A World Health Organisation (WHO) official in Ethiopia has dismissed an article in a respected British medical journal that claims the United Nations agency is undermining the fight against malaria.
The Lancet accuses the agency of approving cheap drugs that do not work, and blocking the use of a newer — albeit more expensive — treatment to combat the disease.
This comes as Ethiopia is experiencing a malaria epidemic.
According to a joint report by government and the UN, 46,2-million Ethiopians are living in malaria-prone areas, out of a population of 70-million. The Ministry of Health estimates that 15-million people are under severe threat of being infected with malaria — the leading cause of death for children under five. About five million cases of the illness are reported in Ethiopia every year.
The WHO’s “Roll-Back Malaria campaign has sought to halve the number of malaria cases worldwide by 2010. To date, the agency has approved grants totalling $700-million for fighting the disease, this through the Global Fund to Fight Aids, Tuberculosis and Malaria.
But last week, The Lancet alleged that the WHO is supplying African countries with conventional anti-malarial drugs such as chloroquine and sulfadoxine-pyrimethamine (SP) despite notable levels of resistance to these medicines.
Doctors from the Médécins sans Frontières (MSF) aid agency who work in the Southern Nations region of Ethiopia and elsewhere also claim to have seen evidence of drug resistance.
“In our case we are seeing double the number of malaria cases compared to the same period last year,” says MSF Ethiopia director Jean-Luc Anglade, adding: “Most of the patients are arriving at the health facilities at an advanced, serious stage of malaria.”
This has prompted MSF to advocate the use of an alternative treatment to deal with malaria. This treatment, known as artemisinin-based combination therapy (ACT), is produced using an extract derived from a Chinese plant, Artemisia annua.
Olusegun Babaniyi, the WHO’s representative in Ethiopia, has hit out at ACT advocates who are criticising the agency.
“Why is there so much euphoria about this new drug? It is not a magic bullet. Even with this drug, some deaths are bound to happen,” he said.
Babaniyi also challenged The Lancet‘s view that chloroquine and SP are becoming increasingly ineffective against malaria.
“Let’s be very clear: no resistance has been proven scientifically. [There are] just anecdotal reports from the field suggesting that something might be happening,” he said.
“I would challenge anybody who has scientifically backed data that can stand WHO criteria to show that there is resistance.”
While the WHO has recommended the use of ACT to combat malaria, Babaniyi hastens to clarify this advice: “Please note the word ‘recommended’ … The final choice depends on the country. WHO never prescribes for a country, never.”
He says governments that wish to start using ACT also need to be carefully advised about how to do so.
“We need to have guidelines on what it would take to adopt a new drug for use in a country. Countries would have to follow careful procedures. If we just introduce a new drug into a country you may in fact create more problems.”
Ethiopian Health Minister Kebede Tadesse said his department had no plans to change the current drugs used for treating malaria.
“SP was introduced to Ethiopia five years ago and we do not expect resistance as fast as that. In our case, chloroquine is still working — but we are closely monitoring whether resistance is developing to it,” he said. — IPS