Business Report & Independent Online
May 24, 2009
By Simeon Bennett
Saron Samnith, 14, slouches in the doorway of his family's thatched hut off a dusty track near Pailin, a city in western Cambodia. He has chills, diarrhoea and a three-day-old headache - signs of malaria.
The bout of the mosquito-borne disease, for which he tested positive, is his second in a month. The first left him comatose and close to death, before medicines curbed the attack. Coursing through Saron's veins may be the strain so dangerous that health officials - and the billionaire Bill Gates - are racing to stop it from spreading before it kills millions.
In Pailin, a flood of counterfeit pills from China and elsewhere is helping to breed a superbug that resists even the most-effective medicine. The development threatens to unleash a global malaria "disaster" and undo decades of work to reduce illness, destitution and death, said Arjen Dondorp, a Thailand-based researcher.
"It's a time bomb," said Dondorp, the deputy director of the Wellcome Trust-Mahidol University Oxford Tropical Medicine Research Programme, with headquarters in Bangkok.
The World Health Organisation (WHO) plans to defuse the bomb with a screening and treatment programme to contain and eliminate the resistant strain in and near Pailin. The effort may begin next month. The programme is backed by $23 million (R192m) from the Bill & Melinda Gates Foundation, based in Seattle.
"There's more money put into baldness drugs than is put into malaria," Gates said in February. "Because the disease is only in the poor countries, it doesn't get much investment. You can't get the economies in these areas going, because it just holds things back so much."
The risk of failure raises what Dorndop calls a "doom scenario". In that sequence of events, migrant workers would first carry the bug to Thailand, Myanmar and India. Later, the strain would spread to Africa, which already has most of the world's malaria cases.
"We rang the warning bell in 2005 and nobody believed us," said Pascal Ringwald, the Geneva-based WHO's leading specialist in the malaria parasite's ability to resist drugs.
The doom scenario may be a decade away from materialising, giving the world time to prevent it, said Charles Delacollette, the head of WHO's Mekong Malaria Programme, which covers Cambodia, Laos, Myanmar, Thailand, Vietnam and part of China.
"We don't have many alternatives to the antimalarial drug artemisinin, to which the parasite is becoming resistant in western Cambodia, Delacollette said. "That drug should be protected."
Interpol, the international police organisation based in Lyon, France, traced counterfeit drugs in Southeast Asia to China in 2006 as part of an investigation called Operation Jupiter.
Last year, under Operation Storm, Interpol arrested 27 people in raids across Asia and seized more than 16 million fake pills valued at almost $7 million (R58.5m).
Chemical analysis of pills bought in Cambodia, Laos, Myanmar, Thailand and Vietnam found several other pharmaceutical ingredients, charcoal, and a precursor of the illicit drug ecstasy, according to an account of Operation Jupiter published in the journal Public Library of Science Medicine. Also present were spores and pollen from trees common in southern China, suggesting that at least some of the drugs were made there, the authors said.
Interpol's actions hardly dented the global market for counterfeit pharmaceuticals, which may reach $75 billion in 2010, an increase of more than 90 percent from 2005, according to estimates by the Center for Medicine in the Public Interest, a nonprofit organisation based in New York.
WHO says that fakes, typically cheaper than real drugs, may account for as much as 30 percent of all medicines in developing nations.
"We're talking about sophisticated, big syndicates, people who are very well organised," said Aline Plancon, the Interpol officer who co-ordinated the operations.
"It's just insane. They're making too much money, they're betting too much on the health of people. We will do it again and again."
Malaria strikes about 250 million people each year and kills more than 880 000, making it the world's most lethal mosquito-borne disease, according to WHO.
The malady is caused by a microscopic parasite called Plasmodium, which is carried in the saliva of female mosquitoes. When an infected insect bites a person, the parasites multiply in the liver before entering the bloodstream.
There they invade red cells, causing fever, chills, nausea and diarrhoea. Unchecked, the bugs cause red cells to stick to the walls of capillaries, slowing blood flow. Without treatment, sufferers can die from organ failure.
While Cambodia accounts for only about 0.4 percent of the world's malaria cases, the country is a breeding ground for strains that withstand medicines. Since the 1970s, at least three once-potent malaria drugs have failed in western Cambodia before becoming useless elsewhere in the world, according to WHO: first chloroquine and Roche Holding AG's Fansidar, then mefloquine.
Now Dondorp and other researchers say the same thing is happening to artemisinin. In a study carried out last year and yet to be published, artesunate failed to clear malaria parasites within two days from the blood of about 70 percent of patients in Pailin compared with 7 percent in western Thailand.
For now, the drugs still clear the parasites, only more slowly - a sign resistance to artemisinin-based treatments is building. While Novartis AG, GlaxoSmithKlinePLC, Genzyme Corp and Ranbaxy Laboratories Ltd are developing new drugs and vaccines against malaria, those products are in the early stages of development and won't be available for years.
"If we lose the artemisinins at this stage, just now when we dare to mention the word 'eradication' again, it would be a disaster for malaria control," said Dondorp, who led the study. "It would cause millions of deaths, without exaggeration."
Fake pharmaceuticals abound in Pailin, but a bigger contributor to drug resistance than counterfeiters is patients who don't take medicines properly, according to WHO scientists.
Saron's mother, Bot Yom, has lost faith in Western pharmaceuticals. She plans to rub a coin against her son's skin until it becomes red. If the disease renders artemisinin-based drugs as useless as their predecessors, the folk remedy might be just as effective.
By Simeon Bennett
Saron Samnith, 14, slouches in the doorway of his family's thatched hut off a dusty track near Pailin, a city in western Cambodia. He has chills, diarrhoea and a three-day-old headache - signs of malaria.
The bout of the mosquito-borne disease, for which he tested positive, is his second in a month. The first left him comatose and close to death, before medicines curbed the attack. Coursing through Saron's veins may be the strain so dangerous that health officials - and the billionaire Bill Gates - are racing to stop it from spreading before it kills millions.
In Pailin, a flood of counterfeit pills from China and elsewhere is helping to breed a superbug that resists even the most-effective medicine. The development threatens to unleash a global malaria "disaster" and undo decades of work to reduce illness, destitution and death, said Arjen Dondorp, a Thailand-based researcher.
"It's a time bomb," said Dondorp, the deputy director of the Wellcome Trust-Mahidol University Oxford Tropical Medicine Research Programme, with headquarters in Bangkok.
The World Health Organisation (WHO) plans to defuse the bomb with a screening and treatment programme to contain and eliminate the resistant strain in and near Pailin. The effort may begin next month. The programme is backed by $23 million (R192m) from the Bill & Melinda Gates Foundation, based in Seattle.
"There's more money put into baldness drugs than is put into malaria," Gates said in February. "Because the disease is only in the poor countries, it doesn't get much investment. You can't get the economies in these areas going, because it just holds things back so much."
The risk of failure raises what Dorndop calls a "doom scenario". In that sequence of events, migrant workers would first carry the bug to Thailand, Myanmar and India. Later, the strain would spread to Africa, which already has most of the world's malaria cases.
"We rang the warning bell in 2005 and nobody believed us," said Pascal Ringwald, the Geneva-based WHO's leading specialist in the malaria parasite's ability to resist drugs.
The doom scenario may be a decade away from materialising, giving the world time to prevent it, said Charles Delacollette, the head of WHO's Mekong Malaria Programme, which covers Cambodia, Laos, Myanmar, Thailand, Vietnam and part of China.
"We don't have many alternatives to the antimalarial drug artemisinin, to which the parasite is becoming resistant in western Cambodia, Delacollette said. "That drug should be protected."
Interpol, the international police organisation based in Lyon, France, traced counterfeit drugs in Southeast Asia to China in 2006 as part of an investigation called Operation Jupiter.
Last year, under Operation Storm, Interpol arrested 27 people in raids across Asia and seized more than 16 million fake pills valued at almost $7 million (R58.5m).
Chemical analysis of pills bought in Cambodia, Laos, Myanmar, Thailand and Vietnam found several other pharmaceutical ingredients, charcoal, and a precursor of the illicit drug ecstasy, according to an account of Operation Jupiter published in the journal Public Library of Science Medicine. Also present were spores and pollen from trees common in southern China, suggesting that at least some of the drugs were made there, the authors said.
Interpol's actions hardly dented the global market for counterfeit pharmaceuticals, which may reach $75 billion in 2010, an increase of more than 90 percent from 2005, according to estimates by the Center for Medicine in the Public Interest, a nonprofit organisation based in New York.
WHO says that fakes, typically cheaper than real drugs, may account for as much as 30 percent of all medicines in developing nations.
"We're talking about sophisticated, big syndicates, people who are very well organised," said Aline Plancon, the Interpol officer who co-ordinated the operations.
"It's just insane. They're making too much money, they're betting too much on the health of people. We will do it again and again."
Malaria strikes about 250 million people each year and kills more than 880 000, making it the world's most lethal mosquito-borne disease, according to WHO.
The malady is caused by a microscopic parasite called Plasmodium, which is carried in the saliva of female mosquitoes. When an infected insect bites a person, the parasites multiply in the liver before entering the bloodstream.
There they invade red cells, causing fever, chills, nausea and diarrhoea. Unchecked, the bugs cause red cells to stick to the walls of capillaries, slowing blood flow. Without treatment, sufferers can die from organ failure.
While Cambodia accounts for only about 0.4 percent of the world's malaria cases, the country is a breeding ground for strains that withstand medicines. Since the 1970s, at least three once-potent malaria drugs have failed in western Cambodia before becoming useless elsewhere in the world, according to WHO: first chloroquine and Roche Holding AG's Fansidar, then mefloquine.
Now Dondorp and other researchers say the same thing is happening to artemisinin. In a study carried out last year and yet to be published, artesunate failed to clear malaria parasites within two days from the blood of about 70 percent of patients in Pailin compared with 7 percent in western Thailand.
For now, the drugs still clear the parasites, only more slowly - a sign resistance to artemisinin-based treatments is building. While Novartis AG, GlaxoSmithKlinePLC, Genzyme Corp and Ranbaxy Laboratories Ltd are developing new drugs and vaccines against malaria, those products are in the early stages of development and won't be available for years.
"If we lose the artemisinins at this stage, just now when we dare to mention the word 'eradication' again, it would be a disaster for malaria control," said Dondorp, who led the study. "It would cause millions of deaths, without exaggeration."
Fake pharmaceuticals abound in Pailin, but a bigger contributor to drug resistance than counterfeiters is patients who don't take medicines properly, according to WHO scientists.
Saron's mother, Bot Yom, has lost faith in Western pharmaceuticals. She plans to rub a coin against her son's skin until it becomes red. If the disease renders artemisinin-based drugs as useless as their predecessors, the folk remedy might be just as effective.
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