Science        
2 November 2012 vol 338, issue 6107, pages 569-712
http://www.sciencemag.org/current.dtl

Policy Forum – Public Health
From Financing to Fevers: Lessons of an Antimalarial Subsidy Program
Ramanan Laxminarayan, Kenneth Arrow, Dean Jamison, and Barry R. Bloom
Science 2 November 2012: 615-616.

Better approaches to affordable drugs, diagnostic tests, and patient-centered treatment are needed in Africa.

Summary
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.