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Interactive data visualizations of antibiotic use and resistance in North America and Europe
What lessons can be taken away from the Affordable Medicines Facility-malaria pilot?
After examining the results of a 2-year pilot in seven African countries (Ghana, Kenya, Madagascar, Niger, Nigeria, and Tanzania, including Zanzibar and Uganda), the authors drew four main conclusions that should be taken into account in subsequent phases of AMFm:
In mid-November 2012, the board of directors of Global Fund to Fight AIDS, Tuberculosis, and Malaria will decide whether to continue, modify, or terminate AMFm. This decision has broad implications for the availability and affordability of effective malaria medications going forward. As the piece concludes:
"Termination of AMFm will create instability in artemisinin production, will reduce access to affordable ACTs, and will be seen as abandonment - both by the many people who depend on AMGm and by the ACT producers. It will cause the kind of reaction that will detract from efforts to reduce deaths from malaria, to engage the private sector in providing community-based health care in poor countries, and to build credible health diplomacy."
In 2001, the World Health Organization (WHO) recommended that countries use artemisinin-based combination therapies (ACTs) to treat malaria patients (1), as continued use of artemisinin monotherapies and substandard drugs had the potential to lead to widespread resistance to artemisinin, the most effective drug for malaria. But ACTs were unaffordable for most people in malaria-endemic countries, particularly in the private for-profit sector where most people seek treatment. Artemisinin monotherapies and the threat of resistance remain a problem. Resistance has now emerged in Cambodia and is spreading to Myanmar and Vietnam (2). Despite WHO's efforts, monotherapies are produced by 37 pharmaceutical companies and marketed in 29 countries (3). Although resistance to artemisinin had not been detected at the time of the Institute of Medicine (IOM) report in 2004 (4), an IOM committee proposed a global subsidy high in the distribution chain, both to make ACTs inexpensive and to displace artemisinin monotherapy and other ineffective drugs.