NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Monday, September 29, 2014

One afternoon this summer, I came across a Duka la Dawa—the drug shops that are as common in Tanzania as bodegas are in Brooklyn—on a winding dirt road in a southwestern town, Mlowo. Beside the store, a man at a repair shop crouched over a dissected motorcycle engine, its oil-stained parts laid out on cardboard. A woman walked past, selling yams balanced on a platter on her head. I entered the Duka and asked what the pharmacist behind a counter had for malaria, the mosquito-borne disease that kills some 1,700 people every day in sub-Saharan Africa and Southeast Asia.

He offered me five kinds of pills of varying quality and price. Some were artemisinin combination therapies, or ACTS, quality assured by the World Health Organization (WHO); others were much less effective medicines, unable to counter the drug-resistant malaria parasites that have emerged in recent years. In some cases, these pills will even accelerate antimalarial resistance. Tragically, in this poor part of the world, many people will choose the pennies saved on the cheaper drugs over the top-shelf stuff.