Every year, from 2000 until 2015, the global health community celebrated its success in reducing the number of cases of malaria – even hailing it as one of the greatest global health success stories. But progress in eliminating malaria has slowed since 2016. Why? The burden of falsified antimalarials Insufficient funding for research into malaria, conflict and crisis, climate change, local infrastructural challenges and a rise in resistance to antimalarial drugs and insecticides have been identified as key factors behind the decrease in the rate of progress in fighting malaria. However, one factor is crucially missing from this analysis: the growing prevalence of falsified antimalarials. Although the latest World Malaria Report does not directly address the role falsified antimalarials have played in the reversal of progress, the World Health Organisation (WHO) acknowledges that antimalarials are “amongst the most commonly reported substandard and falsified medical products”, and recognises their contribution to the growth of antimicrobial resistance. Malaria places the heaviest burden on eleven countries, ten of which are in sub-Saharan Africa accounting for more than 70% of global malaria cases and deaths. This region also reported the highest incidence of falsified and substandard medicines, and among the most commonly identified of these are antimalarials. Estimates suggest that up to 60% of antimalarials circulating in sub-Saharan African countries could be fake and may contribute to over 116,000 deaths annually in the region alone. Another major threat to effective malaria control is antimicrobial resistance which has been declared one of the 10 global health threats in 2019 by the WHO. Falsified and poor-quality medicines significantly contribute to the development of drug resistance. It is well known that resistance to one of the most efficient and commonly used component drugs for malaria treatment, artemisinin, first appeared in a part of the world (Greater Mekong Subregion) where between 38 and 90% of the eponymous medicines on the market were either substandard or falsified. In recent years, drug resistance to artemisinin has been spreading widely across South East Asia, particularly Thailand, Vietnam, Cambodia and Myanmar. The threat to Africa If resistance to artemisinin combination therapies emerges in African countries with the highest incidence of malaria, the consequences could be devastating. To counteract this growing antimalarial drug resistance and ultimately reduce the global malaria burden, continued research and development of next-generation antimalarials must be supported and their availability and accessibility secured. Otherwise, failing treatment due to falsified antimalarials and drug resistance will not only threaten people’s well-being but also increase economic constraints on families and health systems – it is estimated that further required treatment and care could add costs as high as US$ 38.5 million to patients and health providers. As highlighted by Dr Tedros Adhanom Ghebreyesus, Director General of the WHO: ‘Nobody should die from malaria, a disease that is preventable and treatable. But progress has stalled. We need a more efficient, effective and equitable response to end malaria’. On World Malaria Day this year, the global movement to fight malaria must be strengthened, with renewed efforts to contribute to this response by combatting the spread of falsified antimalarials globally, and especially across sub-Saharan Africa. Malaria often hits the most impoverished communities that, in turn, often fall victim to falsified medicines as they are unable to afford high-quality medicines. By stopping the spread of these dangerous fake medicines and ensuring access to quality, effective treatment, we can protect the vulnerable and under-served populations at risk of malaria. Defeating malaria together Reversing the setback of recent years and re-accelerating progress towards malaria elimination requires the multi-stakeholder collaboration of industry, academia, governments and communities. In addition, the global health community must prioritise this growing problem of falsified antimalarials. Medicines for Malaria Venture (MMV) is proud to partner with Fight the Fakes – a global campaign that raises awareness about the dangers of falsified medicines to patient safety and public health. Since its foundation in 1999, MMV and its public and private partners have introduced 10 new antimalarials and taken on the stewardship of two others. While MMV’s mission is to reduce the burden of malaria in disease-endemic countries by discovering, developing and delivering new, effective and affordable antimalarial drugs, it fully supports the crucial need to educate the public about the existence and subsequent dangers of falsified antimalarials. Malaria continues to kill one child every two minutes, claiming more than 700 young lives every day. Over 430,000 people died of the disease in 2017. It is clear that malaria elimination remains one of the most demanding health challenges to date and only combined efforts ranging from raising awareness of falsified antimalarials, through increased prevention efforts, to the development of new, effective and affordable antimalarial drugs will bring us closer to that goal. The writer is Executive Vice President for Access and Product Management for Medicines for Malaria Venture The views expressed in this article are of the author.
