A new subsidy designed to increase access to life-saving antiretrovirals must remain focused on quality patient care if it is to succeed, argues Tido von Schoen-Angerer and colleagues in this week's open access journal PLoS Medicine. The subsidy, called the Affordable Medicines Facility–malaria (AMFm), will be rolled out in 2009 and is designed to address concerns of poor access to artemisinin combination therapies (ACTs) for malaria, and fears about growing resistance to the drugs. Dr. von Schoen-Angerer and colleagues cite a recent household survey across 18 African countries that found only about 3% of children under five years with fever had received an ACT.
The authors say that in order to enhance quality of care, the AMFm should adopt policies to exclusively fund fixed dose combinations, withhold support for ineffective combinations, and support wider adoption of rapid diagnostic tests (RDTs). The authors demonstrate how generic competition has reduced the price of antimalarials over time.
"The AMFm is an innovative but untested global initiative with the potential for both positive and unintended consequences for health," say the authors. "Keeping the focus on quality care—through patient-centered policies on drug choice, diagnostics, delivery, and M&E—will help the AMFm to meet the long unfulfilled promise of artemisinin for the millions who continue to suffer from malaria today."
The Affordable Medicines Facility–malaria (AMFm), a new global health initiative, aims to address inadequate access to ACTs for treating P. falciparum malaria by subsidizing producer prices. First proposed in 2004, the facility aims to lower end-user prices to the level of older antimalarials in order to save lives by making ACTs more affordable and to delay resistance to artemisinin derivatives by driving artemisinin monotherapy and substandard antimalarials out of the market. The AMFm is hosted by the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and 11 countries have been invited to participate in the initial phase: Benin, Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Rwanda, Senegal, Tanzania, and Uganda.
Funding: The authors received no specific funding for this article.
Competing Interests: Jean-Marie Kindermanswas an unpaid member of the Committee on the Economics of Antimalarial Drugs for the Institute of Medicine 2004 report ''Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance,'' which first proposed a subsidy. JMK and Tido von Schoen-Angerer have been consulted as stakeholders during the preparation of the technical proposal of the AMFm, but none of the authors had any role in the design nor any other official role
Citation: Moon S, Perez Casas C, Kindermans J-M, de Smet M, von Schoen-Angerer T (2009) Focusing on Quality Patient Care in the New Global Subsidy for Malaria Medicines. PLoS Med 6(7): e1000106. doi:10.1371/journal.pmed.1000106
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.1000106
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-06-07-von-schoen-angerer.pdf
CONTACT:
Tido von Schoen-Angerer
Medecins Sans Frontieres (MSF)
Campaign for Access to Essential Medicines
Rue de Lausanne 78
Geneva, CH-1211 Geneva 21
Switzerland
+41 22 849 84 05
+41 22 849 84 04 (fax)
tido.von.schoenangerer@geneva.msf.org
Guillaume Bonnet
Medecins Sans Frontieres (MSF)
Geneva
Switzerland
+41 22 849 8403
+41 79 203 1302 (cell)
guillaume.bonnet(at)geneva.msf.org
Stephan Grosserueschkamp
Medecins Sans Frontieres (MSF)
Geneva
Switzerland
+41 79 293 0270
Stephan.GROSSERUESCHKAMP@geneva.msf.org
About PLoS Medicine
PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org
Also this week: The FDA Provides a Pathway for Licensing Vaccines for Global Diseases
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Funding: The author received no specific funding for this article.
Competing Interests: The author is an employee of the Aeras Global TB Vaccine Foundation with a primary goal of developing and introducing new TB vaccines through global partnerships. Aeras currently sponsors clinical trials of new TB vaccines under the Investigational New Drug process with the US Food and Drug Administration. This article expresses the views of the author and does not necessarily represent the opinion of the Aeras Global TB Vaccine Foundation.
Citation: Brennan MJ (2009) The US Food and Drug Administration Provides a Pathway for Licensing Vaccines for Global Diseases. PLoS Med 6(7): e1000095. doi:10.1371/journal.pmed.1000095
IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000095
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-06-07-brennan.pdf
CONTACTS:
Michael Brennan
Aeras Global TB Vaccine Foundation
Medical Affairs
1405 Research Boulevard, Suite 300
Rockville, MD 20850
United States of America
+1 301 547-2959
+1 301 547-2901 (fax)
mbrennan@aeras.org
About the Public Library of Science
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