New global subsidy for the most effective malaria drugs shows promise

October 30, 2012

"Africa is home to 80% of malaria cases, yet most of the population do not have access to affordable ACTs", explains Kara Hanson from The London School of Hygiene and Tropical Medicine, UK, one of the lead authors. "Access is restricted by unreliable public health facility supply, high prices, and limited availability in the private sector where most people go to buy medicines. Cheaper, less effective antimalarials currently dominate the market. Worryingly, artemisinin monotherapies are also widely available in some countries, and use of these medicines can encourage development of resistance to ACTs."**

The study evaluated eight national AMFm pilot programmes in Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (including Zanzibar), and Uganda. Changes in availability, price, and market share were assessed in each country using nationally representative surveys of public and private sector outlets that stock antimalarial drugs before, and 6󈝻 months after, the introduction of subsidised quality-assured ACTs (QAACTs) and supporting interventions (e.g. communication campaigns).

Between August, 2010, and the end of 2011, over 155 million doses of QAACTs were subsidised by AMFm. QAACT availability more than doubled in five countries and market share more than doubled in four. The effect of AMFm was more limited in Niger and Madagascar, where AMFm ACT orders were lower.

AMFm had a particularly dramatic effect on the private sector where QAACT market share increased in all pilots, with the increase exceeding 30 percentage points*** in five of these. What is more, private for-profit QAACT prices fell substantially (by up to 80%) in six countries, with the decrease ranging from US$1.28 to $4.82 per dose.

The market share of artemisinin monotherapies also experienced large declines in Nigeria and Zanzibar, the two countries where their presence on the market was highest at the start of the programme.

Although AMFm had less impact on public health facility ACT supply, the authors point out that there were substantial delays in ordering drugs and implementing the full programme in some countries.

"But not all of the changes observed can be attributed to AMFm", caution the authors. "There was some evidence from two countries that prices had already begun to fall before AMFm started and the market share of ACTs had started to increase, although most of this increase occurred in the public sector."**

According to Hanson, "It is clear that tapping into the private sector distribution chain can have a major influence on which antimalarial treatments are available and their price and quality in just a few months, but more information is needed about whether the subsidised drugs are reaching those most in need and on how diagnostics can be scaled up in the public and private sectors."**

Writing in a linked Comment, some of the world's most eminent scientists warn that despite the programme's success its future could be under threat, "In November, 2012, the Board of the Global Fund will vote to either continue AMFm in a modified form after December, 2013, or terminate the programme. There is a strong push from donors (though not from countries) to integrate AMFm into the regular Global Fund model, whereby countries would choose how much of their country budget envelopes, which are already committed to other priorities supporting the public sector, to reallocate to AMFm. We believe that this approach will create instability in artemisinin demand, lower the number of ACT manufacturers, increase ACT prices, and abandon the millions who depend on AMFm-subsidised ACTs."

Worse still they say, "With the world's largest global health funder [the US President's Malaria Initiative (PMI)] expressing unremitting opposition, even after the positive independent evaluation, 13 the programme's future is uncertain. PMI has yet to suggest an alternative that would come close to the access afforded by AMFm in the private sector."
-end-
Notes to Editors:

*AMFm is a global initiative hosted by the Global Fund to Fight AIDS, Tuberculosis, and Malaria that aims to improve the easy purchase and use of quality assured ACTs by subsidising manufacturer prices and reducing consumption of artemisinin monotherapies.

**Quotes direct from author and cannot be found in text of Article.

***QAACT market share was measured as the share of all antimalarials sold that was made up by QAACTs. The change over time in market share is the change between baseline and endline in these shares, and presented as a percentage point change.

Lancet

Related Medicines Articles from Brightsurf:

Turning alcohol into key ingredients for new medicines
Chemists have found a way to turn alcohol into amino acids, the building blocks of life.

New understanding of asthma medicines could improve future treatment
New research has revealed new insights into common asthma aerosol treatments to aid the drug's future improvements which could benefit hundreds of millions of global sufferers.

2019's new medicines
With 48 drugs approved by the US Food and Drug Administration (FDA), 2019 was another highly productive year for the pharmaceutical industry.

A simpler way to make some medicines
Organic chemists have figured out how to synthesize the most common molecule arrangement in medicine, a scientific discovery that could change the way a number of drugs -- including one most commonly used to treat ovarian cancer -- are produced.

Human medicines affect fish behavior
Human medicines that act on important signal systems in the brain make fish bolder, shows a new study on three-spined sticklebacks by researchers at Linköping University, Sweden.

A Canadian essential medicines list must be evidence-based
An essential medicines list in Canada should be evidence-based and independent of conflicting interests, found a study of decision-makers and policy-makers that is published in CMAJ (Canadian Medical Association Journal).

Did providing free essential medicines increase adherence?
More patients who said they couldn't afford their medications adhered to treatment when they received free essential medicines for one year in a randomized clinical trial, but not all measures of health outcomes improved.

Many grandparents' medicines not secure enough around grandchildren, poll suggests
Whether it's a rare treat or a weekly routine, many older adults enjoy spending time with grandchildren.

Are Canadians kept in the dark about new risks of medicines?
Government warnings about potential drug safety risks vary significantly across countries, according to a new international study co-authored by researchers at the University of British Columbia.

Animal venoms are sources in the search for new medicines
The study of natural toxins and their derivatives may help in the development of medicines to treat diseases like cancer and osteoarthritis, says coordinator of the Center of Excellence in New Target Discovery.

Read More: Medicines News and Medicines Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.