Building a comprehensive picture of malaria drug quality

Poor quality antimalarials pose an immediate threat to vulnerable populations and jeopardise the fragile progress made in the fight against malaria.  Patients may suffer prolonged illness, treatment failure or even death. Loss of income and increased healthcare costs place a financial burden on households and healthcare providers. Falsified or substandard antimalarials containing sub-therapeutic amounts of artesunate or only one of the two active ingredients in Artemisinin Combination Therapy (ACTs) can contribute to emerging antimalarial drug resistance.

“One of the challenges in halting the spread of substandard or falsified drugs is the lack of accessible and reliable information about this vital aspect of public health,” explains Dr Paul Newton, Head of the WWARN Antimalarial Quality (AQ) Group.

Addressing this critical gap, WWARN has launched the AQ Surveyor to support the efforts of national and international organisations working to provide malaria patients with quality-assured, effective medicines.

The AQ Surveyor is an online tool that maps and tabulates published reports about the quality of antimalarial medicines – the first open access, independent, global repository and map of its kind.

Using a simple dashboard, users can customise summaries of antimalarial quality reports describing the quality of malaria medicines, techniques, assays and sampling – over time and by location. Study data can be filtered and mapped according to medicine, report type, collection type, medicine source, and quality classification. 

Patricia Tabernero, WWARN AQ Group Coordinator, has conducted a systematic review of English, French and Spanish publications from resources and databases including Pubmed, Google Scholar, the World Health Organization, United States Pharmacopeial Convention (USP) and Medical Regulatory Agencies’ websites. With the help of the WWARN Informatics Group, over 200 scientific and lay reports published since 1976, and fitting the inclusion criteria, have been codified into the database driving the AQ Surveyor.

There is an urgent need to continue to build on the initial success of the AQ Surveyor. As Patricia Tabernero, AQ Group Scientific Coordinator, is quick to point out, “Estimates of antimalarial quality vary widely depending on sampling methodology. Current data are inadequate to accurately estimate frequency or to deliver aggregated percentages of poor quality antimalarials, especially in large malarious areas.”

The need to expand coverage was also highlighted by Dr Michael J Bangs, Malaria Control Advisor, International SOS, Indonesia, who commented, “Viewing the map, there appears a paucity of published data from Indonesia and the Australasian region in general. As areas in Indonesia and malaria-endemic areas of Oceania have access to a variety of poorly or non-regulated drugs, it would be prudent to expand the coverage to these areas as well. One can hope that institutions in the region will do so and provide access to the data, building this valuable web-based resource.”

The AQ Surveyor will be updated as new data are published and ongoing contributions are welcome. Future versions will include the brand and manufacturer’s name for each sample, types of test used to determine quality criteria, graphs displaying trends over time, and images of samples and packaging.

“We hope that the tool will stimulate debate about improved methodology to assess drug quality and also on terminology – a barrier to international measures to tackle poor quality medicines,” adds Dr Newton.

Open the AQ Surveyor.

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Learn more about WWARN’s activities in the area of Antimalarial Quality.