Obstacles

1
Obstacles Necessities in Prioritizing Public
Health

• Richard Tren
• Africa Fighting Malaria
• www.fightingmalaria.org

2
Malaria

• Approx 300 million cases, gt800,000 deaths every
  year, mostly children. One child every 30
  seconds
• Enormous economic costs Approx 12bn p.a. in
  Africa
• But preventable and curable and recognized as a
  good public health investment
• Successful malaria control closely correlated to
  health systems, logistical capacity expertise
• Tools for malaria control treatment nets,
  insecticides drugs.

3
Malaria Treatment

• January 2006 WHO issues new treatment guidelines.
  Calls for Artemisinin-based Combination Therapy
  (ACT)
• Call for halt to use of Artemisinin Mono-therapy
  tablets, reiterated by WHA 2007
• Access to ACT still too low, sub-standard and
  fake medicines pose major obstacle to treatment
  long term use of Artemisinin.

4
Vector Control

• Indoor Residual Spraying Insecticide Treated
  Bednets (LLINs), limited larval control all
  require insecticides

5
Pressure against insecticide use

• Silent Spring published 1962, Anti-insecticides
  pressure rises in 1970s
• DDT banned for agriculture in Sweden, US many
  other countries by 1972
• Spraying programs restricted, malaria programs
  decentralised, part of community health, focus on
  treatment with chloroquine
• Loss of malaria control personnel, scientists

6
Attaran et al (2000) Nature Medicine 6729-731
7
Anti-insecticides bias

• All but 1 public health insecticide (DDT) adapted
  from agriculture
• Since 1980s, no new insecticide class for
  chemical vector control
• Resistance cross- resistance threatens IRS
  LLINs just as funding for malaria control
  increases, programs scale up
• WHO admits new insecticides needed yet provides
  no leadership
• 1997 WHA resolution calls for reduced use of
  man-made chemicals
• Parallels with drugs/vaccines
• EU polices set to worsen situation dramatically.

8
Malaria Treatment

• Chloroquine Sulphadoxine-Pyrimethamine ACTs
• Yet, price of ACTs high (10 private sector, 1
  subsidized through WHO)
• Wide range of drugs available, many never tested
  by any regulatory authority or WHO
• Study finds 35 poor quality/fake in 6 countries,
  Art. Mono-therapy still widely available
• Political pressure to support local production
  regardless of quality, economic rationale.

9
Drugs of unknown quality
10
What to do

• Talk of elimination eradication long term
  this requires economic growth wealth
• NGOs, FBOs, religious leaders must help to change
  attitudes on insecticides
• Govt. must prioritize research for new, effective
  public health insecticides through PPPs
• Industrial policy must be divorced from public
  healthy policy
• Malarial country governments, India China must
  abide by WHO requests, guidelines, improve
  oversight.

11
Africa Fighting Malaria

• http//fightingmalaria.org
• rtren_at_fightingmalaria.org
• 202 223 3298