The board of the Global Fund to Fight AIDS, Tuberculosis and Malaria yesterday made a major change to a global malaria subsidy plan that has been the subject of an intense debate for the past few months. The Affordable Medicines Facility-malaria (AMFm), as it is called, will cease to exist as a standalone entity and will become part of the fund's regular funding programs—a decision that critics say will make quality malaria drugs more expensive and more difficult to obtain in African pharmacies.
"It's a real tragedy," says Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy, which is headquartered in Washington, D.C., and New Delhi. "I think we will see drug prices go up, probably sooner than we expect."
Many Africans get their malaria drugs in the private sector, from local pharmacies or village shops, where the latest and most effective generation of drugs, the so-called artemisinin-based combination therapies (ACTs), are often hard to find and expensive. Instead, many people end up with less expensive but ineffective drugs such as chloroquine and artemisinin monotherapies, which increase the risk of drug resistance. AMFm sought to address this problem through a global subsidy that helped make ACTs very cheap for importers in Africa. The hope was that the drugs would trickle down to patients at low prices. In a pilot held the past 2 years in seven countries, the plan worked, according to an independent evaluation published recently in The Lancet.
But critics of AMFm—including the U.S. President's Malaria Initiative (PMI) and Oxfam, a U.K. charity—argue that it's not clear how many of the drugs reached the most vulnerable group—children under age 5 in poor areas—and that, with malaria rates declining across Africa, many drugs must have gone to people who did not have malaria at all. Backers of AMFm say PMI, which did not help pay for the program, has lobbied hard behind the scenes to kill it, a charge that PMI denies.