The Global Fund's Malaria Medicine Subsidy: A nice idea with
nasty implications
Richard Tren, Thompson Ayodele et
al. | 08 Sep 2011
Executive Summary
Phase 1 of the Affordable
Medicines Facility for malaria (AMFm) is a $225million
initiative that was launched in 2010 in an effort to increase
access to safe and effective artemisinin-based combination
therapies (ACTs) by dramatically lowering their price with a
global subsidy. The AMFm also seeks to drive out oral
artemisinin monotherapies as their continued use threatens the
entire class of drugs due to drug resistance.
In July 2011, Africa Fighting
Malaria undertook a survey in West Africa to determine the
price and availability of AMFm drugs. While we find that ACT
prices have dropped and there are some positive results
arising from the AMFm, we do not consider these to be
sufficient to mitigate unintended, but not unforeseen, and
worrying consequences that have arisen as a result of this
global subsidy.
As of August 2011, approved AMFm
orders for just four countries, Ghana, Kenya, Nigeria and
Tanzania, account for around 80 percent of the total global
ACT production capacity. This overwhelmingly high demand for
ACTs in just four countries threatens the availability of ACTs
in all other malarial countries. The prospects of ACT
stockouts for non-AMFm participants are real and imminent and
the rapid increase in demand may result in a shortage of
artemisinin.
Our survey and an examination of
AMFm demand and supply records reveal some serious anomalies.
For instance: - Though malaria is mainly a childhood disease,
70 percent of AMFm treatment orders are for adult doses. -
Three ACT manufacturers are also acting as first-line buyers
in Nigeria, Ghana and Uganda with potential conflicts of
interest. - Zanzibar, a country that has almost zero malaria
transmission, has ordered over 240,000 AMFm ACT treatments. -
Our survey in West Africa revealed AMFm products being sold in
non-AMFm countries.
The threat of leakage of AMFm
drugs to non-AMFm countries is real and requires urgent
action. Though our survey was limited in scope, it revealed
that oral artemisinin monotherapies remain on sale and are
often sold at prices below the subsidized AMFm ACTs. No rapid
diagnostic tests were offered or sold to our survey
administrators nor were any prescriptions or other evidence of
definitive diagnosis of malaria demanded.
In this report and on the Africa
Fighting Malaria website we publicize leaked documents that
confirm the scale and seriousness of the problem. In our
opinion the response from the Global Fund Secretariat to the
global supply problems, as evidenced in one of the leaked
documents, is inadequate.
The Global Fund Secretariat
appears preoccupied with continuing the funding for AMFm Phase
1 and with measures to avoid 'reputational' harm. The private
sector can and should play an important role in public health,
but it remains to be seen whether or not the benefits that
have arisen from the AMFm could have been achieved through
alternative mechanisms and potentially at lower cost. In other
words, the evidence to date suggests that the opportunity
costs of the subsidy have probably been considerable. Full
policy paper available at
http://www.fightingmalaria.org/pdfs/amfmpolicypaper.pdf
Thompson Ayodele Director Initiative for Public Policy
Analysis P.O.Box 6434 Shomolu,Lagos Nigeria
Email:thompson@ippanigeria.org Backup:
thompson.ayodele@gmail.com Website: www.ippanigeria.org
*****Good Public Policy is Sound Politics**********
Tel:01-791-0959 Cell:080 2302 5079
