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An effective, but costly, cure

August 15, 2005

ASK RICHARD IDRO IF HE HAD MALARIA as a child, and you will begin to grasp the toll this disease takes on sub-Saharan Africa. Patiently, as though explaining breathing to a visiting Martian, he will answer, "Everybody got malaria."

Growing up in northwestern Uganda, Idro and his nine brothers and sisters had malaria "over and over," especially after the war that toppled strongman Idi Amin destroyed their home and sent them to a crowded refugee camp. But Idro's worst brush came when he was just a year old and lapsed into a coma from cerebral malaria, the most severe form. His mother prayed he would pull through.

The oft-told story of his survival inspired Idro to become a pediatrician when he grew up. Today, he is studying to add a doctorate to his medical degree, specializing in cerebral malaria at the Kenya Medical Research Institute.

The story of malaria in the 30 years since Idro's recovery isn't nearly as uplifting. The mosquito-borne parasite has grown resistant to the drug that cured him. Malaria's mortality rate is higher today than it has been in decades.

Yet it doesn't have to be this way. Even in tropical Africa, where the Anopheles mosquitoes that transmit the parasites thrive, everybody doesn't have to get malaria.

Historically, vaccines have been responsible for reining in some of the world's worst diseases. In an earlier editorial, we urged the United States and other wealthy nations to speed progress by committing in advance to a $4-billion purchasing fund, to be tapped only if an effective vaccine is developed. This innovative, market-based complement to the "push" of grants would "pull" more biotech firms and their armies of scientists into the search by guaranteeing a payoff for success.

But sub-Saharan Africa's dying children can't wait years for a vaccine. Here too the world's wealthy nations can help, by creating a similar fund to pay for an exciting but expensive drug compound made from a Chinese herb.

Good herb, bad name

The wormwood plant does not have good PR. When God wants to curse a people in the Old Testament, he threatens to feed them with wormwood and gall. The Book of Revelation says that a star called Wormwood will strike the Earth at Armageddon and poison the waters. So it's a little surprising that a wormwood species, Artemisia annua, holds a key to curing the deadly, ancient plague of malaria.

Artemisia's beneficial properties might never have been discovered were it not for Mao Tse-tung. During the Cultural Revolution, Mao ordered Chinese scientists to investigate ancient herbal remedies. In the 1970s, an archeological dig unearthed ancient texts, including recipes for herbal cures that may be as much as 2,000 years old. One of them identified artemisia as a cure for fevers; the scientists investigated and discovered that an agent extracted from the plant, artemisinin, was as effective at killing malaria parasites as existing drugs such as chloroquine. The discovery didn't come a moment too soon, because the parasites were becoming resistant to chloroquine.

The newest malaria miracle cure is best used as a cocktail with other drugs, called artemisinin combination therapy. But ACT costs more than legions of Africa's rural poor can afford. And without a market of consumers able to buy it, farmers outside China have little incentive to start growing the artemesia plant, while scientists aren't encouraged to invest in finding a synthetic substitute and manufacturers have no motivation to increase production of the finished drug.

What is needed is a global purchasing pool, separate from the one proposed to spur investment in vaccine research. Rather than guaranteeing a future market for a potential vaccine, the second fund would be tapped now to pay for an already existing cure.

The Washington-based Institute of Medicine, an independent organization that advises the U.S. government on health policy, last year proposed just such a plan. In a report written by a Nobel Prize-winning economist, it called on international organizations and world leaders to contribute $300 million to $500 million a year to a centralized procurement agency to buy ACTs at competitive prices, then resell them at lower prices to public and private distributors in countries battling malaria.

Instead of today's market price of $2, ACT would cost consumers about 10 cents -- the same as the no-longer-effective but still ubiquitous chloroquine. We'd advocate doubling the pool to $1 billion to spur production and subsidize the price of insecticide-treated bed nets as well, delivering a one-two punch against the parasites and the mosquitoes that transmit them.

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