New malaria method could boost drug production

BERLIN (AP) — German scientists have developed a new way to make a key malaria drug that they say could easily quadruple production and drop the price significantly, increasing the availability of treatment for a disease that kills hundreds of thousands every year.

Chemists at the Max Planck Institute take the waste product from the creation of the drug artemisinin — artemisinic acid — and convert it into the drug itself.

The entire apparatus is compact, about the size of a carry-on suitcase, and inexpensive. That means it can be easily added to production sites anywhere around the world.

"Four hundred of these would be enough to make a world supply of artemisinin," said unit director Peter Seeberger, pointing to the machine on a table in his lab in Berlin's Dahlem neighborhood. "The beauty of these things is they're very small and very mobile."

A paper on the new technique was published this month in chemistry journal Angewandte Chemie.

Artemisinin is extracted from sweet wormwood, a plant that primarily grows in China and Vietnam and varies in its availability according to the season. In the extraction process, for every part artemisinin produced, there is 10 times the amount of artemisinic acid discarded as waste.

Past attempts to convert the acid using ultraviolet light to trigger the conversion have been unsuccessful because the process took several steps in a large tank of acid, making production inefficient and far too expensive.

So the Max Planck chemists thought small — creating a machine that pumps all of the required ingredients through a thin tube wrapped around a UV lamp in a continuous process that takes 4 1/2 minutes from start-to-finish to produce the artemisinin.

The technique can convert about 40 percent of the waste acid into artemisinin — producing four times more of the drug from what had in the past been discarded, Seeberger said.

Colin Sutherland, a malaria expert at the London School of Hygiene and Tropical Medicine who was not involved in the Max Planck research, said the development could be significant in boosting production of the key malaria drug. He noted that currently very little artemisinin can be made from a large amount of the sweet wormwood, which is also difficult to grow.

"If it's a simple process, given a certain amount of plant material, you can generate more drugs, that will make things cheaper and faster," he said.

Since the end product is the same molecule, there should be no decrease in effectiveness of the synthetic product, Sutherland said.

Seeberger said a commercial prototype of the Max Planck machine could be ready in about six months and that it could go into production in about a year. He said current price estimates are around euro100,000 (US$132,000).

When it's in production, the idea is to make it available for a minimal fee to cover costs, he said.

"The goal is to make sure that the drug is produced and made available to as many people as possible," said Seeberger, a former Massachusetts Institute of Technology professor who now teaches at Berlin's Free University.

Sabine Haubenreisser, a spokeswoman at the European Medicines Agency, said that if the new drug is close enough to the original, its producers could apply for it to be considered as a generic product or use older data proving artemesinin's effectiveness — which could speed the approval process.

Malaria cases and deaths have been dropping since 2004, due largely to campaigns to distribute bednets, spray homes with insecticide and make better drugs available. The World Health Organization estimates that at least 655,000 people die of malaria every year, mostly children under 5 in Africa.

At the moment, artemisinin-based therapies are considered the best treatment, but cost about $10 per dose — far too much for impoverished communities.

Former U.S. President Bill Clinton's Clinton Foundation currently has a program to purchase the treatments, then sell them at a deeply discounted 50 cents to communities where they're most needed.

Cutting the price further while increasing production could "make a big difference," said Sutherland.

"Many times more children will have access to the right drug early in their disease and that's likely to have an impact on mortality."

___

AP Medical Writer Maria Cheng contributed to this report from London.

View the original article here

Malaria kills twice as many as thought: study

LONDON (Reuters) - Malaria kills more than 1.2 million people worldwide a year, nearly twice as many as previously thought, according to new research published on Friday that questions years of assumptions about the mosquito-borne disease.

Past studies had overlooked hundreds of thousands of deaths because they had wrongly assumed malaria overwhelmingly killed babies and focused their findings on under-fives, said the study by the Institute for Health Metrics and Evaluation (IHME) in the United States.

The new study, published in The Lancet medical journal, found 42 percent of deaths were actually among older children and adults.

The higher number of victims showed the need to increase funding to fight malaria, even as governments came under pressure to cut their aid budgets amid the global economic crisis, said the researchers.

"You learn in medical school that people exposed to malaria as children develop immunity and rarely die from malaria as adults," said Christopher Murray, who led the study as IHME Director. "What we've found in hospital records, death records, surveys and other sources shows that just is not the case."

In their work, which used new data and computer modelling to build a historical database for malaria between 1980 and 2010, they found that more than 78,000 children aged five to 14, and more than 445,000 people aged 15 and older died from malaria in 2010. This means more than four in 10 of all malaria deaths were in people aged fives years and older.

Overall, malaria deaths worldwide rose from 995,000 in 1980 to a peak of 1.8 million in 2004, before falling again to 1.2 million in 2010, the study found.

The World Health Organisation's (WHO) latest global report said the estimated number of malaria deaths fell to 655,000 in 2010, almost half the number in the IHME study.

The WHO, a United Nations agency, said on Friday it stood by its figures and said that much of the data used in the Lancet study had been based on verbal testimony by relatives of how people had died, not on laboratory diagnosis of samples.

"So we would say that again the great majority of deaths would be in children under five and we stand by our estimates," WHO spokesman Gregory Hartl told a news briefing in Geneva.

Both studies showed a downward trend in deaths in recent years, thanks largely to the use of anti-malaria drugs and insecticide-treated bed nets.

The new findings are part of an ongoing series generated by the Global Burden of Diseases, Injuries and Risk Factors 2010 Study. Global trends in child deaths, maternal deaths, breast cancer, and cervical cancer were released last year

and more will be released in coming months.

Malaria is endemic in more than 100 countries worldwide but can be prevented by the use of bed nets and indoor spraying to keep the mosquitoes that carry the disease at bay.

Effective malaria drugs known as artemisinin-based combination therapies, or ACTs, can cure the infection but access to these medicines is often hampered in poor countries, where funding is limited and health services are patchy.

The IHME researchers said much of the decline in deaths was down to efforts by the Global Fund to Fight AIDS, Malaria and Tuberculosis, which was launched in 2001, and other anti-malaria organisations such as the WHO's Roll Back Malaria campaign.

"We have seen a huge increase in both funding and in policy attention given to malaria over the past decade, and it's having a real impact," said Alan Lopez of the University of Queensland and one of the study's co-authors.

"Reliably demonstrating just how big an impact is important to drive further investments... This makes it even more critical for us to generate accurate estimates for all deaths."

The researchers also warned, as the WHO did in its December 2010 malaria report, that recent gains in the fight against the disease malaria could be reversed if global economic troubles stifle funding efforts.

It said an announcement by the Global Fund in November that it would cancel its next round of funding "casts a cloud over the future of malaria programs".

"If the Global Fund is weakened, the world could lose 40 percent of all the funding dedicated to fighting malaria," said Stephen Lim, also at IHME and a co-author on the study.

View the original article here

Malaria kills twice as many as thought: study

LONDON (Reuters) - Malaria kills more than 1.2 million people worldwide a year, nearly twice as many as previously thought, according to new research published on Friday that questions years of assumptions about the mosquito-borne disease.

Past studies had overlooked hundreds of thousands of deaths because they had wrongly assumed malaria overwhelmingly killed babies and focused their findings on under-fives, said the study by the Institute for Health Metrics and Evaluation (IHME) in the United States.

The new study, published in The Lancet medical journal, found 42 percent of deaths were actually among older children and adults.

The higher number of victims showed the need to increase funding to fight malaria, even as governments came under pressure to cut their aid budgets amid the global economic crisis, said the researchers.

"You learn in medical school that people exposed to malaria as children develop immunity and rarely die from malaria as adults," said Christopher Murray, who led the study as IHME Director. "What we've found in hospital records, death records, surveys and other sources shows that just is not the case."

In their work, which used new data and computer modelling to build a historical database for malaria between 1980 and 2010, they found that more than 78,000 children aged five to 14, and more than 445,000 people aged 15 and older died from malaria in 2010. This means more than four in 10 of all malaria deaths were in people aged fives years and older.

Overall, malaria deaths worldwide rose from 995,000 in 1980 to a peak of 1.8 million in 2004, before falling again to 1.2 million in 2010, the study found.

The World Health Organisation's (WHO) latest global report said the estimated number of malaria deaths fell to 655,000 in 2010, almost half the number in the IHME study.

The WHO, a United Nations agency, said on Friday it stood by its figures and said that much of the data used in the Lancet study had been based on verbal testimony by relatives of how people had died, not on laboratory diagnosis of samples.

"So we would say that again the great majority of deaths would be in children under five and we stand by our estimates," WHO spokesman Gregory Hartl told a news briefing in Geneva.

Both studies showed a downward trend in deaths in recent years, thanks largely to the use of anti-malaria drugs and insecticide-treated bed nets.

The new findings are part of an ongoing series generated by the Global Burden of Diseases, Injuries and Risk Factors 2010 Study. Global trends in child deaths, maternal deaths, breast cancer, and cervical cancer were released last year

and more will be released in coming months.

Malaria is endemic in more than 100 countries worldwide but can be prevented by the use of bed nets and indoor spraying to keep the mosquitoes that carry the disease at bay.

Effective malaria drugs known as artemisinin-based combination therapies, or ACTs, can cure the infection but access to these medicines is often hampered in poor countries, where funding is limited and health services are patchy.

The IHME researchers said much of the decline in deaths was down to efforts by the Global Fund to Fight AIDS, Malaria and Tuberculosis, which was launched in 2001, and other anti-malaria organisations such as the WHO's Roll Back Malaria campaign.

"We have seen a huge increase in both funding and in policy attention given to malaria over the past decade, and it's having a real impact," said Alan Lopez of the University of Queensland and one of the study's co-authors.

"Reliably demonstrating just how big an impact is important to drive further investments... This makes it even more critical for us to generate accurate estimates for all deaths."

The researchers also warned, as the WHO did in its December 2010 malaria report, that recent gains in the fight against the disease malaria could be reversed if global economic troubles stifle funding efforts.

It said an announcement by the Global Fund in November that it would cancel its next round of funding "casts a cloud over the future of malaria programs".

"If the Global Fund is weakened, the world could lose 40 percent of all the funding dedicated to fighting malaria," said Stephen Lim, also at IHME and a co-author on the study.

View the original article here

Malaria kills twice as many as thought - study

LONDON (Reuters) - Malaria kills more than 1.2 million people worldwide a year, nearly twice as many as previously thought, according to new research published on Friday that questions years of assumptions about the mosquito-borne disease.

Past studies had overlooked hundreds of thousands of deaths because they had wrongly assumed malaria overwhelmingly killed babies and focused their findings on under-fives, said the study by the Institute for Health Metrics and Evaluation (IHME) in the United States.

The new study, published in The Lancet medical journal, found 42 percent of deaths were actually among older children and adults.

The higher number of victims showed the need to increase funding to fight malaria, even as governments came under pressure to cut their aid budgets amid the global economic crisis, said the researchers.

"You learn in medical school that people exposed to malaria as children develop immunity and rarely die from malaria as adults," said Christopher Murray, who led the study as IHME Director. "What we've found in hospital records, death records, surveys and other sources shows that just is not the case."

In their work, which used new data and computer modelling to build a historical database for malaria between 1980 and 2010, they found that more than 78,000 children aged five to 14, and more than 445,000 people aged 15 and older died from malaria in 2010. This means more than four in 10 of all malaria deaths were in people aged five years and older.

Overall, malaria deaths worldwide rose from 995,000 in 1980 to a peak of 1.8 million in 2004, before falling again to 1.2 million in 2010, the study found.

The World Health Organisation's (WHO) latest global report said the estimated number of malaria deaths fell to 655,000 in 2010, almost half the number in the IHME study.

The WHO, a United Nations agency, said on Friday it stood by its figures and said that much of the data used in the Lancet study had been based on verbal testimony by relatives of how people had died, not on laboratory diagnosis of samples.

"So we would say that again the great majority of deaths would be in children under five and we stand by our estimates," WHO spokesman Gregory Hartl told a news briefing in Geneva.

Both studies showed a downward trend in deaths in recent years, thanks largely to the use of anti-malaria drugs and insecticide-treated bed nets.

The new findings are part of an ongoing series generated by the Global Burden of Diseases, Injuries and Risk Factors 2010 Study. Global trends in child deaths, maternal deaths, breast cancer, and cervical cancer were released last year [ID:nL5E7KF0NP] and more will be released in coming months.

Malaria is endemic in more than 100 countries worldwide but can be prevented by the use of bed nets and indoor spraying to keep the mosquitoes that carry the disease at bay.

Effective malaria drugs known as artemisinin-based combination therapies, or ACTs, can cure the infection but access to these medicines is often hampered in poor countries, where funding is limited and health services are patchy.

The IHME researchers said much of the decline in deaths was down to efforts by the Global Fund to Fight AIDS, Malaria and Tuberculosis, which was launched in 2001, and other anti-malaria organisations such as the WHO's Roll Back Malaria campaign.

"We have seen a huge increase in both funding and in policy attention given to malaria over the past decade, and it's having a real impact," said Alan Lopez of the University of Queensland and one of the study's co-authors.

"Reliably demonstrating just how big an impact is important to drive further investments... This makes it even more critical for us to generate accurate estimates for all deaths."

The researchers also warned, as the WHO did in its December 2010 malaria report, that recent gains in the fight against the disease malaria could be reversed if global economic troubles stifle funding efforts.

It said an announcement by the Global Fund in November that it would cancel its next round of funding "casts a cloud over the future of malaria programs.

"If the Global Fund is weakened, the world could lose 40 percent of all the funding dedicated to fighting malaria," said Stephen Lim, also at IHME and a co-author on the study.

(Additional reporting by Stephanie Nebehay in Geneva; Editing by Andrew Heavens)

View the original article here

Malaria death toll possibly twice as high

LONDON (AP) — Malaria may be killing around twice as many people as experts previously thought, and it could also be hitting older children and adults — long considered the least susceptible — a new study suggests.

Malaria cases and deaths have been dropping since 2004, due largely to big campaigns to distribute bednets, spray homes with insecticide and make better drugs available. In December, the World Health Organization reported about 655,000 had died from the disease in 2010.

But researchers using newly available data and modeling tools put the 2010 figure at about 1.2 million, about 90 percent of which are in Africa.

The findings also challenge the belief that children who grow up in areas with malaria develop immunity to the disease as they get older. Doctors have long thought children under 5 years old and pregnant women were the most susceptible to the mosquito-borne disease.

"That assumption appears to be wrong," said Stephen Lim of the Institute for Health Metrics and Evaluation at the University of Washington, one of the study authors.

"We need to shift our strategies to try protecting everyone, not just children under 5 and pregnant women," he said.

Lim and colleagues analyzed data on malaria deaths from 1980 to 2010, including information not used in prior studies. They made statistical adjustments for deaths that may have been misclassified, including those in adults. They also developed several models to predict how many people likely died of malaria. The study was paid for by the Bill & Melinda Gates Foundation and was published Friday in the journal, Lancet.

Other experts weren't so convinced by the new figures.

"I wouldn't worry unduly about what the (malaria) numbers are," said David Schellenberg, a professor of malaria and international health at the London School of Hygiene and Tropical Medicine.

He said most people killed by the disease aren't hospitalized, making their deaths hard to track, and most malaria estimates are based on patchy and incomplete information. He was not linked to the study.

WHO malaria expert Richard Cibulskis, however, said WHO stood by their estimates.

"We're not sure why they're coming up with this result, but we suspect it may be overdiagnosis." Cibulskis said he wasn't convinced there were significant numbers of malaria deaths in adults and said other studies haven't found this.

He said data from both WHO and the new Lancet study showed the same overall trend, that malaria has been dropping since 2004, due largely to widespread campaigns to fight the disease.

Cibulskis said he was worried the current financial crisis could jeopardize successes in the battle against Malaria. Last year, the Global Fund to Fight AIDS, Tuberculosis and Malaria — which pays for about two-thirds of the world's malaria programs — announced it had run out of money for future grants.

"If we take our foot off the accelerator, malaria could come roaring back," Cibulskis said.

Lim and colleagues projected malaria deaths wouldn't fall below 100,000 until after 2020. That could make reaching certain targets — such as the United Nations' aim of cutting malaria deaths to "near-zero" by 2015 — tricky. "It's unlikely that goal will be met," Lim said, adding a few more decades might be necessary. "Based on what we are seeing, there may be a need to rethink the timeline for malaria elimination."

___

The Gates Foundation was created in 2000 by the Microsoft Corp. chairman and his wife.

View the original article here

Malaria toll far higher than thought: study

Malaria kills more than 1.2 million people a year, nearly 50 percent more than previously thought, and inflicts a high toll among adults and older children and not just toddlers, a new investigation says.

But there is also good news: deaths from the mosquito-borne disease have in fact been falling sharply thanks to access to better drugs and insecticide-treated nets.

Published in The Lancet on Friday, the study by the Institute of Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, says malaria killed at least 1.2 million people worldwide in 2010.

The estimate will be a likely shock for health policymakers. Only last September the UN-backed Roll Back Malaria (RBM) calculated mortality in 2009 at 781,000.

The higher figure, say the US researchers, derives from wider and more reliable data, including use of a technique called "verbal autopsy".

Under this, investigators interview relatives of someone who has recently died in order to help pinpoint the cause of death. In many poor countries which lack medical infrastructure, mortality is often poorly probed or misidentified.

The new study skewers the belief that the overwhelming majority of malaria deaths occur among the under-fives.

In 2010, more than 78,000 children aged five to 14, and more than 445,000 aged 15 or older, died of malaria, together accounting for 42 percent of the total.

"You learn in medical school that people exposed to malaria as children develop immunity and rarely die from malaria as adults," said lead researcher Christopher Murray.

"What we have found in hospital records, death records, surveys and other sources shows that just is not the case."

From 1985, says the paper, malaria deaths grew every year, peaking at 1.8 million in 2004.

But from 2004, the toll fell every year. Between 2007 and 2010, the decline has been particularly acute -- more than seven percent every year -- and the big beneficiary has been Africa.

Among the stars are Tanzania and Zambia, which saw deaths fall by more than 30 percent between 2004 and 2010.

The source of the decline lies in the increased use of artemisinin drugs, replacing medications to which the malaria parasite has become resistant, and the widening distribution of insecticide-treated bed nets, says the probe.

The major players in this campaign are the Bill and Melinda Gates Foundation, RBM and the Global Fund to Fight AIDS, Malaria and Tuberculosis. Funding rose from less than 250 million dollars annually in 2001 to more than two billion in 2009.

"We have seen a huge increase in both funding and in policy attention given to malaria over the past decade, and it's having real impact," said Alan Lopez, a population health expert at the University of Queensland in Australia, who was a member of the research team.

The study warns of the dangers if the momentum is lost, especially in the shortfall of support for the Global Fund.

"There has been a rapid decrease in malaria mortality in Africa because of the scaling up of control activities supported by international donors," it says.

"Donor support, however, needs to be increased if malaria elimination and eradication and broader health and development goals are to be met."

In last September's estimate, RBM said mortality from malaria fell from 984,000 in 2000 to 781,000 in 2009, a decline of 38 percent if the world's population growth over this period is factored in.

The new study was funded by the Gates Foundation; however, the IHME is an independent research institution and The Lancet is a peer-reviewed journal.

View the original article here