Photo by mst7022, Flickr ■ Paul Wallis
About half the world’s population is exposed to endemic malaria. The ancient disease, which was the plague of early civilizations, kills a million people a year, even today. Now, it’s showing resistance to the artemesinin class of drugs in Cambodia.
The suspected increased resistance (see Bob Ewing’s DJ article on this subject) has now been confirmed by international studies. The story of is much the same as that of increased resistance to anti biotics. Use of the drugs in Cambodia isn’t well controlled, and misuse of the drugs seems to be taking the same path as many other diseases.
There are a lot of ramifications in the development of a new form of resistant malaria. In terms of global health, it’s much like a new war, in the numbers of lives lost. Malaria is one of the most widespread global diseases, and the resistant forms have been known to spread rapidly, particularly in other impoverished areas. Asian strains of resistant malaria have previously spread rapidly in Africa.
The problem remains the Plasmodium parasite. Its extraordinary life cycle makes it hard to fight across all stages, and even massive extermination during the postwar years simply slowed it down. Add to this the difficulty of controlling the 60 species of Anopheles mosquito able to transmit malaria, and Plasmodium is the classic hard case of epidemiology. It's one of the hardest targets in medicine. Generations of work have gone into developing treatments, and this situation adds levels of difficulty nobody needs, and no poor countries can afford.
The World Health Organization has previously warned of serious ramifications to drug resistant malaria as far back as 2001, and has continued to express deep concern about the potentials of the drug resistant strains to spread globally.
This dramatic increase in resistance has happened before, with disastrous consequences. According to the WHO, referring to a previous form of anti malarial drugs:
Resistance of Plasmodium falciparum to choloroquine, the cheapest and the most used drug is spreading in almost all the endemic countries. Resistance to the combination of sulfadoxine-pyrimethamine which was already present in South America and in South-East Asia is now emerging in East Africa.
There’s been further complications caused by fake drugs sold in poor countries like Cambodia, which contain enough drugs to pass tests, but not enough to work effectively as treatment. This is roughly the equivalent of inoculating the disease against the cure, and killing a few people on the side for ambiance.
(The fake drugs are said to be sold by criminal gangs. An interesting form of mass murder of thousands of people, if so. No doubt the traditional totally ineffective international law enforcement response will take care of the cosmetic elements, and charge them with the medical equivalent of jaywalking.)
The BBC says that the WHO actually told the drug producers of the current malaria drugs to stop selling the artemesinin drugs on their own, specifically to avoid this scenario.
The routine lack of cooperation from the drug companies is another problem. Medical professionals and organizations routinely cooperate internationally, even dealing with individual cases of infection. Nations usually cooperate and enforce their own regulations. But there are no effective global governing laws or coherent mechanisms to deal with the many cases of global spreads of diseases. The WHO doesn’t have the authority to demand enforcement of its policies. An enchanting international ad hoccery, as usual, pervades international law, and the pharmaceutical companies have exploited it. They can't be compelled to comply with WHO.
From the look of the malaria situation, the drug companies haven’t even noticed there’s a problem. For the sake of a few bucks extra on sales, millions of people could be put at risk. Even media terminology hasn’t quite found a name for this process, where health risks are monetized and sold to the world’s poor.
I can only think of one, off the cuff: Free Market Genocide. Catchy, isn’t it?
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