New malaria drug subsidy fails to ensure patients receive best treatment options - The scheme's procurement policies must change.

A global malaria drug subsidy to be launched this month is failing to look at medical needs and is jeopardising the future of the most effective malaria treatments that exist today, says international medical humanitarian organisation Médecins Sans Frontières (MSF).

The Affordable Medicines Facility for Malaria (AMFm) will massively subsidise the price of artemisinin-based combination therapies (ACTs), the most effective malaria treatments that exist today. The scheme seeks to reduce the price of ACTs sufficiently to drive older, ineffective treatments that are still being purchased because they are considerably cheaper, out of the market.

"The AMFm has potential to save lives and at the same time to make sure that ACTs stay effective for as long as possible, by ensuring that patients only have access to the best treatment options," said Dr. Tido von Schoen-Angerer, Director of MSF's Campaign for Access to Essential Medicines. "But the guidance issued for purchasing the malaria treatments that the scheme will subsidise is failing to make sure that happens."

The Global Fund to Fight AIDS, Tuberculosis and Malaria, which hosts the AMFm, has stopped short of saying that it will exclusively purchase fixed-dose combinations (FDCs), where several drugs that need to be taken together are combined into a single pill. FDCs lead to better patient adherence and reduce the risk of drug resistance. The key anti-malarials needed in Africa are available in these easy-to-use combinations from several producers and meet WHO quality standards. FDCs from more producers are expected to meet these standards in the coming year.

But by authorising the purchase of co-blisters, where drugs are packaged together but not combined in the same pill, the Global Fund is running the risk that patients take only one of the drugs, which greatly increases the risk of resistance developing. "Chloroquine, previously the main drug used to treat malaria, is now ineffective because the parasite has grown resistant to it," said Dr. von Schoen-Angerer. "We have to prevent that happening to ACTs, because if resistance develops, there is no back up treatment option."

MSF is now calling on the Global Fund and the international organisations supporting the AMFm to revise the purchasing rules in order to prevent the risk of resistance developing to ACTs. "It is feasible to rely on FDCs alone, and keep co-blisters as a back up but for a limited time only, after which they should no longer be bought with donor support," said Dr. von Schoen-Angerer. "The purchasing policy of the malaria subsidy needs to be changed now before the initiative is officially launched - there is just no excuse not to do so."