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NEWS ALERT | 11:09 AM ET

Alito Is Confirmed for Supreme Court

Drug Makers Get a Warning From the U.N. Malaria Chief

Published: January 20, 2006

Warning that misuse of the most promising new malaria drug could create an incurable strain of the disease, the new chief of the World Health Organization's malaria program demanded yesterday that 18 pharmaceutical companies stop selling some forms of the drug.

After several of the companies refused, the official, Dr. Arata Kochi, made an unusually strong threat for an official of the health organization, saying he would publicly name the companies still selling the drugs three months from now and, if they persisted, would try to disrupt sales of their other medicines.

The new drug, artemisinin, a derivative of sweet wormwood isolated by Chinese scientists, is the most powerful new weapon in the antimalaria arsenal. Health agencies consider it the best hope for controlling the disease, one of the world's leading killers, which takes more than a million lives each year, mostly those of young children.

But these agencies say artemisinin should be used only in a cocktail with other malaria drugs, usually including a slower-acting one that lingers longer in the blood.

Combination therapy, which is routine with AIDS and tuberculosis drugs, not only attacks a disease more effectively, but slows the emergence of microbes resistant to drugs.

But at least 18 companies from Belgium, China, France, Ghana, India, Kenya, Switzerland and Vietnam make the drug as a pill that can be taken by itself, in what doctors call monotherapy, and sell it cheaply in Africa, Asia and Latin America. People with fevers often buy drugs without a prescription or a test to make sure that they have malaria.

That is a recipe for disaster, Dr. Kochi said. ''We can't afford to lose artemisinin,'' he said. ''If we do, it will be at least 10 years before a drug that good is discovered. Basically, we're dead.''

If companies refuse to stop selling artemisinin in monotherapeutic form, Dr. Kochi said, he will ask his agency to stop endorsing their other drugs, including AIDS drugs, that they sell to poor countries, and he will ask the Global Fund, the World Bank and other donors to stop buying from those companies.

The World Health Organization, a United Nations agency, is usually far more cautious in its public declarations, consulting many member countries before taking a position.

Executives of some companies he named disagreed about how they would react.

Dr. Robert Sebagg, chief of access to medicines for Sanofi/Aventis, the world's third-largest drug company, said it now sold two artemisinin cocktails and was withdrawing its old monotherapy products ''step by step.''

But Dr. Bruno Jansen, president of Dafra, a small Belgian company that makes drugs in generic form, argued that artemisinin monotherapy in China and Vietnam had virtually wiped out malaria there without creating resistance. Also, he said, patients often refuse combination therapy. In Burundi, he said, his company phased out monotherapy at the government's request and introduced artemisinin and amodiaquine pills packaged together, as recommended by the W.H.O.

''But patients refused to take the amodiaquine, because it made them feel ill, and doctors refused to prescribe the combination,'' he said. ''Now monotherapy continues happily with illegal imports from Uganda and the Congo. That's Africa.''

Told of that, Dr. Kochi argued that giving patients anything they wanted -- good for them or not -- ''was like saying you should sell heroin or cocaine because there is demand.''

Dr. Yusuf Hamied, chairman of Cipla, the third-largest drug company in India, said that although his company makes a combination pill and he favors two-drug therapy, ''all drugs should be available and doctors should decide what they want.''

No proven artemisinin resistance has been documented, but the history of antimalarial medicines is one of cures that fade through overuse.

The companies Dr. Kochi asked to stop making the drug in monotherapy form are these:

Arenco Pharmaceutica and Dafra of Belgium; Cipla, GVS Laboratories and IPCA of India; ETDZS, Guilin Pharmaceutical Works, Holly Pharmaceuticals, Beijing Holley-Cotec Pharmaceuticals, Beijing Holley-Cotec New Technology and Kunming Pharmaceutical of China; Sanofi-Aventis/Africasoins of France; Kinapharma of Ghana, Cosmos of Kenya; Mepha of Switzerland; and Mediaplantex, Pharbaco and Traphaco of Vietnam.

U.S. to Reorganize Malaria Aid
By The New York Times

WASHINGTON, Jan. 19 -- Stung by criticism from Republican senators for spending most of its $90 million malaria control budget on consultants, conferences and travel, the main United States foreign aid agency by next year will spend half the money on drugs, mosquito nets and insecticide spraying, a senior official said Thursday.