f_0020454_17216 - Paula Park who is based in London has...

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© 2010 World Policy Institute 35 Paula Park, who is based in London, has written for the New York Times and the Wall Street Journal . The border between Thailand and Cambodia is a petri dish for drug-resistant strains of malaria. Scientists believe that in this region, more than 50 years ago, parasites that cause the disease mutated to fight a common anti- malarial drug, chloroquine, and multiplied. People carried these new parasite strains across the world, spreading the drug resist- ance. Today,these same borderland parasites show new signs of resistance. This time, it’s to a combination of drugs, including one called artesunate, that had, until recently, made inroads against the spread of the dis- ease. In 2004, the Cambodian government found that nearly one in five cases of arte- sunate sold by retailers in four provinces bor- dering Thailand lacked sufficient amounts of the active ingredient. Six years later, Cambo- dian health officials cracked down on the dis- tribution of these counterfeits. By April 2010, officials had closed two-thirds of the country’s 1,081 illegal retail shops, the main sellers of fakes. “Closing down the illegal outlets is cer- tainly going to have an effect on the avail- ability of substandard drugs in the market,” says Patrick Lukulay,manager of drug quali- ty for the United States Pharmacopeia Con- vention ( USP ), which provided technical assis- tance to the Cambodian government. “More importantly,because there will be fewer sub- standard medicines…the efficacy of the good drugs” will be improved. The hope is that these measures did not come too late. Scientists still do not fully understand the mechanisms of drug resistance, but they do believe that drugs with inadequate levels of active ingredients encourage mutations. The same goes for medicines that were im- properly made or expired. As Chris Drakeley, the director of the Malaria Centre at the Lon- don School of Hygiene and Tropical Medi- cine, puts it, “Suboptimal concentrations of the drug just don’t kill everything.” The malaria parasite replicates so quickly that the genes left unscathed by a low dose of medicine change and multiply rapidly, creat- ing what is essentially a new strain. But the medicine was designed for the original muta- tion. Drakeley says that scientists have not yet seen evidence that full-fledged resistance has developed along the Thai-Cambodian border.Still, the parasite does seem to be de- veloping a tolerance to the drugs. A Global Curse An estimated 243 million people worldwide contracted malaria in 2008, according to the World Health Organization’s ( WHO ) most recent global count. Nearly 1 million died. Eighty-five percent of the victims were chil- Lethal Counterfeits Paula Park
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36 WORLD POLICY JOURNAL SUMMER 2010 dren. The spread of drug resistance is one of a handful of reasons why malaria has been so difficult to contain. Cambodia’s experience with fake antimalarials contains all the ele- ments of a tragedy that’s repeated across the globe. A disease that kills the poor and the
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