Letter to Roll Back Malaria regarding guidelines for 2004-08 (New: RBM response)

On 3 December, MSF received a response to its letter (see below) to Roll Back Malaria (RBM) which raised a number of questions about the new draft RBM guidelines for 2004-2008, in particular what appeared to be a change in policy with regards to the use of artemisinin-based combination therapy (ACT) to treat malaria.

MSF is pleased to note that RBM remains fully committed to the common objective of ensuring rapid access to ACTs and maintaining the important balance between prevention and treatment strategies. We look forward to receiving a new version of the guidelines which reflects these commitments.

Dr Fatoumata Nafo-Traoré
Executive Secretary
Roll Back Malaria Partnership

cc: Dr Yves Bergevin
Roll Back Malaria Secretariat

28 November 2003

Dear Dr Nafo-Traoré,

As experts and health workers committed to improve health care in the developing world, we are extremely concerned and alarmed by the newly released draft Roll Back Malaria (RBM) guidelines for 2004-08, which represent a major backward step in malaria control.

Malaria is killing up to 2 million people every year, most of whom are children in Africa. Despite best efforts to date, global control of this lethal disease has failed, and infection and death rates are rising.

Effective malaria control requires effective prevention and treatment programmes. While the international community is putting significant efforts to improve prevention measures, treatment is becoming increasingly difficult because of loss of inexpensive drugs (chloroquine and sulfadoxine-pyrimethamine [SP]) to resistance. These drugs simply do not work now in much of the malaria affected world.

In 2001 the World Health Organization (WHO) took the lead in acknowledging the need to bring effective treatments to those affected by epidemics of this devastating disease, advocating the use of artemisinin-based combination therapy (ACT). It was also recommended that any country changing national antimalarial drug policy should change to ACTs. It is well established that ACTs are the most rapidly and reliably effective antimalarial drugs. Increased use of ACTs has led to a fall in drug prices; today it cost less than $US 1 to save the life of a child with malaria using these drugs.

However, chloroquine and SP continue to be provided by donors and still recommended in many African countries, leading to avoidable death and wasted resources. These ineffective drugs are often the only available antimalarials. There is an urgent and pressing need to increase the availability of ACTs to replace these failing drugs.

The new RBM strategy sacrifices life-saving treatment to narrow cost-effectiveness considerations, and chooses instead to focus mainly on prevention of malaria. Emphasizing prevention alone for such a common killing disease will certainly not “roll back malaria”. It is widely accepted in the field of HIV/AIDS that there are medical, macro-economic, social, moral, and ethical imperatives to provide life-extending treatment to the 6 million people who are in need. Why is malaria, which is so much easier to treat, any different?

RBM’s guidelines set to reverse more than 5 years of consultation and expert opinion in the field of global control of malaria. We believe that “Rolling Back Malaria” is possible with effective vector control and effective treatment, and that it is not the time to abandon this important initiative. We call on the WHO for an urgent and complete rethinking of the RBM 2004-08 strategy based on a comprehensive review of available evidence and genuine expert field experience. If RBM is truly committed to reducing the number of deaths from malaria as soon as possible, it should strive to provide technical support to assist countries to implement effective diagnostic tools and widespread ACT use now, and push for increased donor money to support this.

Sincerely,

Dr Abdullah Ali
Malaria Programme Manager
Zanzibar

Dr Fred Binka
School of Public Health, University of Ghana
Ghana

Prof. Philippe Brasseur,
Institut de Recherche pour le Développement
Senegal

Professor Oumar Gaye,
Coordinator of the RAOTAP1/WAMTN
West African antimalarial treatment network
Senegal

Dr F. K. Kato,
Senior Medical Officer,
Malaria Control Programme, Ministry of Health – Kampala
Uganda.

Dr T.K. Mutabingwa
Chairman of EANMAT
Tanzania

Prof. Robert Snow
Head Malaria Public Health Group
KEMRI/Wellcome Trust Collaborative Program
Kenya

Dr François Nosten
Director
SMRU Shoklo Malaria Research Unit
Thailand

Prof. Nick White
Wellcome Trust Mahidol University Oxford Tropical Medicine Research
Programme
Faculty of Tropical Medicine - Mahidol University, Bangkok
Thailand

Prof. Barry R. Bloom, PhD
Dean, Harvard School of Public Health
Professor of Immunology and Infectious Diseases
Harvard University
USA

Prof. Carol Hopkins Sibley,
Professor of Genome Sciences
University of Washington- Seattle
USA

Allan Rosenfield, MD
Dean, Mailman School of Public Health
DeLamar Professor of Public Health
Columbia University
USA

Ron Waldman, MD, MPH
Center for Global Health and Economic Development
Mailman School of Public Health
Columbia University
USA

Prof. Dyann Wirth, Ph.D.
Professor, Infectious Diseases, Department of Immunology and Infectious Diseases
Harvard University School of Publich Health
Director, Harvard Malaria Initiative
Harvard University
USA

Prof. Dr Marleen Boelaert
Public Health Department
Prince Léopold Tropical Medicine Institute - Antwerpen
Belgium

Docteur Paolo Chiodini
Responsable des projets
CUAMM
Italy

Prof. Umberto D’Alessandro
Head Epidemiology Unit, Dept Parasitology
Institute Tropical Medicine - Antwerp,
Belgium

Pr Martin Danis
Parasitology, University Hospital Pitié-Salpêtrière,
Pierre et Marie Curie-Paris 6 University
France

Dr Cristiana De Lorenzi
Alisei
Italy

Dr Pierre Druilhe
Head of the BioMedical parasitology Unit
Institut Pasteur
France

Suzanne Fustukian
Lecturer, Centre for International Health Studies
Queen Margaret University College – Edinburgh
United Kingdom

Prof. Massimo Galli
Director of the Infectious Diseases Institute
University of Milan
Italy

Dr Philippe J Guerin
Scientific Director
Epicentre - Paris
France

Dr Christa Hook
Malaria expert,
Médecins Sans Frontières
United Kingdom

Prof. Giuseppe Ippolito
Scientific Director of the National Institute of Infectious Diseases
Lazzaro Spallanzani, Rome
Italy

Dr Jean-Marie Kindermans
Malaria Access Campaign
Médecins Sans Frontières
Belgium

Dr Marina Madeo
Health Department coordinator
ONG COOPI
Italy

Prof. Mauro Moroni
Coordinator Infectious diseases department
L. Sacco Hospital, Milan
Italy

Dr Bernard Pécoul
Director Access to medicines campaign
Médecins Sans Frontières
Switzerland

Dr W. M. Watkins
Wellcome Trust Fellow,
Department of Pharmacology & Therapeutics, University of Liverpool
United Kingdom

Prof. Nick Anstey
Head, International Health Program
Menzies School of Health Research,
Darwin, Australia

Dr Dave Durrheim, MPH&TM, DrPH
Associate Professor James Cook University
Head of School of Public Health and Tropical Medicine
and Director of the Anton Breinl Centre of Public Health and Tropical Medicine
Australia

Dr Ric Price
Senior Researcher - Menzies School of Health Research,
Darwin,
Australia

Since the letter was sent to Roll Back Malaria on 28 November, the following additional signatures were received:

Dr A.Talisuna, Ministry of Health
Member of the EANMAT secretariat
Uganda

Dr Karen I Barnes
University of Cape Town Division of Pharmacology.
South Africa

Arjen M Dondorp, MD, PhD
Deputy Director Wellcome Trust Unit Bangkok
Wellcome-Mahidol University-Oxford
Tropical Medicine Research Programme
Faculty of Tropical Medicine - Bangkok
Thailand

Dr Francis N Muu
MBChB, MMed (Paed), MSc (Community Health)
National Health Coordinator
World Vision Kenya
Nairobi, Kenya

Prof. Sornchai Looareesuwan
Dean of Mahidol University, Bangkok
Thailand

Peter O. McOdida
Country Representative
International Medical Corps - Nairobi
Kenya