Malaria treatment initiative under attack

by Paul Chinnock, TropIKA.net:

An initiative that aims to improve the availability of effective treatment for malaria to people in poor countries has come under attack from leading development agency Oxfam.

The Affordable Medicine Facility was formally launched in April this year and is intended to expand access to the most effective treatment for malaria - artemisinin-based combination therapies (ACTs). The initiative will reduce the sales price of ACTs in the public, private and not-for-profit sectors. It is operated by the Global Fund to Fight AIDS, Tuberculosis and Malaria, with the support of the World Bank, the UK government and other donors. Prices of ACTs will be reduced from US$6-10 per treatment to 20-50 cents

Oxfam says it supports the overall goal of the Affordable Medicine Facility to cut the prices of antimalarials. But it is concerned that the distribution of drugs through ordinary shops will lead to misdiagnosis and mistreatment, including the sale of incomplete courses of medicines. All of these will increase the likelihood of drug-resistant malaria developing and spreading.

Many people in malaria-endemic countries obtain the drugs they need through the private sector, and government health facilities are frequently out of stock of many essential medicines including antimalarials. There has, therefore, been general agreement that the availability and cost of drugs in the private sector is a key issue, hence the decision to include this as part of the new initiative. However, most private outlets for drugs are unregulated; medicines are sold by unqualified shopkeepers.

Anna Marriott: Oxfam health policy adviser, says: "By promoting the distribution of anti-malarial drugs through unregulated private shops and despite its good intentions, the UK Government risks unwittingly contributing to a major setback in the fight against the disease.

"The world has already lost chloroquine, a very effective and cheap drug, because poor people could not buy a full course from ordinary shops. We now risk repeating the same story. That would be a disaster for hundreds of millions of people at risk from malaria."

Most comment on the Affordable Medicines Facility has so far been positive. It has been described as "a triumph of international cooperation" by Professor Awa-Marie Coll-Seck, Executive Director of the Roll Back Malaria Partnership. (See also a commentary in the UK Guardian newspaper.) However, the issue raised by Oxfam could now be the subject of some debate.

Selected countries - Benin, Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Rwanda, Senegal, Tanzania and Uganda - have now been invited to apply for support from the initiative during its first two years. The appearance of artemisinin resistance in one of these countries, Cambodia, has been linked with the widespread availability of substandard drugs containing artemisinin in private outlets.

http://www.oxfam.org.uk/media-centre