Malaria | Affordable Medicines Facility for Malaria Announces $225M Initiative To Reduce ACT Cost, Curb Malaria Drug Resistance

April 20, 2009

The Affordable Medicines Facility for Malaria on Friday announced plans to reduce the price of artemisinin-based combination therapies with a $225 million subsidy program, the New York Times reports. The campaign, launched in Norway, aims to prevent malaria-associated mortality and curb the spread of drug resistance (McNeil, New York Times, 4/17). According to Reuters, the Global Fund To Fight AIDS, Tuberculosis and Malaria will manage the project, and the British government and the international drug purchasing facility UNITAID will provide financial support. In addition, the project will receive technical support from the Roll Back Malaria Partnership and a consortium of public and private organizations that includes the World Bank, UNICEF, the Bill & Melinda Gates Foundation, the Clinton Foundation and the Dutch government (Acher, Reuters, 4/17). According to the Times, the U.S. has not contributed to the project at this stage.

Although early plans for the campaign include a $1.9 billion budget, the organizers intend to run the $225 million initiative as a pilot project (New York Times, 4/17). The pilot program will be launched in Cambodia and 10 African countries: Benin, Ghana, Kenya, Madagascar, Niger, Nigeria, Rwanda, Senegal, Tanzania and Uganda. The project organizers intend to expand the project to additional countries in the future, the AP/San Francisco Chronicle reports (AP/San Francisco Chronicle, 4/18). According to the Times, the campaign aims to encourage drug manufacturers to reduce the cost of ACTs by lowering the wholesale private-sector price from $4 per treatment to $1 per treatment and using donor funds to subsidize 95 cents of that dollar. By lowering the wholesale prices to five cents, the stakeholders hope to drive down retail prices enough to curtail the use of older, less-effective malaria drugs, which can contribute to drug resistance (New York Times, 4/17). According to the AP/Chronicle, the subsidy program could reduce retail ACT prices from $6 to $10 per dose to 20 cents to 50 cents per dose (AP/San Francisco Chronicle, 4/18). Olusoji Adeyi, member of the World Bank task force that designed the campaign, said, "For a poor farmer in Cameroon or a poor market woman in Ghana, the difference between 20 cents and $8 is huge."

Although pharmaceutical companies typically sell ACTs to governments for $1 per treatment and to private wholesalers for $4 per treatment, the drugs often cost about 10 to 40 times more than older drugs by the time they reach village health centers, the Times reports. Therefore, by significantly reducing the price of ACTs in retail clinics, the partnership hopes to crowd out older drugs, such as chloroquine and Fansidar, because many malaria parasites have developed resistance to these compounds. In addition, the stakeholders hope to curb the use of artemisinin monotherapies because these drugs might increase the likelihood that parasites will develop resistance to artemisinin. Although the World Health Organization currently recommends the use of ACTs produced by three companies -- Novartis, Sanofi-Aventis and the Indian generics company Ajanta -- several other manufacturers soon are expected to produce drugs that meet WHO standards. According to the Times, the malaria drug subsidy program will undergo a re-evaluation after two years.

Awa-Marie Coll-Seck, executive director of the Roll Back Malaria Partnership, called the subsidy program "a triumph of international cooperation" (New York Times, 4/17). Michel Kazatchkine, executive director of the Global Fund, said the campaign will be "an important part of the global effort to control malaria worldwide," adding that there "is no reason any child should die of malaria anymore" (Reuters, 4/17). According to Kazatchkine, because the international community has access to insecticide-treated nets and effective malaria drugs, "we only need to ensure that all who need these things get them" (AFP/Google.com, 4/17). Norweigan Foreign Minister Jonas Gahr Stoere added, "The age when the world had effective drugs against infectious diseases but let millions die each year because they couldn't afford them is over" (Reuters, 4/17).

Concerns About Malaria Drug Subsidy Program
Bernard Nahlen, deputy coordinator of the President's Malaria Initiative, on Thursday in an interview said the U.S. would need to review more studies proving that subsidies would work before investing in the initiative. According to the Times, when Congress reauthorized the President's Emergency Plan for AIDS Relief last year, the law prohibited donations to AMFm until the U.S. malaria coordinator had "compelling evidence of success from pilot programs." Nahlen said, "I sometimes joke that this is the biggest faith-based initiative in the world of malaria. I'm perfectly willing to be convinced, but sometimes the advocacy gets out ahead of the evidence."

Although Medecins Sans Frontieres endorsed the ACT subsidy plan, the organization also warned that the campaign "jeopardized the future" of artemisinin by allowing subsidies for ACTs sold in blister packs, which allow people to take artemisinin without its companion pill. In addition, a lack of accurate diagnostic tools in many malaria-endemic areas often leads parents to dispense malaria drugs every time a child has a fever, even though some studies have found that 90% of fevers are not related to malaria, the Times reports. According to the Times, subsidies can be "costly and wasteful" in situations where malaria is over-diagnosed and over-medicated (New York Times, 4/17).