Health experts acknowledge they must quickly find new weapons in the fight against malaria. Chloroquine, the lifesaving drug they have relied upon for years, is losing its effectiveness, as resistant strains of malaria spread in Africa and elsewhere. The U.S. Institute of Medicine says adopting a new malaria strategy is as much a question of economics as of medicine.
A new Institute of Medicine report calls for a worldwide fund that would provide a new class of anti-malarial drugs at an affordable price. The proposed fund would seek from $300-$500 million per year, many times what the world currently spends on anti-malarial medicines.
Transmitted through mosquitoes, malaria infects about 300 million people and causes about one million deaths each year. And with chloroquine-resistant malaria on the rise in places like Africa, the disease will only spread unless Africans can get access to a new anti-malarial drug.
The drug, called artemisinin, is currently used in Southeast Asian countries and some parts of South Africa. Doctors give artemisinin in combination with another medicine, so that it is harder for the malaria to develop resistance.
Physician Fatoumata Nafo-Traoré directs the Roll Back Malaria Partnership at the World Health Organization. She agrees that chloroquine is failing and supports the study's recommendation to subsidize the so-called artemisinin combination therapies (ACTs).
"If we all can agree on this recommendation it will give us a tremendous impact," she said. "We are promoting the use of these new, highly effective drugs. What happens at a country level is that it takes time for a country to have evidence on the level of drug resistance, to change the drug policy, to go for training, for procurement, and finally have the drug available at a country level."
Stanford University economist and report author Ken Arrow explains that cost is the main barrier to using ACTs in Africa. ACTs cost over two dollars a treatment, whereas chloroquine costs only about ten cents.
"In Africa, the resistance has been very simply, cost," he noted. "These are countries with incomes of $1000 per person per year, so drugs that cost two dollars a treatment, and may be needed several times a year, become impossible to conceive without subsidies."
Mr. Arrow explains that the $500 million ACT fund would act like a single, dependable customer for ACT manufacturers. He looks to industrialized countries and organizations like the World Bank for funding.
"We want an organization to operate at an international level to buy the drugs from the manufacturers and then sell it at a big loss to private and public sectors, for the final distribution," he explained. "If you look closely at the international development agency, and the World Bank, there are a lot of funds that have been set aside for poor countries under various headings. We feel that would be a good source."
Mr. Arrow says an ACT fund will give drug manufacturers the financial incentive to ramp up production, so that there will be enough ACT to treat the millions of malaria-affected people in Africa. He adds that creating this large market for the medicine will also drive down its price. Finally, Mr. Arrow says the fund will subsidize ACT so that it will be as inexpensive as chloroquine.
At the World Bank, malaria coordinator Olusoji Adeyi welcomes the report but is not yet sure what the organization will do with it. According to Mr. Adeyi, the World Bank has given $150 million to malaria control projects over the past five years.
"With reference to this particular report, we are studying it very carefully to see what the specific implications might be for the way we approach malaria control, and we'll take it forward from there," he added.
At the Institute of Medicine, Mr. Arrow says getting the ACT subsidy fund up and running will take two to five years. He says that in addition to malaria treatment, increased malaria prevention measures will also be needed to combat the disease.