The Coming Plague (132 page)

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Authors: Laurie Garrett

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130
P. Lepage, J. Bogarts, C. Van Goethem, et al., “Community-Acquired Bacteraemia in African Children,”
Lancet
I (1987): 1458–61.
131
Corruption and black marketeering were critical problems for antibiotic distribution and misuse in developing countries. In many parts of the world untrained medical “injectionists” earned a living by injecting illegally obtained antibiotics and vitamins into customers, often in the major marketplaces in full view of police. Needles and the medicinal drugs were, therefore, of very high value. Such misuse of the drugs no doubt contributed both to resistance and to lack of supplies for diarrheal epidemics.
The following wire story release from the Associated Press in July 1993 illustrated the problem:
NAIROBI, KENYA (AP)—Patients bring their own medicine, food and syringes to some government hospitals because employees often steal and sell what few supplies are issued.
Inflation is soaring, partly because the government printed billions of new shillings last year to finance the ruling party's campaign and bribe voters.
Much of the social security fund was lost when officials illegally put it into real estate deals and other bad investments. Asked by journalists whether anyone would be held accountable, Treasury Secretary Wilfred Koinange replied: “What do you want, heads to roll?”
132
An excellent summary of the ivermectin saga is in E. Tanouye, “Merck's ‘River Blindness' Gift Hits Snag,”
Wall Street Journal,
September 23, 1992: A1, B7. Merck was able to reap ample profits off veterinary use of ivermectin: annual sales topped the $500 million mark in 1990, according to the World Bank.
133
See, for example, W. C. Hsiao, “Lessons for Developing Countries from the Experiences of Affluent Nations About a Comprehensive Health Financing Strategy,” presented at International Seminar on Comprehensive Financing Strategy in Select Asian Nations, December 10–14, 1990, Bali, Indonesia.
134
International Federation of Pharmaceutical Manufacturers Associations,
The Pharmaceutical Industry: International Issues and Answers
(Washington, D.C.: Pharmaceutical Manufacturers Association, 1979).
135
See, for example, S. Lall and S. Bibile, “The Political Economy of Controlling Transnationals: The Pharmaceutical Industry in Sri Lanka, 1972–1976,”
International Journal of Health Services
8 (1978): 299–328: T. Heller,
Poor Health, Rich Profits: Multinational Drug Companies and the Third
World
(London: Spokesman Books, 1977); UNCTAD Secretariat, “Dominant Positions of Market Power of Transnational Corporations: Use of the Transfer Pricing Mechanism,” Geneva, November 30, 1977; J. M. Starrels, “The World Health Organization, Resisting Third World Ideological Pressures” (Washington, D.C.: Heritage Foundation, 1985); R. Deitch, “Commentary from Westminster: More Pressure on the Profits of the Pharmaceutical Industry,”
Lancet
I (1984): 521; and International Federation of Pharmaceutical Manufacturers Associations (IFPMA), “Medicines and the Developing World,” Geneva, 1984.
136
S. Kingman, “Malaria Runs Riot on Brazil's Wild Frontier,”
New Scientist
, August 12, 1989: 24–25.
137
World Health Organization, “Malaria Worsening in Many Areas,” PR/WHA/6/May 9, 1991, Geneva.
138
P. G. Kremsner, G. M. Zotter, H. Feldmeier, et al., “
In vitro
Drug Sensitivity of
Plasmodium falciparum
in Acre, Brazil,”
Bulletin of the World Health Organization
67 (1989): 289–93; and S. Reyes, C. H. Osanai, and A. D. Passos, “
In vivo
Resistance of
Plasmodium falciparum
to 4-Aminoquinolones and to Sulfadoxine-Pyrimethamine Combination: II. Study of Manaus, Amazonas, 1983–84,”
Revista Brasileira de Malariologia e Doenças Tropicais
38 (1986): 37–44.
139
American Association for the Advancement of Science,
Malaria and Development in Africa: A Cross-Sectional Approach
, No. AFR-0481-A-00-0037-00, U.S. Agency for International Development, Africa Bureau, Washington, D.C., 1991.
140
Centers for Disease Control, “Chloroquine-Resistant Malaria Acquired in Kenya and Tanzania: Denmark, Georgia, New York,”
Morbidity and Mortality Weekly Report
27 (1978): 463–64; B. H. Kean, “Chloroquine-Resistant
falciparum
Malaria from Africa,”
Journal of the American Medical Association
241 (1979): 395–96; and C. C. Campbell, W. Chin, W. E. Collins, et al., “Chloroquine-Resistant
Plasmodium falciparum
from East Africa: Cultivation and Drug Sensitivity of the Tanzanian I/CDC Strain from an American Tourist,”
Lancet
II (1979): 1151–54.
141
H. C. Spencer, S. C. Masaba, and D. Kiaraho, “Sensitivity of
Plasmodium falciparum
Isolates to Chloroquine in Kisumu and Malindi, Kenya,”
American Journal of Tropical Medicine and Hygiene
31 (1982): 902–6.
142
W. M. Watkins, D. G. Sixsmith, H. C. Spencer, et al., “Effectiveness of Amodiaquine as Treatment for Chloroquine-Resistant
Plasmodium falciparum
Infections in Kenya,”
Lancet
I (1984): 357–59.
143
D. Overbosch, A. W. vanden Wall Bake, P. C. Stuiver, and H. J. van der Kaay, “Chloroquine-Resistant
falciparum
Malaria from Malawi,”
Tropical and Geographic Medicine
36 (1984): 71–72.
144
A. M. Blumenfeld, W. L. Sieling, A. Davidson, and M. Isaacson, “Probable Chloroquine-Resistant
Plasmodium falciparum
Malaria in South-Western Africa,”
South African Medical Journal
66 (1984): 207–8.
145
K. R. Perry, N. M. Hone, and J. M. Cairns, “Chloroquine Resistant
Plasmodium falciparum
Malaria Confirmed by
in-vitro
Testing in a District Hospital,”
Medical Journal of Zambia
18 (1984): 8–9.
146
J. Linberg, T. Sandberg, B. Bjorkholm, and A. Bjorkman, “Chloroquine and Fansidar Resistant Malaria Acquired in Angola,”
Lancet
I (1985): 765.
147
N. J. Visagie and W. L. Sieling, “Chloroquine-Resistant
Plasmodium falciparum
Malaria in South Africa: A Case Report,”
South African Medical Journal
68 (1985): 600–1.
148
G. Charmot, J. Le Bras, P. Sansonetti, et al., “Eight Cases of Drug-Resistant
Plasmodium falciparum
Malaria Contracted in Mozambique,”
Bulletin de la Société de Pathologie Exotique et de Ses Filiales
78 (1985): 500–4.
149
C. C. Draper, G. Brubaker, A. Geser, and V. A. E. B. Kilimali, “Serial Studies on the Evolution of Chloroquine Resistance in an Area of East Africa Receiving Intermittent Malaria Chemosuppression,”
Bulletin of the World Health Organization
63 (1985): 109–18.
150
P. Nguyen-Dinh, “Etudes sur la Chimioresistance de
Plasmodium falciparum
en Afrique: Donnees Actuelles,”
Annals de la Société Belgique de Médecine Tropique
65 (1985): Suppl. 2, 105–13.
151
“Chloroquine-Resistant Malaria in Africa,”
Lancet
I (1985): 1487–88; and H. C. Spencer, D. C. O. Kaseje, A. D. Brandling-Bennett, et al., “Changing Response to Chloroquine of
Plasmodium falciparum
in Sarididi, Kenya, from 1981 to 1984,”
Annals of Tropical Medicine and Parasitology
81 (1987): Suppl. 98–104.
152
A. Björkman, M. Willcox, N. Marbiah, and D. Payne, “Susceptibility of
Plasmodium falciparum
to Different Doses of Quinine
in vivo
and to Quinine and Quinidine
in vitro
in Relation to Chloroquine in Liberia,”
Bulletin of the World Health Organization
69 (1991): 459–65.
153
“One Bite Is Too Many,”
The Economist
, August 21, 1993: 33–34; and American Association for the Advancement of Science (1991), op. cit.
154
Ibid.
Similar observations were made from one end of the continent to the other. In Brazzaville, for example, cerebral malaria in children soared between January 1988 and June 1989, as did chloroquine resistance. Fifteen percent of the cases were immediately lethal. And a third of the survivors went on to suffer debilitating ailments, such as periodic convulsions, as a result of fever damage to their brains. See B. Carme, J. C. Bouquetry, and H. Plassart, “Mortality and Sequelae Due to Cerebral Malaria in African Children in Brazzaville, Congo,”
American Journal of Tropical Medicine and Hygiene
48 (1993): 216–21.
Even more striking were the escalating malaria admissions to hospitals in Kinshasa. Between 1982 and 1986 the percentage of all pediatric admissions that were due to acute malaria rose from 29.5 percent to 56.4 percent. See A. E. Greenberg, M. Ntumbanzondo, N. Ntula, et al., “Hospital-Based Surveillance of Malaria-Related Paediatric Morbidity and Mortality in Kinshasa, Zaire,”
Bulletin of the World Health Organization
67 (1989): 186–9.
155
During that time, malaria incidence in “Zambia, Togo, and Rwanda … increased by 7, 10, and 21 percent, respectively, every year over the 1980s,” Brinkmann and his colleagues wrote. “Thus, the burden of malaria in 1995 is likely to be two to three times its level in the late 1980s.”
Costs included lost workdays due to prolonged bouts with the parasites; funeral expenses; hospital and drug costs; family impoverishment due to the death of a major breadwinner; and a host of other factors.
“Overall, in 1987 the cost of malaria in sub-Saharan Africa was about $791 million per year,” the group wrote. “This figure is projected to rise to $1,684 billion by 1995. By comparison, the entire 1990 health assistance to Africa of a major bilateral donor, the U.S. Agency for International Development, was only $52 million for all conditions. In 1987 malaria represented 0.6 percent of GDP; by 1995, if current trends continue, this share will rise to 1.0 percent of GDP.” See D. S. Shepard, M. B. Ettling, U. Brinkmann, and R. Sauerborn, “The Economic Cost of Malaria in Africa,”
Tropical Medicine and Parasitology
42 (1991): 199–203. See also in the same volume U. Brinkmann and A. Brinkmann, “Malaria and Health in Africa: The Present Situation and Epidemiological Trends”: 205–13; M. B. Ettling and D. S. Shepard, “Economic Cost of Malaria in Rwanda”: 214–18; and R. Sauerborn, D. S. Shepard, M. B. Ettling, et al., “Estimating the Direct and Indirect Economic Costs of Malaria in a Rural District of Burkina Faso”: 219–23.
156
See S. C. Redd, P. B. Bloland, P. N. Kazembe, et al., “Usefulness of Clinical Case-Definitions in Guiding Therapy for African Children with Malaria or Pneumonia,”
Lancet
340 (1992): 1140–43.
157
See P. B. Bloland, E. M. Lackritz, P. N. Kazembe, et al., “Beyond Chloroquine: Implications of Drug Resistance for Evaluating Malaria Therapy Efficacy and Treatment Policy in Africa,”
Journal of Infectious Diseases
167 (1993): 932–37; C. C. Campbell, P. Nguyen-Dinh, and J. G. Breman, “Epidemiological and Operational Considerations in the Use of Antimalarial Drugs for Chemotherapy and Chemoprophylaxis of Malaria in Africa,”
Annals de la Société Belgique de Médecine Tropique
65 (1985): 165–70; and E. M. Lackritz, C. C. Campbell, T. K. Ruebush, et al., “Effect of Blood Transfusion on Survival Among Children in a Kenyan Hospital,”
Lancet
340 (1992): 528–88;
158
D. L. Heymann, R. W. Skeketee, J. J. Wirima, et al., “Antenatal Chloroquine Chemoprophylaxis in Malawi: Chloroquine Resistance, Compliance, Protective Efficacy and Cost,”
Transactions of the Royal Society of Tropical Medicine and Hygiene
84 (1990): 496–8.
159
Malawi Ministry of Health, “Malaria Control in Malawi, 1984–1988: Policy Modification and Program Development in Response to Chloroquine Resistance,” unpublished, 1993.
160
S. L. Hoffman, C. N. Oster, C. V. Plowe, et al., “Naturally Acquired Antibodies to Sporozoites Do Not Prevent Malaria: Vaccine Development Implications,”
Science
237 (1987): 639–42.
161
Similar results were obtained by L. W. Pang, N. Limsomwong, J. Karwacki, and H. K. Webster, “Circumsporozoite Antibodies and
falciparum
Malaria Incidence in Children Living in a Malaria Endemic Area,”
Bulletin of the World Health Organization
66 (1988): 359–63.

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