PIP: There are more than 1 million malaria deaths annually in Africa, approximately 90% of such deaths globally. Parasite resistance is such that chloroquine can no longer be relied upon to cure deadly Plasmodium falciparum infections. Pyrimethamine-sulfadoxine is almost as cheap as chloroquine and easier to use, but resistance to this drug is also likely to become widespread across Africa within the next five years. Practical alternatives to Fansidar must be identified now. The author describes pyronaridine, a drug which in Cameroon achieved 100% cure of uncomplicated falciparum malaria. It is a synthetic Chinese drug currently being assessed by the WHO Committee on Drugs for Malaria. Although pyronaridine's mode of action and disposition are poorly understood, it is nonetheless known to be effective against multidrug-resistant P. falciparum; that it does not seem to exhibit much cross-resistance with chloroquine, quinine, or mefloquine; that it has proved clinically effective in trials in China; and that it seems to be well-tolerated. Much remains to be seen, however, before pyronaridine can be recommended for routine use in Africa. Dose schedules are empirical and pharmacokinetic data are urgently needed; current formulations have low oral bioavailability; the geographic variation in parasite chemosensitivity, expected potential for resistance, and toxicity must be investigated; pyronaridine's toxicological profile has not been established to standards acceptable in the US or the European Union; and its clinical risk-benefit profile is poorly understood. Little clinical work has been conducted outside of China. Furthermore, Plasmodium species can develop resistance to the drug in the laboratory, which necessitates careful attention when used in areas of high transmission, and it remains unclear whether pyronaridine will be well tolerated in humans. Assembling the necessary data for regulatory approval will be costly. If pyronaridine is to be developed, attention must be given to further costs; treating an adult currently costs about $3, too expensive for Africa.