of medical attention, straining state resources even further. While quinine is favoured by private medical practitioners, Fansidar, a relatively new drug combining sulfadoxine and pyrimethamine, is the preferred first-line treatment used by governments in the fight against malaria.
Three Fansidar pills are usually enough to cure the disease and the symptoms disappear in a day or two.
However, despite emergency supplies of the drug organised by the Department of Health, there’s no certainty there will be enough of it.
Workers at some rural KwaZulu-Natal clinics told the M&G that they are experiencing long waits for supplies of Fansidar and doubt they will have enough to see them through summer – the peak malaria period.
Dave McGlew, representative for the KwaZulu-Natal Department of Health, says: “The best option would be for us to stockpile the drugs. The problem is we cannot afford to.
“The other problem is that malaria has been increasing at such a rate we cannot reliably estimate how much we will need of any particular medicine.”
And while provincial health departments can barely afford the necessary medicines to combat malaria, they also have to spend a good deal of their anti-malaria budget on education.
“A big part of our problem with malaria can be laid at the feet of previous governments,” says McGlew.
“In the past, tourists were amply warned about the dangers of malaria and given proper medical care. The locals living in malaria zones were simply ignored. If they got malaria they were given medication, but were seldom educated that they have to finish the course.
“As a result many people did not take enough medicine to kill the malaria – only enough to allow it to develop an immunity to the common drugs used to fight it.”
McGlew’s department is now having to embark on a massive education programme. “If we don’t do this the malaria will simply become immune to the medication and all our efforts will be for naught.”