Malaria is a major concern for public health officials throughout much of the world. Now a new report indicate US citizens returning from Africa are coming home with drug-resistant malaria, while The Lancet tells us up to one third of all malaria treatments are counterfeit.
News from Alertnet reports that US travelers returning from visits to sub-Saharan Africa are bringing home artemisinin-resistant malaria. Though no indication of large-scale malaria drug resistance has yet appeared on the African continent, it is a worrying trend that may presage full-scale drug resistance in African malarial strains.
At present malaria is not endemic to any US state, but disease resistent malaria will make transmission more likely within the US and create treatment difficulties for those infected, said Dr. Michael Green of the Center for Disease Control in a recent interview with PSM.
Dr. Green, a speaker at the 2010 Partnership for Safe Medicines Interchange, said, “Outbreaks of locally transmitted cases of malaria in the United States have been small and relatively isolated, but the potential risk for the disease to re-emerge is present due to the abundance of competent vectors, especially in the southern states. The spread of multi-drug resistant malaria will limit the drugs available for preventing malaria among Americans traveling abroad. Artemisinin-containing drugs are used in North America when visitors or returning travelers develop the most severe, life-threatening form of malaria infection. Resistance to this class of drugs would require relying on older drugs that are now shown to be less effective and potentially more harmful for curing severe malaria illness.”
Malaria was fairly common in some parts of the United States until the CDC’s campaign to eliminate it was successfully concluded in 1951.
The impact of hightly drug-resistant malaria upon successful treatment and life saving is beginning to be evaluated in Asia as well as Africa. According to a new study in Lancet, researchers Nayyar, and Breman reviewed drug quality studies from 21 countries in Central Africa, and 7 in Southeast Asia. They discovered that up to one third of antimalarials available in these locations are counterfeit, or as they describe them “falsified, substandard, and degraded.” The authors implicate the recent development of drug resistance in malaria to the prevalence of counterfeit treatments and warn that penalites for producing counterfeit malaria drugs are not strong enough to detract criminals, saying “Production and distribution of counterfeit antimalarial drugs should be prosecuted as crimes against humanity.”
A report by Pierre Ambroise-Thomas in the Mediterranean Journal of Hematology and Infectious Diseases describes the impact of fake malaria drugs upon patients.
Writes Ambroise-Thomas, “Counterfeiting is more than a criminal act. Manslaughter is perfectly justified to describe such an act although some prefer calling it simply murder. It always involves unscrupulous people directing a highly organized technical and sophisticated criminal trade. These criminals make tablets out of starch, chalk, and a variety of wrong active ingredients for a life-threatening disease that particularly affects the poor populations who can least afford. These perpetrators knowingly manufacture these fakes medicines and they fully know that their ineffective product may kill people who would otherwise survive their malaria infection.”
The role of counterfeit drugs in malaria resistance first came to light in reports last year of artemisinin-resistant malaria strains popping up first along the Thailand-Cambodia border. Soon after, resistant malaria appeared along the Cambodia/Myanmar border as well. Each season of infection has the potential to spread resistant strains of malaria further, confounding medical efforts to save those infected. Children are disproportionately represented among malaria sufferers, and are also the most likely to die if left untreated. Counterfeit drugs put malaria-infected children in grave danger, but the drug resistant strains that result from their use are even more dangerous.
While counterfeit medications can kill, authentic treatments can easily save lives and prevent suffering. Find out more about how countries and law enforcement agencies throughout the globe are working together to try to stem the tide of counterfeit drugs at 2012 Interchange on September 28th in Washington DC. Register today.
By S. Imber