Your Special Report (July 25, p 277) provides a timely and balanced account of ongoing efforts to contain the spread of artemisinin-resistant falciparum malaria on the Thai-Cambodian border.One of the most urgent and challenging priorities is to replace the use of artemisinin monotherapy in Cambodia with a fixed-dose combina-tion such as artesunate-mefloquine or dihydroartemisinin-piperaquine. Dihydroartemisinin-piperaquine is safe and effective in Cambodia and elsewhere. However, there is still no quality-approved product on WHO's list of prequalified drugs, making it almost impossible to procure with donor funds.The continued availability of artemisinins as separate tablets threatens the entire class of combination drugs. Why does this happen? Partly because of skewed incentives in the pharmaceutical industry, and partly through bureaucracy. Many manufacturers of new combination therapies are small-scale industries and lack the resources to clear the final hurdles of stringent international drug regulatory requirements. And why should they, when they can market their products in the thriving and often poorly regulated private sector in malaria-endemic countries? They will need extra incentives if they are to meet the necessarily exacting quality, safety, and efficacy standards required for WHO approval.
展开▼
