Last month marked the annual release of the World Malaria Report, a yearly pulse check on global progress to end malaria, one of the world’s deadliest infectious killers. Malaria cases and deaths have been cut by more than half since 2010, as a result of new tools, widespread political will, and targeted investments. But in recent years, the news has been less positive. The newly released report shows that while the number of malaria-related deaths was slightly down, cases increased slightly for the second year in a row.
The latest data from the World Health Organization shows progress against the disease has stalled.
In response to this news, the World Health Organization and Roll Back Malaria released an action plan targeting 11 high-burden countries, which contain more than 70 percent of cases and deaths. This plan has good recommendations that will help the response.
But both the World Malaria Report and the action plan miss a crucial part of the puzzle, one that’s hiding in plain sight. To combat malaria, we must ensure that the medicines used to treat the disease actually work. And far more often than you might think, that’s not the case.
“No patient or family should have to expend money, effort, or hope on medicines that are ineffective or dangerous.”—
WHO estimates that 1 in 10 medicines in low- and middle-income countries are substandard or falsified. At best, these drugs simply fail to work, promising to help a patient while delivering nothing; at worst, they can further sicken or kill. Every year, governments waste an estimated $30 billion delivering drugs that fail — money that could be spent in a hundred better ways to save lives.
Alongside antibiotics, anti-malarials are among the most commonly reported to WHO for quality issues. While existing data can only paint a partial picture, by some estimates, about a third of all anti-malarial medicines in sub-Saharan Africa are poor-quality; by others, the numbers are as high as 60 percent.
It’s hard to wrap your head around the enormity of this problem. We all deserve medicines we can trust. No patient or family should have to expend money, effort, or hope on medicines that are ineffective or dangerous.
Simply put: We will not be able to end malaria if 1 out of 3 malaria medications are not doing their job.
Failing to control the spread of poor-quality treatments also undermines hard-fought anti-malaria efforts in broader, more insidious ways.
When malaria medicines don’t work, patients can lose faith in malaria programs or the health system as a whole. It’s easy to see why: Imagine carefully taking your malaria medicine as instructed, only to stay sick or get sicker. If this happened even once, let alone on a routine basis, you might avoid or delay seeking care the next time you get sick. From a public health perspective, this decision is likely to harm people’s health in the long run, facilitate the spread of disease and undermine hard-earned progress.
Administering a partial dose of medicine can also fuel drug resistance, one of the greatest threats to malaria elimination today. Resistance to artemisinin, the most commonly used malaria treatment, was first detected in the Mekong River valley nearly a decade ago, when up to 90 percent of the artemisinin medicines on the market were substandard or falsified.
Thankfully, the challenge of poor-quality medicines is fixable — and Ghana offers cause for hope.
Ten years ago, nearly a third of antimalarials circulating in Ghana were substandard or falsified.
Alarmed, the government recognized the need to better prevent, detect, and respond to poor-quality medicines. In partnership with the U.S. Agency for International Development-funded, USP-implemented Promoting the Quality of Medicines program, Ghana invested in training staff and strengthening regulatory systems. Last year, just 1.4 percent of anti-malarials in Ghana were poor-quality.
To sustain progress and succeed against malaria, we need to apply some of the lessons from Ghana and elsewhere.
To start, we need to shine a brighter spotlight on this problem. By collecting better data and increasing information-sharing within and across countries, we can catch poor-quality medicines faster, deploy resources more efficiently and prevent these drugs from spreading through the market.
Additionally, as part of efforts to strengthen health systems in every country, governments must keep quality top of mind when buying and obtaining medicines for distribution. Once medicines are in hand, leaders must strengthen regulatory systems to protect quality at every step of a medicine’s life span: from manufacturing to delivery and beyond.
Finally, we need to ensure that physicians, pharmacists, and health workers have the training and tools they need to detect poor-quality medicines before they ever reach our patients’ hands.
Done right — as Ghana’s leadership shows — these efforts can produce dramatic results.
Today, we have the life-saving medicines to put an end to malaria for good. By protecting medicines quality, we can carry this promise forward not just for malaria, but for all diseases whose progress is threatened by poor-quality medicines and systems that don’t reach patients with the care they deserve.
Update, Dec. 13, 2018: This article has been updated to clarify that Ghana partnered with the Promoting the Quality of Medicines program, which is funded by USAID and implemented by USP.