Fighting Against Malaria: The Dangers of Drug Resistance and the Need for Global Subsidies in this Economic Climate

By: Faigy Abdelhak

The Global Fund to Fight AIDS, Tuberculosis and Malaria, the world’s largest investor in fighting these three ailments, recently announced that they are not able to offer any funding over the next two years due to effects from the financial crisis. In the face of the fact that resistance to Chloroquine is growing – the cheap and thus-far effective drug of choice against malaria – an impending decline in funding becomes even more pressing. The alternative when Chloroquine ceases to do the job is artemisinin-combinations therapies (ACTs), and it is ten times the price.

In 2001 the World Health Organization (WHO) pushed to prevent drug-resistance by encouraging governments to ban monotherapies so people use ACTs, but the move was evident to become moot and unenforceable. However, ACTs are still the WHO’s official recommendation in the treatment of even uncomplicated case of malaria. While in the short-term, Chloroquine is still an effective solution in many uncomplicated cases, in the long-term it’s repeated usage may prove harmful in building resistance among the population.

The lack of funding for implementing ACTs sooner rather than later can slow or even reverse the rate of progress made thus far against this disease. It is a dangerous gamble for the world to delay finding the proper funding for subsidizing ACTs worldwide in the near future in the hopes the the resistance to the drug Chloroquine won’t grow at the rate predicted. The U.S. Institute of Medicine (IOM) established a committee to tackle just this dilemma, and in 2004 their primary recommendation was to develop a global subsidy in the distribution chain. While allowing both Cholorquine and ACTs to both be available on the global market, the subsidy would allow impoverished people to make a drug choice based on efficacy rather than cost.

The subsidy of ACTs has led to mixed results; while urban or wealthier communities have seen growth in it’s uptake, more impoverished and rural communities have seen less of an impact. So while subsidies did lead to strong gains for ACTS in the global market place, which is significant progress that is not to be minimized, it is not reaching the poorest communities that are most affected by malaria and are most likely taking Cholorquine more than one time in their lives.

Therefore, further action for promoting ACTs among rural communities, especially in Africa, is crucial. Whether it means finding further subsidies for certain regions or educating local communities about the greater benefits of ACTs over the drug of choice they have known for many years, the global community need to take this opportunity to prevent an endemic due to drug-resistance while it still can. With the The Global Fund to Fight AIDS, Tuberculosis and Malaria withdrawing funding for the next two years, many other individuals, governments, and NGOs are going to have to step up to the plate and contend with this challenge.

Sources:
Heilprin, John. “Global Fund for World Health Halts New Programs.” 11.24.11. Associated Press. 
Laxminarayan Ramanan and Hellen Gelband. “A Global Subsidy: Key To Affordable Drugs For Malaria?” Health Affairs: Vol.28 No.4. 2009.
Yamey, Gavin and Marco Schaferhoff.”Price Subsidy Schemes for Artemisinin-Based Combination Therapies (ACTs): Do They Work?” Evidence to Policy Initiative. 2011.

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