Press release |

AMFm - New global subsidy for malaria medicines must ensure quality of care – says MSF

Geneva - 21 July 2009 - A new drug subsidy designed to increase access to life-saving malaria treatment must remain focused on quality patient care if it is to succeed, according to a paper published by Médecins Sans Frontières (MSF) authors 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 plans to address concerns of poor access to artemisinin-based combination therapies (ACTs) for malaria, currently the most effective treatment that exists. The authors cite a recent household survey across 18 African countries that found only about three percent of children under five years with fever had received an ACT.

In order to enhance quality of care, the paper argues that 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 also demonstrate how generic competition has already significantly 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,” says one of the authors, Dr von Schoen-Angerer, Director of MSF’s Campaign for Access to Essential Medicines. “Keeping the focus on quality care - through patient-centred policies on fixed-dose combinations, increased access to rapid diagnostics, delivery, and monitoring of real impact for people - will help the AMFm to meet the long unfulfilled promise of artemisinin for those who continue to suffer from malaria today.”

The AMFm aims to address inadequate access to ACTs for treating P. falciparum malaria by subsidising producer prices. First proposed in 2004, the facility aims to lower end-user prices to the level of older antimalarials, making ACTs more affordable and delaying 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.

MSF treats malaria in its programmes around the world and treated close to 1.2 million malaria cases in 2008. MSF was an early proponent of ACTs, and started using them in its projects in Africa in 2001.

The article, “Focusing on Quality Patient Care in the New Global Subsidy for Malaria Medicines”, is freely available from the open access journal PLoS Medicine at:

For more information, please contact:
Guillaume Bonnet, Press Officer, +41 79 203 13 02

Artemisinin-based combination therapy — ACT

The best current treatment is a combination of drugs that includes artemisinin derivatives, extracts of a Chinese plant, Artemisia annua. Artemisinin derivatives should not be used alone, but always with a companion drug such as amodiaquine. A combination of drugs with independent modes of action and different biochemical targets is not only more effective, but also successful in preventing or slowing the development of resistance, because the probability of parasites being simultaneously resistant to two drugs is greatly reduced. Combining artemisinins with a companion drug shortens the treatment course to three days.

How FDCs can protect artemisinins

When provided in co-blisters, where two different drugs are packaged together but not combined in the same pill, there is the risk that patients take only one of the drugs, which greatly increases the risk of resistance developing. Fixed-dose combinations (FDCs), where the drugs that need to be taken together are combined into a single pill, lead to better patient adherence and reduce the risk of drug resistance.