Bad malaria pills in Africa

[Ordie]

If you're in Africa, bring your own meds.


Bad malaria pills in Africa raise resistance fears
By MARGIE MASON, AP Medical Writer
Monday, February 8, 2010
(02-08) 06:28 PST , (AP) --

High rates of the most effective type of malaria-fighting drugs sold in three African countries are poor quality — including nearly half the pills sampled in Senegal — raising fears of increased drug resistance that could wipe out the last weapon left to battle a disease that kills 1 million people each year, according to a U.S. report released Monday.

Between 16 percent and 40 percent of artemisinin-based drugs sold in Senegal, Madagascar and Uganda failed quality testing, including having impurities or not containing enough active ingredient, the survey found.

Artemisinin-based drugs are the only affordable treatment for malaria left in the global medicine cabinet. Other drugs have already lost effectiveness due to resistance, which builds when not enough medicine is taken to kill all of the mosquito-transmitted parasites.

If artemisinin-based drugs stop working, there is no good replacement and experts worry many people could die.

"It is worrisome that almost all of the poor-quality data that was obtained was a result of inadequate amounts of active (ingredients) or the presence of impurities in the product," said Patrick Lukulay, director of a nongovernmental U.S. Pharmacopeia program funded by the U.S. government, which conducted the survey. "This is a disturbing trend that came to light."

The study is the first part of a 10-country examination of antimalarials in Africa by the U.S. and the World Health Organization. It follows evidence from the Thai-Cambodian border that artemisinin-based drugs there are taking longer to cure malaria patients, the first sign of drug resistance.

The three-country report also found bad drugs in both the public and private health sectors, meaning governments — some buying medicines with donor funds — are not doing enough to keep poor-quality pills out. All of the drugs tested from the public sector in Uganda, however, passed the quality tests. But 40 percent of the artemisinin-based drugs in Senegal failed.

"There are countries where donated medicines are not subjected to quality controls, they're just accepted," said Lukulay. "There are countries in Africa where Chinese products have been donated and found to be unacceptable later in the public sector."

A total of 444 samples of artemisinin-based combination drugs along with the antimalarial sulfadoxine-pyrimethamine — to which resistance has already developed — were first screened locally using visual inspection and basic lab tests. Sulfadoxine-pyrimethamine is still used, mainly for preventative treatment for pregnant women.

Nearly 200 samples then underwent full quality control testing in a U.S. laboratory to examine the amount of active ingredient present and drug purity. For both drugs, 44 percent from Senegal failed the full quality testing, followed by 30 percent from Madagascar and 26 percent from Uganda.

While the study is not the first to assess the quality of antimalarials in Africa, it is the most rigorous and complete. Similar failure rates were found in previous work, but those did not focus specifically on artemisinin-based drugs.

"I am alarmed by these results because it means there are many cases of malaria that are being only partially treated, and that just guarantees acceleration of artemisinin drug resistance," said Rachel Nugent, deputy director for Global Health at the Center for Global Development, a U.S. think tank. "It is the most comprehensive study out there on antimalarials and should be a wake-up call."

Nugent was not involved in the study.

In all three countries, the antimalarial brands collected from various areas and sectors tended to either do well across the board or poorly, which could prove helpful for governments working to ban low-grade drugs.

Results from the other countries surveyed — Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria and Tanzania — have not yet been publicly released by the WHO. But Clive Ondari, who worked on the study for the WHO in Geneva, said failure rates in three of those countries were also significantly high.

Ghana has already withdrawn more than 20 drugs from the market after receiving the initial results, Lukulay said.

____

Associated Press Writer Justin Pritchard in Los Angeles contributed to this report.

____

On the Web:

www.usp.org/

Source:
http://sfgate.com/cgi-bin/article.cgi?f=/n/a/2010/02/08/international/i060057S37.DTL

[Nano]

My understanding of some of the manufacturing that goes into making some of these relatively in-expensive medicines is that they are made by generic drug makers. Some of these drugs have been cheap licensed/free to some drug makers in India.
I would caution that we have a similar problem with non-name brand generic medications. The quality issue with pharmaceuticals is potentially large .
My concern is with the non-medications like vitamins and the like who's standards may not be up to par with brand name equivalents though are marketed as being an equivalent to them.

[Dercius]

Conspiracy theorists would say population control.

[Nano]

Conspiracy theorists would say population control.
How so by offering them cheap meds? Nature and their circumstances would have done the job faster and cheaply no?
In any case there are issues with corruption and how that works it ways down to these lower quality medications. Some officials have even been suspected of replacing their good stock medications with sugar pills and selling the good stock on the black market. Africa certainly is not in the circumstances it is in because of righteous and legitimate political leaders.

[Dercius]

How so by offering them cheap meds? Nature and their circumstances would have done the job faster and cheaply no?

Yes, but that will have consequences in our society creating unrest and rage among some populace because our innaction. This way we sell them meds that dont work and its not our fault, you take little money and do the same job without feeling any guilt. (((thats what a conspiracist would say)))

[Nano]

Yes, but that will have consequences in our society creating unrest and rage among some populace because our innaction. This way we sell them meds that dont work and its not our fault, you take little money and do the same job without feeling any guilt. (((thats what a conspiracist would say)))
In any case it is not effective population control if that was their actual goal they would fail.

[P.Koschei]

Maybe if someone actually bothered to kill mosquitoes and their breeding habitats they wouldn't be so dependent on the capricious charity of others. You would think that after half a century of independence that someone somewhere in Africa would have taken the initiative to fix their problems.

People need to learn to read between the lines in these "woe is Africa" articles and connect the underlying logic which seems to be a nigh impossible task for most people so I'll go ahead and draw the line from point A to point B.

"It is worrisome that almost all of the poor-quality data that was obtained was a result of inadequate amounts of active (ingredients) or the presence of impurities in the product"

"The study is the first part of a 10-country examination of antimalarials in Africa by the U.S. and the World Health Organization. It follows evidence from the Thai-Cambodian border that artemisinin-based drugs there are taking longer to cure malaria patients, the first sign of drug resistance."

The underlying problem is not that some of the anti-malarial drugs are useless. It's that the dosages contained are enough to treat incidents of malaria in locations where it is rare and weak but in Africa heavy reliance on the drug has means that the disease is almost certainly already resistant in Africa requiring larger dosages to be effective.

[Imp]

Ya know what works wonders against malaria? DEET. Malaria used to be widespread in North America and in Europe. Ya know what wiped it out? DEET.


Over the next 100 years, malaria spread across the United States of America and Canada and by around 1850 A.D., it prevailed through the length and breadth of the two American continents. At this time, malaria was common in Italy, Greece, London, Versailles, Paris, Washington D.C., and even New York City.

[Gleipnir]

Ya know what works wonders against malaria? DEET. Malaria used to be widespread in North America and in Europe. Ya know what wiped it out? DEET.

Are you sure you aren't confusing deet with DDT?


Maybe if someone actually bothered to kill mosquitoes and their breeding habitats they wouldn't be so dependent on the capricious charity of others. You would think that after half a century of independence that someone somewhere in Africa would have taken the initiative to fix their problems.

You make it sound ever so simple.

[Connaught Ranger]

My understanding of some of the manufacturing that goes into making some of these relatively in-expensive medicines is that they are made by generic drug makers. Some of these drugs have been cheap licensed/free to some drug makers in India.
I would caution that we have a similar problem with non-name brand generic medications. The quality issue with pharmaceuticals is potentially large .
My concern is with the non-medications like vitamins and the like who's standards may not be up to par with brand name equivalents though are marketed as being an equivalent to them.

Not to mention the full-time production of Fake / Copys of top name medical brands down to the exact same packaging, which have no medica ingrediants in them at all, which are flooding in from India where fake pills is a booming business.

Connaught Ranger.

[Connaught Ranger]

Maybe if someone actually bothered to kill mosquitoes and their breeding habitats they wouldn't be so dependent on the capricious charity of others. You would think that after half a century of independence that someone somewhere in Africa would have taken the initiative to fix their problems.

People need to learn to read between the lines in these "woe is Africa" articles and connect the underlying logic which seems to be a nigh impossible task for most people so I'll go ahead and draw the line from point A to point B.

"It is worrisome that almost all of the poor-quality data that was obtained was a result of inadequate amounts of active (ingredients) or the presence of impurities in the product"

"The study is the first part of a 10-country examination of antimalarials in Africa by the U.S. and the World Health Organization. It follows evidence from the Thai-Cambodian border that artemisinin-based drugs there are taking longer to cure malaria patients, the first sign of drug resistance."

The underlying problem is not that some of the anti-malarial drugs are useless. It's that the dosages contained are enough to treat incidents of malaria in locations where it is rare and weak but in Africa heavy reliance on the drug has means that the disease is almost certainly already resistant in Africa requiring larger dosages to be effective.

Mosquito born malarial type disease was common even in the Balkans in the late 1800's, it was then eradicated, however the mosquitos still remain and are very troublesome in the summer time, disturbingly cases of malarial type sickness have been occuring over the last few years again in the Balkans.

While D.D.T. played a large part in eradicating the mosquito pest in many countries the long term affects to the soil. water, and peoples health would prohibit the use of such cheimical again.

Connaught Ranger.

[Ordie]

there's a malaria vaccine in the works and the results seems promising so far.



New malaria vaccine shows promise in children

Wed Feb 3, 2010 8:00pm EST









* Vaccine produced 100-fold increase in antibodies in kids
Stocks (http://www.*******.com/finance/stocks) | Regulatory News (http://www.*******.com/finance/deals/regulatory)
* New vaccine uses Glaxo immune system booster
By Julie Steenhuysen (http://blogs.*******.com/search/journalist.php?edition=us&n=julie.steenhuysen&)
CHICAGO, Feb 3 (*******) - A new vaccine showed promise at protecting young children from malaria, offering a potential new weapon against a disease that kills at least 1 million people each year, U.S. researchers said on Wednesday.
In a study of 100 West African children aged 1 to 6, the experimental vaccine produced immune responses similar to or even higher than those of adults infected by malaria all their lives.
The vaccine, which uses an immune system booster called an adjuvant from British drugmaker GlaxoSmithKline Plc (GSK.L (http://www.*******.com/finance/stocks/overview?symbol=GSK.L))(GSK.N (http://www.*******.com/finance/stocks/overview?symbol=GSK.N)), targets the malaria parasite as it is actively infecting red blood cells and causing fever and illness.
This so-called blood stage vaccine acts at a later stage in the malaria parasite's life cycle than Glaxo's experimental vaccine Mosquirix.
"What jumps out to me about this vaccine is the antibody response," said Christopher Plowe of the University of Maryland in Baltimore and a Howard Hughes Medical Institute investigator whose study appears in PLoS ONE, a journal of the Public Library of Science.
"When you just look at the antibodies before you immunize anybody, the adults in Mali who have been exposed to malaria life-long, they don't get sick from malaria any more. They get infected but they don't get sick," Plowe said in a telephone interview.
"That is exactly what you want a blood stage vaccine to do."
SECOND ROUND OF TESTING
Plowe said children start out with fewer antibodies -- the immune system proteins that recognize invaders such as viruses or parasites. But after they were vaccinated, the children's antibody levels were just as high, or even a bit higher, than adults in their community.
The results were strong enough to start a second round of testing in 400 children to see if the vaccine can blunt the infection.
The new vaccine targets the malaria parasite after it has made its way though the bloodstream and into the liver, where it transforms into a new form called a merozoite, which can infect new red blood cells and cause fever and illness.
Plowe said he thinks the adjuvant from Glaxo, the same one used in Mosquirix, is priming the children's immune system to develop such a robust response.
"The hope would be that you could get two or more such first-generation vaccines, especially when you have the same adjuvant, and be able to come up with a multi-stage vaccine," he said.
Last month, Glaxo said Mosquirix is expected to complete late-stage testing in 2011 and, if proven effective, the company will seek regulatory approval by 2012.
Plowe's study was funded by the National Institute of Allergy and Infectious Diseases and the U.S. Agency for International Development. The vaccine was invented and made by the Walter Reed Army Institute of Research and formulated with an adjuvant by GlaxoSmithKline Biologicals.
Most of the 1 million or more people killed every year by malaria are young children and most live in Africa. The World Health Organisation says a child dies of malaria every 30 seconds.
Source:http://www.*******.com/article/idUSN0314763020100204?type=marketsNews

[Imp]

Are you sure you aren't confusing deet with DDT?

Indeed I did mean DDT. Thanks for the correction.

[Ragno]

Are you sure you aren't confusing deet with DDT?


no i guess he meant DEET that unfortunately is a repellent and not a drug. Its action lasts from 2 to 3 hours, the old fashioned commercial generic insect repellent. I smell sense of Nobel prize somehow...nice one.

as far as i remember there is written "avoid sun exposure" easy in Africa, being serious someone named corruption, i guess is the right answer.

[Dinges]

Yes there is corruption in both the purchasing and distribution of anti-malaria drugs in Africa , no argument. But have any-one asked why these African governments are going to second tier - or even third - to purchase the drugs.

[Mr Gently Benevolent]

There was a documentary in the UK on low quality and fake pharmaceutical products from India being marketed in Africa seems like its been an ongoing issue for some time.

[2495]

If all the money that was used ofr HIV research was instead used for anti malari studies and medical trials, it would be as dead as smallpox is now. Instead? the luvvies all time favorite got all the cash and it was shoved to the side.

Deadly deadly disease and with a cash injection, very beatable.

[Dinges]

Deadly deadly disease and with a cash injection, very beatable.

Has African governments not already proven that premise wrong?

[2495]

Has African governments not already proven that premise wrong?

No - becasue African Governments know the square root of fvck all about combatting disease vectors at the DNA level. Attack the very mosquito, make their breeding cycle breed only males, and after 10 years.. voila, no malaria.

[skyeye]

The use DDT has been rehabilitated in recent years. Hopefully responsible use will reduce the deaths of millions of children, who are the main victims of malaria.

From NPR.ORG
http://www.npr.org/templates/story/story.php?storyId=6083944


WHO Backs Use of DDT Against Malaria
by Joanne Silberner

September 15, 2006

The World Health Organization today announced a major policy change. It's actively backing the controversial pesticide DDT as a way to control malaria. Malaria kills about 1 million people a year, mainly children, and mainly in Africa, despite a decades-long effort to eradicate it.

The WHO previously approved DDT for dealing with malaria, but didn't actively support it. While DDT repels or kills mosquitoes that carry the malaria parasite, it doesn't get much good press. In 1962, environmentalist Rachel Carson wrote a book, Silent Spring, about how it persists in the environment and affects not just insects but the whole food chain.

As activist Malvina Reynolds once sang, "It kills the bugs in the apple tree, I eat the pie and it's killing me. DDT on my brain, on my brain."
In the early 1960s, several developing countries had nearly wiped out malaria. After they stopped using DDT, malaria came raging back and other control methods have had only modest success.

Which is why Arata Kochi, head of the WHO's antimalaria campaign, has made the move to bring back DDT. His major effort at a news conference Friday in Washington, D.C., was not so much to announce the change, but to deflect potential opposition from environmental groups.

"We are asking these environmental groups to join the fight to save the lives of babies in Africa," Kochi said. "This is our call to them."

A number of major environmental groups support the limited use of DDT, such as spraying only inside of houses and huts once or twice a year. That type of use is supported by the Sierra Club and Environmental Defense, which was originally founded by scientists concerned about DDT. The limited application is also part of President Bush's new malaria initiative.

Aricle continues. (http://www.npr.org/templates/story/story.php?storyId=6083944)

[Dinges]

No - becasue African Governments know the square root of fvck all about combatting disease vectors at the DNA level. Attack the very mosquito, make their breeding cycle breed only males, and after 10 years.. voila, no malaria.

I have to disagree with you on this. The know-how is there.

[Flagg]

All I know is that the spare Doxy I had on my trip to Africa in October was in great demand. :(

[Dinges]

I think there is a general misconception when it comes to malaria and medicine. All pharmaceutical treatments for malaria is not the prophylaxis that everyone thinks. These medication that are given in Africa are for locals that have been diagnosed with malaria.

The meds I saw when in Mozambique where top notch and worked like a charm. And Mozambique is widely regarded as one , if not one the poorest African countries.

Yes Africa is in a bad shape. But bloody hell do not for one moment think that it is any better in some parts of SE Asia , South America and other parts of the world.

Apples - Apples.