DiagnosticsNew Global Subsidy For Malaria Medicines Must Ensure Quality Of Care
A new subsidy designed to increase access to life-saving antiretrovirals
must remain focused on quality patient care if it is to succeed, argues
Tido
von Schoen-Angerer and colleagues in this week"s open access journal PLoS
Medicine. The subsidy, called the Affordable Medicines Facility-malaria
(AMFm), will be rolled out in 2009 and is designed to address concerns of
poor access to artemisinin combination therapies (ACTs) for malaria, and
fears about growing resistance to the drugs. Dr. von Schoen-Angerer and
colleagues cite a recent household survey across 18 African countries that
found only about 3% of children under five years with fever had received
an ACT.
The authors say that in order to enhance quality of care, the AMFm should
adopt policies to exclusively fund fixed dose combinations, withhold
support
for ineffective combinations, and support wider adoption of rapid
diagnostic tests (RDTs). The authors demonstrate how generic competition
has reduced
the price of antimalarials over time.
"The AMFm is an innovative but untested global initiative with the
potential for both positive and unintended consequences for health," say
the
authors. "Keeping the focus on quality care-through patient-centered
policies on drug choice, diagnostics, delivery, and M&E-will help the AMFm
to meet the long unfulfilled promise of artemisinin for the millions who
continue to suffer from malaria today."
The Affordable Medicines Facility-malaria (AMFm), a new global health
initiative, aims to address inadequate access to ACTs for treating P.
falciparum malaria by subsidizing producer prices. First proposed in 2004,
the facility aims to lower end-user prices to the level of older
antimalarials in order to save lives by making ACTs more affordable and to
delay resistance to artemisinin derivatives by driving artemisinin
monotherapy and substandard antimalarials out of the market. The AMFm is
hosted by the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and 11
countries have been invited to participate in the initial phase: Benin,
Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Rwanda, Senegal,
Tanzania,
and Uganda.
Funding:
The authors received no specific funding for this article.
Competing Interests:
Jean-Marie Kindermanswas an unpaid member of the
Committee on the Economics of Antimalarial Drugs for the Institute of
Medicine
2004 report ""Saving Lives, Buying Time: Economics of Malaria Drugs in an
Age of Resistance,"" which first proposed a subsidy. JMK and Tido
von Schoen-Angerer have been consulted as stakeholders during the
preparation of the technical proposal of the AMFm, but none of the authors
had any
role in the design nor any other official role
Citation:
"Focusing on Quality Patient Care in the New Global Subsidy for Malaria Medicines."
Moon S, Perez Casas C, Kindermans J-M, de Smet M, von Schoen-Angerer T (2009)
PLoS Med 6(7): e1000106. doi:10.1371/journal.pmed.1000106
PLoS Medicine