|  Focus
on Zambia
| Watch a 5 minute
Global Fund video on Zambia, a pioneer in the fight against malaria |
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Zambia is a country endemic with
malaria (malaria facts and figures), dealing
with 4.8 million cases of malaria each year among
a population of just over 10 million people (Zambia
fact sheet). Chloroquine used to be the health
system’s first drug of choice to fight the disease, but high
levels of resistance (up to 64% in some areas) forced it
to start using Fansidar – trade name for
a sulfadoxine + pyrimethamine (SP) drug. Unfortunately resistance
to SP has also increased dramatically over the last couple of years,
and in some areas has reached a level as high as 19%.
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According to 2001
WHO guidelines on drug resistance to malaria (more WHO
guidelines for malaria control), the world health body makes
the recommendation that if a country’s resistance levels to
a drug reach 15%, the government should consider making the shift
to a new drug.
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In some ways, ACT (artemisinin combination therapy) drugs
are the ARVs of malaria: known to bring people back from
the brink of death (it makes people feel better almost immediately
AND kills the parasite so that the patient no longer becomes a carrier
of the disease) but are still very expensive. In
the case of Zambia for example, chloroquine treatment is very
cheap, at $0.20 per treatment whereas ACT costs $2.40 and in the private
sector up to $10.
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The new malaria “wonder drugs” on the
market are artemisinin based drugs which come from Artemisia annua
– the sweet wormwood known to traditional Chinese medicine for
some 2000 years for treating fevers. In 1970, Chinese scientists isolated
the active component, artemisinin and developed it for the treatment
of malaria.
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Zambia therefore took a very big risk when it decided to
adopt ACT treatment to fight malaria. Despite a lot of pressure
NOT to buy this drug (with a 95% cure rate and has no documented
resistance to date) because it is far too poor a country
to sustain this choice, the govenrment of Zambia began
in 2003 to treat its patients with ACT.
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With the help of the Global Fund to fight AIDS, TB and Malaria,
Zambia has been able to distribute ACT in the form of Coartem (Coartem fact sheet)
- an artemisinin based drug produced by Swiss company Novartis -
to 28 out of its 72 districts and intends to reach all districts
by the end of 2004.
"The Zambians called us in the summer
and said: 'Hey, this is going too slowly, the malaria season starts
at the end of December, malaria will peak in January, February,
March in Zambia, the Coartem has not reached us yet, we need it
more quickly'. So we called up Novartis, and by our triangular
collaboration between the drug company, the Zambians and the Global
Fund, we got this product to Zambia quickly."
Richard Feachem, Executive Director, The Global
Fund to Fight AIDS, TB and Malaria
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Price is still a huge problem as without Fund money,
the drug would be unaffordable and is unaffordable to a
lot of other African countries. Not all are willing to take the
bold step that Zambia has made.
“Somebody said to me: How can you buy a limousine, when you
cannot even afford to buy a bicycle?” the Acting Director
of the Zambian National Malaria Control Centre, Dr Naawa Sipilanyambe,
said of the criticims her department faced when they made their
choice for ACT. |
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90%
of all malaria deaths in the world occur in Sub-Saharan Africa.
Each year, an estimated 1 million Africans
die from malaria, 71% of them under 5.
A photo
gallery on ACT in Zambia
Visit the Roll Back
Malaria's website
ACT in Zambia:
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The Global Fund and ACT
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