Executive Summary

ACT Now. This is an urgent call to international donors to join African countries in implementing World Health Organization (WHO) treatment guidelines for malaria. On the advice of international experts, WHO recommends African countries facing resistance to classical antimalarials to introduce drug combinations containing artemisinin derivatives – artemisinin-based combination therapy, or ACT for short.

Artemisinin derivatives have attributes that make them especially effective: they are highly potent, fast-acting (parasite clearance is fast and people recover quickly), very well tolerated and complementary to other classes of treatment.

Implementation of new malaria recommendations is a matter of life and death in Africa, where malaria kills between 1 and 2 million people each year. Sickness and death from malaria account for 30-50% of hospital admissions and a yearly loss of US$12 billion on the African continent.

The WHO-led global malaria eradication programme launched in the 1950s sought to eliminate the disease via vector control and effective treatment. The eradication programme was successful in some parts of Asia, North America and Europe, but bypassed sub-Saharan Africa. In 1969, the focus switched to the less ambitious goal of control through treatment. At the time, the treatment of choice was chloroquine, dispensed in a three-day course. This effective treatment campaign led to falling death rates through to the early 1980s.

However, since the early eighties, the situation has stopped improving, and has in fact been getting dramatically worse. Average annual cases were four times higher between 1982 and 1997 compared to the period 1962-1981. Death rates have also jumped: hospital studies in various African countries have documented a two- to three-fold increase in malaria deaths. The continuing use of ineffective drugs despite spectacular levels of resistance is leading to increased treatment failure.

While African countries are heeding the advice of world experts to switch from old failing single-drug treatments to combination treatments, they are being forced to switch to stop-gap, less expensive combinations because of a lack of resources.