In a relatively short period, 2003 – 2007, all malaria endemic countries in Africa adopted artemisinin-based combination therapy (ACT) drugs as their nationally approved first line treatment.Â Unfortunately the uptake of ACTs in actually treating children remains extremely low. The Press Center at the Multilateral Initiative for Malaria 5th Pan-African Malaria Conference hosted a press conference to highlight efforts to promote and keep track of ACT use.
Suprotik Basu, Advisor to the UN Special Envoy for Malaria, moderated the panel and explained that the United Nations is promoting universal coverage of correct and prompt malaria treatment by the end of 2010 with a goal of ending malaria deaths by 2015. This is a huge challenge starting from a baseline in 2006 of only 3% of children who received any malaria treatment getting ACTs.
While there are efforts underway to ensure that more ACTs will be available at prices people can afford, including the new ‘experimental’ program Affordable Medicines Facility – malaria (AMFm), it is also important to have a mechanism in place to track what is happening with ACTs.
Des Chavasse, PSI’s Vice President for Malaria Control and Child Survival, is also heading up the ACT Watch project, funded by the Bill and Melinda Gates Foundation. ACT Watch is monitoring malaria medicine outlets – public and private – in 7 countries in Africa and Southeast Asia and conducting community surveys to achieve this goal of ACT tracking.
At its start, ACT Watch has documented that more than half of parents access malaria medicines for their children in private outlets, and where ACTs are available in these shops, a rare occurrence, they can cost 10 to 20 times more than the (ineffective) common treatments available. Many parents are not aware of ACTs as the new approved malaria medicine, but those who do are four times more likely to get ACTs at a private outlet.
While efforts are underway to promote and track ACTs, ACT Watch is also tracking the distribution of other antimalarials.Â Peter Olumese who focuses on malaria case management at WHO’s Global Malaria Program, explained that due to cost and communication challenges, monotherapy artesunate drugs are often sold in the private sector. This will exacerbate the development of resistance of malaria parasites to artemisinin-based drugs. The availability of effective and cheap ACTs through programs like AMFm will hopefully drive the ineffective or dangerous antimalarials from the market.
Oliver Sabot from the Clinton Foundation shared that although US$ 180 million was now available annually to buy ACTs, but in the best situation only about 25% of children who receive malaria treatment get ACTs.Â There needs to be a dramatic scale-up if even 80% coverage is to be achieved by the end of 2010. AMFm may make a dent if ACTs can actually reach the consumer at only 5% of current retail costs.
The most exciting aspect of the press briefing was a report by Ambrose Talisuna who represents Medicines for Malaria Venture in Uganda. Uganda has been experimenting with with subsidized ACTs in the private sector. Child doses are only 10 US cents and 40 cents for adults in contrast to $US 6-10 generally.Â ACT market share has increased from below 1% to 50-60%, and consumers seem to like ACTs. At the same time share of ‘obsolete’ malaria medicines in the market has dropped by 50%.
AMFm will not be a magic bullet to achieve universal coverage since the first few pilot countries will not receive funding until 2010 at the earliest. AMFm will also operate for only 2 years until an evaluation will guide further work. In the meantime more efforts like those in Uganda are needed – nothing stops countries using their existing GFATM grants to subsidize ACT costs in the private sector as Nigeria is doing.