A Global Subsidy: Key To Affordable Drugs For Malaria?

Abstract

ABSTRACT:The global fight against malaria has been continually challenged by poor access to affordable, effective medicine. Growing resistance to chloroquine, the traditional treatment, has worsened the situation. Artemisinins, the successor therapy to chloroquine, are at least ten times more costly than the older drug. In developing countries, most malaria medicines are purchased in the private sector, where traditional aid mechanisms do not reach. So a new aid approach was needed. The Affordable Medicines Facility-malaria (AMFm) will efficiently supply publicly subsidized drugs to meet public-and private-sector demand in malaria-endemic countries. If artemisinins are priced more competitively, resistance to them will be delayed. [Health Affairs 28, no. 4 (2009): 949-961; 10.1377/hlthaff .28.4.949] C h l o r o q u i n e wa s t h e o r i g i na l m i r ac le d ru g for malaria-effective for half a century in Africa, safe, and cheap. Despite the spread of chloroquine-resistant malaria parasites (Plasmodium falciparum) throughout Southeast Asia beginning in the 1960s, no plans were laid for replacing chloroquine throughout Africa until it was failing in a big way, toward the end of the 1990s. Even though it was clear that no other available and relatively inexpensive drugs would last more than few years before resistance set in, there was no movement to introduce the single best new alternative: the artemisinin compounds. In use in Asia for decades, artemisinin compounds-derived from the plant species Artemisia annua-are heirs apparent to chloroquine.No serious attempt was ever made to try to preserve chloroquine's effectiveness by promoting combination therapy, now the standard in infectious diseases such as tuberculosis and HIV/AIDS. But with no backup for the artemisinins, malaria thought leaders began laying out a case for delaying their (inevitable) loss to resistance by using them only in combination with another antimalarial.1 The partner drugs would protect the artemisinin by killing any parasites that, by chance, contained an artemisinin resistance mutation. Partner drugs would also be protected

Malaria parasitemia and its association with lipid and hematological parameters among malaria-infected patients attending at Metema Hospital, Northwest Ethiopia

“…13 Previous studies in culture of P. falciparum in vitro experiments proposed that uninfected RBCs in the culture serve as a major source for increased lipid content of malaria-infected cells, and an inverse relationship was observed between the levels of acidic phospholipids and cholesterol. 51,52 Consistent with our study, the review noted that serum levels of VLDL and TG were significantly higher in malaria-infected patients. They further noted that oxidized LDL from malarial patients increased the endothelial expression of adhesion molecules that increased the risk of cardiovascular disease.…”

Subsidizing the Distribution Channel: Donor Funding to Improve the Availability of Malaria Drugs

“…Price-Setting Intermediary Because donors are primarily interested in the availability and affordability of ACTs at the point where products are made available to consumers (Laxminarayan and Gelband 2009), it is essential that a model include the retailer's stocking and pricing decisions. However, in focusing on the retail level, we have ignored vertical layers above in the distribution channel (e.g., wholesaler).…”

Subsidising artemisinin-based combination therapy in the private retail sector

“…The AMFm subsidy programme is designed to increase access to ACTs in the retail and public sector by subsidising the prices of ACTs at the manufacturer level (Arrow 2004; Laxminarayan 2009). The programme aims to lower consumer prices of ACTs, compared to older and less effective antimalarial drugs, available through the retail sector via two mechanisms: (1) negotiating with manufacturers of ACTs to reduce ACT prices; and (2) co-paying a proportion (about 90%) of the reduced ACT price directly to participating manufacturers, hence further lowering prices to eligible wholesalers of ACTs (Global Fund; Laxminarayan 2009).…”

“…The programme aims to lower consumer prices of ACTs, compared to older and less effective antimalarial drugs, available through the retail sector via two mechanisms: (1) negotiating with manufacturers of ACTs to reduce ACT prices; and (2) co-paying a proportion (about 90%) of the reduced ACT price directly to participating manufacturers, hence further lowering prices to eligible wholesalers of ACTs (Global Fund; Laxminarayan 2009). The wholesalers thus pay a lower price for ACTs and prices fall all along the supply chain, increasing affordability for the final consumer, while at the same time undercutting the price of resistance-inducing artemisinin monotherapy and competing with the prices for chloroquine and SP.…”