Poor-quality antimalarial drugs threaten to jeopardize progress made in malaria control over past decade

May 21, 2012

Poor-quality and fake antimalarial drugs are leading to drug resistance and inadequate treatment that is endangering global efforts made to control and eliminate malaria over the past 10 years, according to a review of the evidence published in The Lancet Infectious Diseases. In particular, the emergence of resistance to artemisinin drugs, currently the most effective treatment against malaria, on the Thailand-Cambodia border should be a wake up call, warn the authors.

Findings from the Review indicate that around 36% of antimalarial drugs analysed in southeast Asia were fake*, while a third of samples in sub-Saharan Africa failed chemical testing for containing too much or too little of the , potentially encouraging .

"3.3 billion people are at risk of malaria, which is endemic in 106 countries. Between 655 000 and 1.2 million people die every year from Plasmodium falciparum infection. Much of this morbidity and mortality could be avoided if drugs available to patients were efficacious, high quality, and used correctly", explains Gaurvika Nayyar from the Fogarty International Center at the National Institutes of Health (NIH) in the USA, who led the research.

Nayyar and colleagues from the NIH analysed data from published and unpublished studies that looked at chemical analyses and the packaging of antimalarial drugs in sub-Saharan Africa and southeast Asia, where the risk of contracting and dying from malaria is greatest.

Data from seven countries in southeast Asia including analysis of 1437 samples of seven , showed that over a third failed chemical testing, nearly half were incorrectly packaged, and about a third were fake.

Further analysis of data from 21 countries in sub-Saharan Africa including over 2500 showed similar results, with over a third failing chemical analysis and a fifth found to be fake.

Worryingly, say Nayyar and colleagues, this might only be the tip of the iceberg: "Despite a dramatic rise in reports of poor-quality antimalarial drugs over the past decade, the issue is much greater than it seems because most cases are probably unreported, reported to the wrong agencies, or kept confidential by pharmaceutical companies."

Worse still they say: "No reliable global estimates are available about the frequency of poor-quality antimalarial drugs because of no internationally accepted definitions of different types of poor-quality drugs; no globally standardised or statistically robust sampling schemes, testing protocols, and requirements for drug content; a dearth of funds; and no recognised international forum to provide technical and scientific guidance and oversight."

They conclude that several parallel interventions are needed to define and eliminate criminal production, distribution, and poor manufacturing. Their recommendations include increased investment in medicine regulatory authorities in Africa to encourage country ownership of the problem, adding that: "Currently, only three of the 47 malarious countries in Africa have laboratories that are equipped to chemically analyse ."

In a linked Comment, Michael Seear from British Columbia Children's Hospital, Vancouver, Canada calls for more research to clarify the extent and cause of poor drug quality: "Drug quality is dependent on the overlapping effects of poor manufacturing standards, criminal counterfeiting, adulteration with inactive or toxic fillers, relabeling of time-expired drugs, and degradation during storage. Reliable research concerning counterfeiting is limited, and almost no information is available about the other four factors."

Moreover, he notes, the international response to the problem has been poor: "Construction of a balance between protection of intellectual property and the maintenance of drug quality has plagued the relation between WHO and the International Medical Products Anti-Counterfeiting Taskforce (IMPACT)…Hopefully, public health will be given more priority than are intellectual property rights and WHO will develop a clearly defined and widely accepted mandate in this area."

Explore further: Fake malaria drugs a growing problem: experts

More information: Study online: www.thelancet.com/journals/lan … (12)70064-6/abstract

Related Stories

Fake malaria drugs a growing problem: experts

December 5, 2011
Fake or poor quality malaria drugs are boosting resistance in parts of southeast Asia, a problem that is likely to worsen unless tighter regulations are adopted, US experts said Monday.

Fake malaria drugs threaten crisis in Africa

January 17, 2012
(Medical Xpress) -- The emergence of fake and poor quality anti-malarial drugs could dash hopes of controlling malaria in Africa, warn experts writing in the Malaria Journal. Millions of lives could be put at risk unless ...

Study finds early signs of malaria drug resistance in Africa

April 27, 2012
Africa's deadliest malaria parasite has shown resistance in lab tests to one of the most powerful drugs on the market -- a warning of possible resistance to follow in patients, scientists said Friday.

Comparing antimalarial drugs and their effects over the Plasmodium lifecycle

February 21, 2012
In this week's PLoS Medicine, Michael Delves of Imperial College London, UK and colleagues compare the activity of 50 current and experimental antimalarials against liver, sexual blood, and mosquito stages of selected human ...

Recommended for you

Researchers report new system to study chronic hepatitis B

July 25, 2017
Scientists from Princeton University's Department of Molecular Biology have successfully tested a cell-culture system that will allow researchers to perform laboratory-based studies of long-term hepatitis B virus (HBV) infections. ...

Research examines lung cell turnover as risk factor and target for treatment of influenza pneumonia

July 24, 2017
Influenza is a recurring global health threat that, according to the World Health Organization, is responsible for as many as 500,000 deaths every year, most due to influenza pneumonia, or viral pneumonia. Infection with ...

Scientists propose novel therapy to lessen risk of obesity-linked disease

July 24, 2017
With obesity related illnesses a global pandemic, researchers propose in the Journal of Clinical Investigation using a blood thinner to target molecular drivers of chronic metabolic inflammation in people eating high-fat ...

Raccoon roundworm—a hidden human parasite?

July 24, 2017
The raccoon that topples your trashcan and pillages your garden may leave more than just a mess. More likely than not, it also contaminates your yard with parasites—most notably, raccoon roundworms (Baylisascaris procyonis).

Google searches can be used to track dengue in underdeveloped countries

July 20, 2017
An analytical tool that combines Google search data with government-provided clinical data can quickly and accurately track dengue fever in less-developed countries, according to new research published in PLOS Computational ...

MRSA emerged years before methicillin was even discovered

July 19, 2017
Methicillin resistant Staphylococcus aureus (MRSA) emerged long before the introduction of the antibiotic methicillin into clinical practice, according to a study published in the open access journal Genome Biology. It was ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.