October 05, 2012
Last month, nearly 80 global health experts met at the National Academy of Sciences to review the independent evaluation of the Affordable Medicines Facility-malaria program (AMFm) and to discuss the future of broader febrile illness management and financing. AMFm is an innovative financing mechanism designed to expand access to the most effective treatment for malaria, artemisinin-based combination therapies (ACTs), through high-level subsidies. An issue brief on AMFm is available, and additional background reading suggestions can be found on the meeting page.
The meeting, co-hosted by CDDEP and the Institute of Medicine (IOM) in Washington DC has received attention from several press outlets: NPR, Humanosphere, and The Center for Global Development have recently blogged about AMFm, and Nature published a story this week covering the challenges the program may face moving forward.
This blog is a place for meeting participants to share observations from the meeting and reflect on what the future may hold for AMFm and the financing of febrile illness management.
The opinions expressed here are solely those of the authors and do not necessarily reflect the views of CDDEP, the Institute of Medicine, or other organizations represented at the meeting.
Dana G. Dalrymple
USDA, USAID (retired)
Subsidies are not usually best of tools to utilize over time with commodities of social importance. They can be tricky to operate, controversial, and difficult to fund over the long run. But there are cases where they can be essential in the short run, particularly where the private sector has not yet developed or shown an interest (market failure).
Malaria control is a prime example. The disease is almost entirely found in developing nations, especially among the poorest, of which there are many in Africa. Many patients and their families lack purchasing power for even the most important commodities (such as medications), and are highly dependent on the public sector, which may be far from their homes and inadequate for their needs.
For a fairly substantial period, cheap, effective, and widely distributed medicinal drugs, such as chloroquine, were able to keep malaria in check. But, as is well known, the parasite developed resistance to them and there was little in the way of backup treatments with the exception of, fortuitously, the artemisinins. Their resistance is beginning to weaken in Southeast Asia but has not yet extended to Africa, though it likely will in time.
A massive and in many ways remarkable effort spearheaded by the Medicines for Malaria Venture (MMV) is underway globally to discover and develop drugs with a different mode of action that can fill the gap. Some remarkably promising candidates have been identified and are under development and clinical trials. But even if they survive this process (few do), their production will need to be scaled up to commercial levels and at a cost that reduces or eliminates the need for a subsidy—not an easy or quickly-solved task.
Hence, any way you look at the current situation, substantial funding over more than a few years will very likely be needed to bring even the most promising drugs into use. And when science and technology have accomplished this, subsidies may be necessary to enable or stimulate additional adoption in the poorest nations. It is a job for all sectors—private, public/private, or public.
While very promising scientific and technological developments have been made, a continuation of The Affordable Medicines Facility-malaria (AMFm) for at least a few more years is essential to maintain their current momentum and bring their most promising current developments into play. Without it, the whole package might well be greatly reduced or even crumble in critical aspects.
