From Financing to Fevers: Lessons of an Antimalarial Subsidy Program

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Science  02 Nov 2012:
Vol. 338, Issue 6107, pp. 615-616
DOI: 10.1126/science.1231010

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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.