The Rise in the Morbidity and the Mortality of Malaria is a Global Threat:
Evidence from Multiple Antimalarial Drug Resistance
by Nestor Sapathy
Abstract
Antimalarial multidrug resistance is a major global public health problem and the main reason for the erosion of efficacious treatments. The spread of malaria globally has been attributed to emergence of falciparum strains that are insusceptible to antimalarials, which medical experts blamed on the development of monotherapy (single-pill form). This research paper examines the policies of the pharmaceutical industry that account for antimalarial resistance. Further, it focuses on malaria as a threat to global health, and the parasite's increasing resistance to antimalarial drugs. Strategies are also suggested for international collective action for containment of drug resistance to malaria as well as solutions to some of the problems that confront the pharmaceutical industry.
This paper noted that the pharmaceutical companies' policies today promote early resistance to antimalarials, and thus treatment failures. Combination therapy, a new approach to making antimalarial drugs including artemisinin and other antimalarials, is particularly effective in slowing development and the spread of resistance, and reducing the death toll in the endemic areas. This objective is achievable only if it gains adequate support from international organizations such as the World Health Organization (W.H.O.), political leaders around the globe and other stakeholders.
Malaria, an infectious disease, is a global threat and therefore requires a global response and control. An estimated 350 - 500 million clinical cases of malaria occur worldwide, and greater than 90% of them are reported in Africa (Center for Disease Control and Preventive [CDC], 2004). Out of these, at least two million deaths are recorded annually, mostly among children less than 5 years and pregnant women. The rapid spread of the debilitating disease around the world is mainly attributed to Plasmodium falciparum strains that are now resistant to most of the antimalarial drugs that have been developed. At the end of 2004, over 3.2 billion people lived in areas at risk of malaria transmission in more than 107 countries and territories (CDC, 2004). Economists believe that malaria is responsible for a growth penalty of up to 1.3% per year in some endemic countries, such as those in Africa (CDC, 2004). With globalization booming, this disaster can lead to a substantial difference in gross domestic product (GDP) between nations with and without malaria and severely impede the economic growth and productivity of the entire world.
Drug options for treatment of malaria are becoming increasingly difficult and limited as a result of growing falciparum strains becoming resistant to antimalarial drugs. This has become a global problem. Globalization with concomitant international travel increases the risk of countries importing diseases such as malaria, an infectious disease that travels faster and further than ever before. This stems from many factors, but currently health experts blame pharmaceutical companies. The companies' development of antimalarial drugs in a single-pill form, instead of combination therapy, results in early antimalarial drug resistance. The proponents blame drug insusceptibility on the development of substandard and counterfeit drugs by the pharmaceutical companies. On the other hand, the critics attribute drug resistance to inappropriate use or prescription of antimalarials by clinicians to patients. Also, the inability of the medical technologists to identify the species of the plasmodium in cross-infection in endemic regions is a major problem. In addition, the availability of antmalarial drugs from roadside stalls and hawkers who have little or no knowledge of dosage regimens, especially in poor countries where drug regulation is weak, is also a cause of drug resistance.
The rapid spread of antimalarial drug resistance over the past few decades globally has necessitated an increased monitoring of pharmaceutical companies, and for which the W.H.O. has taken the lead. The high morbidity and mortality rate worldwide calls for a new policy to be implemented. Also, the pharmaceutical industry is developing few new malarial drugs, so there is an urgent need to take action to preserve the effectiveness of the available drugs, for example, artemisinin. Furthermore, political leaders and health policy makers in malaria-endemic regions especially in Africa are alarmed over the death toll of the disease; hence the need to find alternative treatments.
Since most malaria-endemic countries are generally poor, pharmaceutical companies have argued that research and development of drugs are very expensive and a risky activity if their investment would not be recouped before the patent period has ended. The public-private partnership collaboration and incentives to boost the pharmaceutical industry are inadequate.
The question this research paper considers is, do the policies of pharmaceutical companies lead to antimalarial drug resistance? With booming globalization, antimalarial drug resistance is a major public health challenge and the principal reason for treatment options to avert morbidity and mortality worldwide. This paper will therefore focus on the policies of pharmaceutical companies to address the following:
- Malaria as a global threat.
- Why does the parasite become resistant to antimalarial drugs?
- What are some of the problems that confront the pharmaceutical industry?
- Mechanisms for containment of antimalarial resistance.
- How can these problems be addressed?