The Shell Technology for Development Award
Short-listed: Glaxo Wellcome plc
Glaxo Wellcome is offering to the health services in Africa and elsewhere up to a million courses a year of free treatment with a new drug combination, Malarone, which cures malaria. In pilot projects at three district hospitals in Kenya and Uganda where malaria parasites commonly resist the standard treatment, chloroquine, the first 100 treatments with Malarone have been administered.
Up to 300 million people a year contract malaria and a million or more, mostly children in Africa, die. Millions are too sick to plant and harvest their crops. The bite of infected mosquitoes injects malaria parasites into the bloodstream where they multiply causing a high and disabling fever. Many Africans are reckoned to receive over 300 infective bites a year. Malaria parasites are adept at developing resistance to the drugs used against them; while the high cost of researching new drugs and the small rewards for selling them in poor countries mean that Malarone is the first remedy wholly developed by industry for 40 years.
It took a long while, nevertheless, to persuade Kenya to take up the offer of free Malarone. Some health officials were suspicious of the motives behind a free offer of an inherently expensive remedy. They wondered whether, having started to use it, they would find their cash-strapped government having to pay heavily for it. "I would never have believed it could be so difficult to give something away," says Andrew Bulloch, managing director of Glaxo Wellcome Kenya.
Malarone was developed at Wellcome's Beckenham laboratories before the merger with Glaxo Wellcome had produced a cure for East Coast Fever, a malaria-like disease in cattle. It studied related compounds for their impact on malaria and settled on one, atovaquone, which hinders the proliferation of malaria parasites in the bloodstream. Atovaquone on its own was not sufficiently effective. But Wellcome discovered that, when mixed with proguanil (well known to travellers as Paludrine) which has a different mode of action, it was effective in 98 per cent of cases and had few side effects. Wellcome called the mixture Malarone.
However, atovaquone is difficult to synthesise. A bright, yellow, sticky compound, it also contaminates equipment, so that this cannot be used for other products. As a result, Malarone is expensive by anti-malaria standards, costing £24 a treatment in Britain, far too much for African countries. Hence Glaxo Wellcome's decision to give away up to a million treatments a year for those most in need.
Glaxo Wellcome chose an American agency, the Task Force for Child Survival and Development, to administer the Malarone programme. The agency appointed a group of international malaria experts to decide how the Malarone given by Glaxo should be used. They decided that, at least to begin with, it should be held in reserve, for when other remedies failed. This approach, they believed, would meet a medical need and lengthen the time before parasitic resistance to Malarone became a problem. Olukayode Oyediran, former vice-chancellor of Ibadan University, who is the director of the Malarone programme, says: "One hopes and prays that we'll have Malarone with us as an effective drug for a very long time."
In Kenya, the standard treatment for malaria is at present a mixture of sulphadoxine and pyrimethamine also known as SP or Fansidar. In Uganda, the first treatment is still chloroquine followed by SP. The experts laid down rules for Malarone's use when these treatments failed. Doctor's would need to be sure, by looking at a blood sample under a microscope, that patients do indeed have malaria. They would also need to be sure that patients had taken SP unsuccessfully and that, once prescribed Malarone, they took the three-day course. This means that, for Malarone treatment, patients have to reach a hospital.
Essentially Malarone is currently being used to help people get clear of malaria and return to their normal activities. It has the potential to be a lifesaver, when it is approved for treating small children. Malarial infection threatens their lives because they lack even partial immunity. Glaxo Wellcome is pressing on with tests to demonstrate Malarone's safety for treating malaria in children weighing under 11 kilograms.
For travellers to malarious areas, Malarone may offer the answer to a dilemma. At present they can take Lariam (mefloquine) and protect themselves from malaria, at some risk of serious side effects. Or they can take Chloroquine and Paludrine but risk contracting malaria if bitten by a mosquito infected with resistant parasites.
Malarone is approved for use by Danish travellers but not yet by Britons, pending completion of clinical testing. However, British doctors can prescribe it if they feel it is in the patient's best interest. Donated Malarone will not be used for travellers visiting malarious areas.