Paris

African patients currently receive drugs to which malaria is becoming resistant. Credit: A. JOHNSTONE/PANOS

An outcry from researchers has helped prompt a move to switch malaria treatment in Africa to a more effective therapy. The drug, artemisinin, comes from a Chinese herb, and cures 90% of patients in three days.

But aid donors have shrunk from promoting artemisinin, largely because it costs at least ten times more than established malaria treatments, to which the parasite that causes the disease has grown resistant.

At a closed meeting last month, the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria agreed to instruct African countries to retrospectively modify all malaria grants awarded to specify only the newer drug. The move will cost the fund more than a billion dollars over the next five years, says Vinand Nantulya, one of its senior officials.

All future funding will stipulate the use of artemisinin. The policy change is expected to force most countries to change their national drug policies. “Money talks,” says Allan Schapira, coordinator of malaria policy and strategy at the Roll Back Malaria team of the World Health Organization (WHO).

Nantulya admits that the move was given “further impetus” by the discussion that followed publication of an article in The Lancet in January in which prominent scientists accused the fund and the WHO of “malpractice” for bowing to pressure from aid-giving countries. They also cautioned against the use of out-dated drugs (Lancet 363, 237–240; 2004).

Donors such as the United States and Britain had discouraged African countries from adopting artemisinin on the grounds that it cost too much, that data on its effect in children were insufficient, and that it was not needed in regions where other anti-malaria drugs still worked, says Amir Attaran of the Royal Institute of International Affairs in London, and the article's lead author.

In 2002, the WHO recommended artem-isinin as the treatment of choice, but in Africa only Zambia and Zanzibar have adopted it.

The growing resistance of the malaria parasite Plasmodium falciparum to chloroquine and sulfadoxine–pyrimethamine, the mainstay of treatments in Africa — where 90% of global malaria deaths occur — has also damaged the lofty ambitions of the Roll Back Malaria initiative. This was launched in 1998, with the goal of halving malaria deaths by 2010.

But deaths are up, not down, and mortality rates of treated patients are doubling in many parts of Africa. John Lidén, a spokesman for the Global Fund, says that it revisited resistance data from the WHO and other sources, and that this “composite set” convinced it to act. “We are results-based,” he says, “and if we find we are paying for medicines that don't work, we want to pay for those that do.”

The higher cost of artemisinin means that African countries will spend their revised grants more rapidly than they had intended. The drug costs about US$2 for each adult treatment, compared with ten cents for existing drugs. Its price is expected to fall to about $1 with improvements in production.

Countries might be allowed to apply for further grants in advance to make up the loss, Lidén says, and donors may be asked to release an additional $1 billion to pay for the drug. “I appeal to the donor community to recognize that moving countries to using the right drugs will require much more money,” says Nantulya, “They must take this seriously.”