Health Policy and Planning
Volume 26 Issue 6 November 2011
http://heapol.oxfordjournals.org/content/current

Commentary
Oliver Sabot, Megumi Gordon, Bruno Moonen, Ambrose Talisuna, and George Amofah
A path to an optimal future for the Affordable Medicines Facility – malaria
Health Policy Plan. (2011) 26(6): 441-444 doi:10.1093/heapol/czr067
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In 2004, the Institute of Medicine (IOM) proposed a simple solution to a pressing global problem (Arrow et al. 2004). The price of artemisinin-based combination therapies (ACTs), the most effective malaria treatment in many countries, would be subsidized at the factory-gate to make them as affordable as ubiquitous, sub-optimal monotherapies such as chloroquine. This would, the IOM theorized, lead to widespread crowding out of the less effective drugs through both public and private channels, thereby improving immediate health outcomes and delaying the development of devastating resistance to artemisinin.

The subsequent process to translate that theory into a corresponding global initiative, however, was complex and lengthy, with 3 years of debate. Sceptics of the subsidy argued that it would not have the necessary impact because middlemen would capture excessive profits, poorer patients would not access the drugs through private shops regardless of price, and most ACTs would be purchased by individuals without malaria and would be wasted (Oxfam International 2009; Kamal-Yanni 2010). Proponents countered that market forces would ensure affordable pricing and broad supply, and that the problems of ensuring the equity and targeting of ACTs were not unique to the private sector and had not hampered major investments in distribution of drugs in the public sector (Roll Back Malaria Partnership 2007). After significant negotiation and compromise, the Affordable Medicines Facility-malaria (AMFm), as the subsidy concept is now known, opened its doors in July 2010. One of the most important compromises was that the AMFm would not begin as a global initiative, but would rather be ‘piloted’ at national-scale in selected malaria-endemic countries with an extensive evaluation of that initial phase. The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which hosts the AMFm, eventually set December 2012 as the target date to review the evaluation …