Malaria Drug Subsidies: Good Idea Or Wrong Path?

By Scott Hensley

Published October 31, 2012 at 1:40 PM EDT

Dr. Esther Dalizu holds a pack of Coartem Malaria drugs in a pharmacy in Nairobi, Kenya, last year.

A month ago we wrote about results from an experiment in getting the most effective malaria drugs to more people who need them in Africa.

The idea was to subsidize the cost of drugs, sometimes to a price point below their wholesale cost, and make them more widely available.

Now the findings, presented publicly at a meeting in Washington, have been published in The Lancet.

In most of the countries where the subsidies were tried, the share of the market for artemisinin-combination therapies, or ACTs, went up a lot. In Zanzibar (part of Tanzania) and Nigeria, the ACT drugs helped drive down sales of one-drug treatments. Those so-called monotherapies, which are cheaper, are a problem because they can spur drug-resistant malaria.

The Affordable Medicines Facility-malaria program, or AMFm, brought more than 100 million doses of malaria drugs to clinics and pharmacies in 2011.

"The programme has been highly controversial," the authors of the study acknowledge. A big worry: Middlemen would pocket the subsidies and consumers, especially the poorest ones, wouldn't benefit.

Others say the program, a pilot test of the concept, hasn't been able to show it saves lives or made a dent in resistance. The aid group Oxfam blasted the approach, saying it's risky and a distraction:

The Affordable Medicine Facility–malaria has shown no evidence that it has saved the lives of the most vulnerable or delayed drug resistance. Rather, this global subsidy has incentivised medicine sales without diagnosis and shown no evidence that it has served poor people. It poses a risk to public health and could skew investment away from effective solutions.

Oxfam recommends that the board of the Global Fund pull the plug on it next month.

But supporters of the idea, writing an accompanying editorial in The Lancet, disagree, saying a board vote against the program would be a mistake:

Most importantly, it will kill a programme that, when fully implemented, rapidly met its benchmarks despite the many constraints, expectations and unrealistic timelines imposed on it. We must acknowledge that an efficient approach to subsidising antimalarial drugs has worked, making them available in the private sector where people go to buy them.