WHEN malaria began to rage through the villages east of this remote town in southern Laos a few weeks ago, people accepted it with fatalism as a scourge that comes every year.
The steamy rainy season creates ideal breeding conditions for mosquitoes carrying a disease that claims 3,000 lives a day around the world, a bane for the villagers in this poor land of jungles and great rivers.
People are dying here mainly because drugs at the local pharmacies do not work. Although malaria can be defeated with new forms of therapy, foreign donors are accused of continuing to fund provision of old drugs that have lost their effect.
Critics fear that, if this does not change, malaria mortality rates will double in Africa and Asia over the next two decades.
Professor Nicholas White, a British world authority on malaria, has accused self-interested bureaucracies in the Third World of being too slow to take up new life-saving therapies — and said Britain and other rich Western donors were too reluctant to push them into action.
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“In contrast to the other big killers, malaria isn’t getting better, it’s getting worse,” said White, head of the Wellcome Trust’s Tropical Medicine Research Unit in Bangkok. “The reason is the continuous use of drugs which were effective 50 years ago but now don’t work.”
Every year there are an estimated 300m to 500m cases of malaria around the world and at least 1m deaths, mostly in Africa.
For decades the anti-malarial chloroquine was hailed as a wonder medicine in the Third World. It saved millions of lives but, as parasites became resistant to it, its effectiveness waned dramatically.
White said Western aid — including money from Britain’s Department for International Development (Dfid) — has not kept pace with the disease. New effective drugs, artemisinin-based combination therapies (ACTs), are available, but chloroquine is still used because it costs only a tenth as much.
The dire results are unfolding in a cluster of villages east of Savannakhet, towards the old Ho Chi Minh Trail that nudges the border with Vietnam.
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“The authorities know it amounts to an epidemic but pretend everything is okay,” said one western aid worker.
Ponemek Dalaloy, the Lao minister of health, arrived here recently in a convoy of gleaming jeeps donated by the European Union, declared there were no signs of an epidemic and set off on the dirt roads back to Vientiane, the capital.
“They ordered the villages to check pools of still water for mosquito larvae and they fine anyone who does not,” said a local driver. That measure, directed at mosquitoes carrying dengue fever, not malaria, appeared to be the extent of government emergency action.
On the shelves of Savannakhet’s main pharmaceutical wholesaler three types of malaria drugs are available. All are chloroquine-based, sold to Laos by Thai manufacturers and of no use here.
White, who helped to develop ACTs, said Dfid and USAid, the American government aid agency, were partly to blame for failing to ensure effective drugs were provided. Donors were reluctant to accept they must pay higher costs to make their aid worthwhile, he said.
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“The people at the top of Dfid are getting very bad advice from their line managers,” he said. “There needs to be a change of policy — fast.”
Dfid rejects White’s criticism, saying it works hard to ensure effective anti-malarial drugs are delivered to everyone who needs them, and defending the working of the UN’s Global Fund. In a statement it said it was helping to pay for work on a cheaper and more effective anti-malarial drug. Dfid is also helping to fund the provision of ACTs, but says it cannot force a country to buy specific drugs.
The problem for the villagers in a place like Savannakhet is that their rulers have little incentive to change. The new drugs cost about £1.25 a dose compared with 5p for chloroquine, so the Lao government sticks with the cheaper option. The regime is nominally Communist but foreign aid officials say it is riddled with corruption, raising suspicions about its motives.
Whatever the reasons, children and old people are succumbing to the chills and fever that signify the onset of the sickness as the rains fall from a thunderous sky. The few people with money in Laos, one of the world’s poorest countries, stand a better chance. Staff at the city’s new provincial hospital and at a private clinic, when asked how they would help a foreign tourist with malaria symptoms, said there was no problem obtaining the latest drugs for cash.
In Thailand, just a 15-minute boat ride across the Mekong River, anyone suffering from malaria can get the new generation of therapy in local hospitals — but most Lao people cannot afford the fees for a passport, let alone the medical bills.
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Malaria pioneers such as White want a drive for cheap anti-malarial therapy in the same way that Aids activists drove down the price of retroviral drugs that keep the HIV virus in check.
A flurry of recent publicity over a cheap substitute for artemisinin, OZ227, obscured the fact that it will not be available for at least four to five years, White said.