Drug Safety

Artemisinin-based Combination Therapies, or ACTs, are now considered to be the best treatment for uncomplicated P. falciparum malaria. The World Health Organization (WHO) currently recommends the following ACTs:

Artemether-lumefantrine (e.g. Coartem®, available through Novartis AG)
Artesunate plus amodiaquine (e.g. Arsuamoon®, available through Guilin Pharmaceutical Co. Ltd.)

Artesunate plus sulfadoxine-pyrimethamine (e.g. Sulfamon plus 500, available through Cipla Ltd.
)
Artesunate plus mefloquine (e.g. ArtequinTM, available through Mepha Ltd.
)

Parasitic resistance to chloroquine and sulfadoxine-pyrimethamine monotherapies was a driver of malaria's recent resurgence throughout sub-Saharan Africa. In order to preserve ACTs as an effective treatment for malaria, the WHO recommends that drug companies not produce, and governments, donors and private organizations not purchase or administer Artemisinin monotherapies. The WHO recommends changing national treatment policy when treatment failure rates reach 10%, preferably to one of the ACTs listed above. For more detailed information, please refer to the WHO's "Guidelines for the Treatment of Malaria".

The production and distribution of substandard and counterfeit drugs, including ACTs, is a vast, increasing and largely underreported, problem. Adulterated medicines contain little or none of the active ingredients found in their branded equivalent, and often have adverse health effects. AFM has made policy recommendations based on the global threat of fake and substandard drugs and the qualitative risks associated with counterfeit medicines.

AFM published a study in PLoS ONE in May 2008 indicating 35% of antimalarial drugs sold in six major African cities are substandard. The AFM team educated millions of people and policymakers around the world on this issue by generating over 50 earned media hits in leading print, broadcast and electronic media in 17 countries on five continents, including feature stories in The New York Times, Reuters, Economist, and National Public Radio.

AFM's work on this issue has spurred immediate action. Just three weeks after this study was published, the Kenyan and Rwandan governments publicly initiated investigations into drug counterfeiters and nationwide pharmacies, citing AFM's research.

Since then, AFM has published a number of papers focusing on substandard and counterfeit drugs. These include a paper on attitudes and exposure to counterfeit drugs in Nigeria, a pilot study of essential drug quality in two major cities in India, a pilot study comparing technologies to test for substandard drugs, and an investigation into the physical and chemical stability of fixed dose combination artemether-lumefantrine. Most recently, in June 2010, AFM published a report comparing various quality assessments of antimalarial drugs in Lagos and Accra, which examined discrepancies between methods used to test for substandard drugs.

AFM held two briefings on Capital Hill on the subject of Improving Antimalarial Drug Quality in Africa. The first was a Congressional Briefing in June 2008 in collaboration with the Congressional Malaria Caucus. The second was a Senate Briefing in September 2008 hosted by the US Senate Committee on Foreign Relations. 

AFM is also helping to ensure that every African in need of a malaria treatment has access to a safe and effective one through the March of Washingtons - a broad-based campaign to buy and distribute high quality malaria drugs to people in Africa, and test for fake and substandard malaria drugs on sale in African markets. Funds from the March of Washingtons have been used to collect and test antimalarial drugs on sale in private pharmacies in Zambia. In March 2009, AFM published a report of its findings. Funds have also been used to collect and test essential drugs from pharmacies in Lagos, Nigeria as well as conduct informal surveys of doctors, pharmacists, and healthcare workers in Lagos, Ondo, and Ogun. AFM published a working paper with its findings in August 2009.

To learn how you can become involved in the March of Washingtons visit www.marchofwashingtons.org.