Saving Lives, Buying Time Economics of Malaria Drugs in an Age of Resistance (2004) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-16
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or European standards and highly costeffective by any norm, neither national governments nor consumers in most 1
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This committee was asked to recommend economic mechanisms to make effective antimalarial drugs widely accessible in order to stem the deaths from drug-resistant malaria that now occur day in, day out. When it comes to saving lives, effective drugs will always be a mainstay while malaria continues to threaten humankind.
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for first-line treatment of uncomplicated malaria; however, without external funding neither governments nor consumers -- who bear most of the cost -- can afford them. The IOM committee took these realities into account in devising a concrete plan for reversing the trend of increased malaria morbidity and mortality while preserving effective drugs for the future.
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The logic is as follows. In the case of any antimalarial drug, the new development of drug resistance is a rare event: a chance genetic change in a single parasite in a single patient.2 But once that single malaria parasite generates multiple descendants, the math changes.
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The window of opportunity to create a global public good -- years of extended effective antimalarial drug life -- is open now, but it may not remain open very long. The equal urgency for change in Asia and Africa may seem counterintuitive but antimalarial drug resistance historically has emerged in areas of low transmission -- mainly Southeast Asia and South America -- and then spread to high-transmission areas, mainly Africa.
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THE CASE FOR A GLOBAL SUBSIDY FOR ANTIMALARIAL DRUGS: THE CORE RECOMMENDATION OF THIS REPORT The global community can take definitive action by subsidizing the difference in cost between inexpensive but ineffective antimalarials, and effective ACTs. For ACTs to reach most consumers, the subsidy must first bring the price of ACTs down to about the price of chloroquine (even at those prices, the poorest in society will need assistance to make them af 3On average, one hectare of A
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. Then the subsidy must be sustained, at least over the medium term, until either economic conditions improve in the endemic countries, or the price of effective antimalarials comes down significantly.
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Structuring an antimalarial subsidy supranationally is also consistent with recent efforts to increase global funding for the major diseases of poor countries.
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In the best case, demand will decline as better treatment and other control measures take effect. The Need for a Centralized Procurement System A mechanism for centralized procurement of antimalarial drugs (analogous to the process by which many nations now obtain subsidized tuberculosis drugs and childhood vaccines)
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, and consumer education will facilitate both price controls and the rational use of antimalarial drugs, and should be supported internationally and nationally. The need for action is urgent, but optimal levels of financing and procurement will likely take 2 to 5 years to ramp up.
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This will require strengthened health care systems, better patient education regarding combination antimalarial treatment, and further innovations in antimalarial tools and access to them. On the positive side, there is every reason to believe that effective drugs combined with other control measures in well-designed, locally appropriate programs can lower the malaria burden close to zero in some places.
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Within 5 years, governments and international finance institutions should commit new funds of US $300-$500 million per year to subsi dize coformulated ACTs for the entire global market to achieve end user prices in the range of US$0.10-.20, the current cost of chloro quine. The subsidy must be applied high up in the ACT supply chain, above the level of individual countries.
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Monotherapy with oral drugs as first-line treatment will be discouraged by the availability of lower-priced ACTs, but this should be reinforced by other disincentives. Countries that obtain subsidized ACTs through the centralized procurement organization should neither register nor allow domestic production of artemisinin monotherapies or other drugs that are or would be effective partners to artemisinins.
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Early warning systems that identify drug resistance, if acted upon in a timely way, could lead to the replacement of a failing ACT partner drug. This action, in turn, could protect the artemisinin component of a given ACT and save lives.
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The requirement for monitoring and surveillance cannot be absolute, however, in cases where it would impede access to effective, combination antimalarials. Countries in or just emerging from conflicts, or those dealing with natural or manmade disasters, for example, may not have the administrative capacity to monitor drug resistance.
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