The WWARN Antimalarial Quality Surveyor

Over the last decade there has been a resurgence of awareness that poor medicine quality is a vitally important, but neglected, public health issue. A growing number of studies have highlighted the importance of drug quality with examples from all over the world. This is an important problem, not only for antimalarials but for all types of medication. The use of poor quality medicines can result in deaths amongst those who would have otherwise survived their infection. They erode public confidence in medicines; have dire economic consequences for patients, their families, health systems and pharmaceutical producers. Of particular relevance are those containing sub-therapeutic amounts of the active pharmaceutical ingredients that can engender drug resistance. Scientific data on the frequency and consequences of poor quality medicine are relatively sparse. There is no clear picture on the prevalence of poor quality antimalarials, their geography and trading patterns. There are diverse sources of information such as newspaper articles; websites from medicine regulatory authorities (MRAs) and national malaria control programmes (NMCPs), and academic publications, but there is no single accurate global databank, with a mapping system of publicallyaccessible detailed information on poor quality antimalarials. In order to try to fill this gap, the WorldWide Antimalarial Resistance Network (WWARN; www. wwarn.org) has built a new Antimalarial Quality Scientific Group that aims to collate information and stimulate discussion on the epidemiology of poor quality antimalarials. The work conducted by the Scientific Group includes a database and an interactive web application displaying the spread of poor quality antimalarials through space and time, the AQ Surveyor (see Fig. 1 and http://www.wwarn. org/aqsurveyor/). We hope that this will help enhance information availability, increase understanding, monitor geographical and temporal trends, and be especially useful for medicine regulatory authorities and malaria control programmes. This work also aims to facilitate improvements both in sampling and analytical methodology, and advocate for more investment in this, but neglected, aspect of public health.