Drug Resistance Is Deadly
Pharmaceutical knock-offs may threaten our ability to treat malaria.


Thai government officials, led by commerce permanent secretary Siriphol Yodmuangcharoen, will meet with their Washington counterparts on June 10, hoping to persuade the U.S. Trade Representative to remove Thailand from its “Priority Watch List.” Thailand is one of nine countries listed, earning its place because of intellectual property-rights violations by the previous Bangkok government — which broke patents on AIDS and heart drugs, undermining its trade relationship with the U.S., and harming foreign investment. While the U.S. will continue to demand stronger support for patents before removing Thailand from the Watch List, the discussions this week are not just about trade: Bootleg pharmaceuticals in Southeast Asia constitute a health emergency — proliferating poor drug quality and inducing widespread drug resistance around the globe.

Thailand has made some progress recently. In the past few weeks, the entire board of the Thai national drug company, the Government Pharmaceutical Organization (GPO), was fired and replaced. The old GPO board had promoted patent breaking and produced poor quality HIV drugs, accelerating resistance to that class of drugs. GPO’s products were so bad that donor agencies, even some that are sympathetic with patent-breaking in developing countries, stopped procuring them a few years ago. Around the beginning of the year, GPO started revamping its production entirely, and hopefully quality will be much improved. And it needs to be: substandard drugs are a matter of life and death.

While Thailand has a problem with resistance to HIV drugs, countries far poorer than Thailand are facing drug resistance problems for other infectious diseases. This has fatal consequences, for resistant strains can no longer be cured by previously effective drugs.

Malaria has always been a problem in the region, with hundreds of thousands of cases and thousands of deaths annually. In 2005, there were over 100,000 cases and over 300 deaths in Cambodia and Thailand combined. But that is a great improvement on the 1990s; fatality rates have fallen recently thanks to the development of new drugs containing the compound artemisinin.

For all the principal anti-malarial pharmaceuticals developed over the past 30 years, drug resistance always seems to develop along Thailand’s borders with Cambodia and Myanmar. Those border regions were the first to note significant resistance to the last best drug, mefloquine: Between 1984 and 1989 the efficacy of the best combination treatment — of mefloquine and sulfadoxine pyrimethamine — plummeted from 97 percent to 54 percent along those Thai borders. People carrying drug-resistant parasites then traveled from the region to Africa and elsewhere, helping the resistance to spread.

From at least 2006, the latest best drug, artemisinin, is beginning to suffer the same drug-resistant fate. In the city of Pailin in Western Cambodia, close to the Thai border, failures of mefloquine/artemisinin combination therapies are now over 12 percent, and close to 10 percent elsewhere along the Thai border. Resistance has also been noticed at lower levels in China and Vietnam. Soon enough, these artemisinin treatments will become as compromised as earlier combinations are today. Experts meeting in Phnom Penh in January 2007 gave the newest combination only two years before a change would be required.