Promising Malaria Drug

Saw this item over at NYT. Excerpt:

After years of hesitation, world health agencies are racing to acquire 100 million doses of a Chinese herbal drug that has proved strikingly effective against malaria, one of the leading killers of the poor.

The drug, artemisinin (pronounced are-TEM-is-in-in), is a compound based on qinghaosu, or sweet wormwood. First isolated in 1965 by Chinese military researchers, it cut the death rate by 97 percent in a malaria epidemic in Vietnam in the early 1990's.

It is rapidly replacing quinine derivatives and later drugs against which the disease has evolved into resistant strains.

To protect artemisinin from the same fate, it will be given as part of multidrug cocktails.
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Like many tropical disease drugs, artemisinin is a fruit of military research. Chinese scientists first isolated it in 1965 while seeking a new antimalarial treatment for Vietnamese troops fighting American forces, said Dr. Nelson Tan, medical director of Holley Pharmaceuticals, which makes the drug in Chongqing, China.

Another antimalarial drug still in use, mefloquine, was isolated at the Walter Reed Army Institute of Research in 1963 for American troops in the same jungles. Under the name Lariam, it is still issued to troops and sold to travelers.

Artemisinin, which has no significant side effects, quickly reduces fevers and rapidly lowers blood-parasite levels, which can keep small outbreaks in mosquito-infested areas from becoming epidemics.

Two years ago, Dr. Dennis Carroll, a health adviser to the United States Agency for International Development, said artemisinin was "not ready for prime time." But on April 30 at a malaria conference at the Columbia University School of Public Health, he led a session on ways to induce farmers to plant more wormwood.

Dr. Carroll said that more evidence had emerged that the drug was safe and that older drugs were not working. Also, the creation of the Global Fund expedited grants for it.

Dr. Stewart Tyson, a health expert with the British Department for International Development, said his agency changed its opinion about the drug after its experience in Uganda, where resistance to older drugs had climbed to 31 percent in some areas in 2003 from 6 percent in 2000.

The price of artemisinin cocktails has fallen from $2 per treatment to 90 cents or less as more companies in China, India and Vietnam have begun making them. (Older drugs cost only 20 cents.) Novartis, the Swiss drug giant, sells its artemisinin-lumefantrine mix, Coartem, to poor countries for 10 cents less than it costs to make, a company official said. The same drug, under the name Riamet, is sold to European travelers for about $20.
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Even if enough artemisinin can be made, obstacles will arise, experts warned. For example, Dr. Kopano Mukelabai, a malaria specialist at Unicef, said shopkeepers would have to be trained not to sell one or two pills to patients who lacked the money for a full course of 12.

And what Richard Allan, director of the Mentor Initiative, a public health group that fights malaria epidemics, called "the love of chloroquine" will have to be broken. That quinine derivative, in use since the 1950's, is now almost useless against parasites, but poor people still buy it because it is cheap and lowers fever as aspirin does.

Also, counterfeiting will become a problem. In Kenya in 1997, Mr. Allan said, he found 120 versions of sulfadoxine-pyrimethamine for sale, "ranging from very good drugs to talcum powder." A recent study of artemisinin drugs in Asia "found that 38 percent were fakes," he said. "We can expect the same thing to happen in Africa."

He favors giving artemisinin away to remove the counterfeiters' profit motive.

Here is an area where I part company with my libertarian leanings. Free market forces probably aren't strong enough to drive malaria drug research. It seemed to only make progress because the military needed it so that government driven research was essential. Also driving research would have to be humanitarian instincts.