A controversial program that uses
the private market to provide affordable malaria treatments to people in Africa
has dramatically increased access to care and should be continued, according to a policy article by
scholars including Ramanan Laxminarayan of Princeton University in the Nov. 2
issue of the journal Science.
The researchers stated that the
two-year old pilot program, which is up for renewal this November and enables
reduced-price malaria drugs to
be sold in shops and market stalls, successfully broadened the availability of
effective malaria therapies and reduced the use of less effective treatments
that promote drug-resistance.
The private-market
approach—sometimes called the Coca-Cola model in reference to the soda's
apparent ability to reach remote areas of the world—aims to deliver drugs in
regions where the majority of people obtain medicines from shops rather than
from district hospitals or clinics.
"This experiment
demonstrates that we can use private distribution mechanisms to make treatments
available in rural areas," said Laxminarayan, a research scholar in the
Princeton Environmental Institute, lecturer in economics at Princeton University
and director of the Center for Disease Dynamics, Economics and Policy in
Washington, D.C.
Laxminarayan co-authored
the Science article with Kenneth Arrow, professor of economics
at Stanford University and a 1972 Nobel laureate in economics; Dean Jamison,
professor of global health at the University of Washington in Seattle; and
Barry Bloom, Harvard University Distinguished Service Professor at the Harvard
School of Public Health.
The researchers found that the
program, known as the Affordable Medicines Facility - malaria (AMFm), enhanced
access to the most effective malaria medicine, known as artemisinin combination
therapy (ACT), while reducing purchases of less-effective drugs, such as
artemisinin alone, which has been shown to promote artemisinin-resistance.
ACT prices were lowered by a
range of US $1 to US $5 per dose in the five countries that substantially
implemented the program, according to results published in
the Oct. 31, 2012 issue ofThe Lancet. The price-reductions were achieved
via negotiations with manufacturers and subsidies from donors. The program
operated in seven African countries (Ghana, Kenya, Madagascar, Niger, Nigeria,
Tanzania and Uganda) and was organized by the Global Fund to Fight AIDS,
Tuberculosis, and Malaria.
Controversial when first proposed
(see "Malaria
Drugs, the Coca-Cola Way" in Science, Nov. 21, 2008),
the private-market approach is a departure from government-run programs that
rely on healthcare workers or clinics to distribute free or subsidized malaria
drugs. Critics worried that the approach was unproven and that distributors
might pocket the subsidies, according to the 2008 article.
The success of Coca-Cola and
other goods at making it to rural markets stems from the fact that someone
makes money at every step in the distribution chain, Laxminarayan said. Making
malaria drugs available at low prices to distributors and retailers enables
these distribution chains to carry ACTs to distant marketplaces, he said.
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