PHA-Exchange> Malaria drug for the poor ‘a bad idea’

[claudio at hcmc.netnam.vn]

 from Vern Weitzel <vern at coombs.anu.edu.au> -----


http://www.ft.com/cms/s/36050d54-e6b3-11db-9034-000b5df10621.html

Malaria drug for the poor ‘a bad idea’

By Andrew Jack in London

Published: April 9 2007 17:04 | Last updated: April 9 2007 17:04

Innovative plans to subsidise malaria drugs to make them more affordable for 
the poor will be 
counter-productive and should be abandoned, the outgoing head of the world’s 
largest multilateral 
funder of projects to fight infectious disease has warned.

Sir Richard Feachem, who stepped down from the Global Fund to fight Aids, TB 
and Malaria last month, 
said a “high-level” malaria subsidy under development with World Bank 
support risked failing to 
reach those for whom it was intended and even worsening the incidence of 
malaria. He said it would 
undermine pharmaceutical innovation and distract political commitment.

His comments came at the end of his five-year contract with the Fund, which he 
has built into an 
organisation with more than $10bn in donor pledges to support treatment and 
prevention programmes 
that tackle the most lethal infectious diseases around the world.

Significant new hope in the fight against malaria – which kills more than 1m 
people a year – has 
come recently via the launch of highly effective combination drugs based on 
artemisinin, a Chinese 
medicinal herb, to which the parasite has little resistance.

However, the relatively high cost of the drug compared with existing less 
effective anti-malarials 
prompted Kenneth Arrow, the US Nobel prize-winning economist, two years ago to 
propose a “high-level 
subsidy” for malaria, designed to reduce substantially the raw material 
costs and to persuade the 
poor to use it.

The Bill and Melinda Gates Foundation gave a $4m grant to study the 
feasibility of the idea to the 
World Bank, which has since sub-contracted to specialist consultants an 
analysis of how the scheme 
would work.

Earlier this year the Dutch government, strong backers of the proposal, hosted 
a technical meeting 
to discuss progress in Amsterdam, and British officials have also been 
involved in talks that could 
lead to a $300m annual subsidy being launched by early next year.

However, a recent internal position paper by the Global Fund argued that even 
with the subsidy, the 
price would remain unaffordable for many consumers, who may start treatment 
and then drop it, 
triggering drug resistance and a further increase in the number of victims of 
malaria.

It also argued that advocates for the subsidy had attempted to create the 
impression of consensus in 
favour, when serious criticisms had not been addressed. “It’s not just 
getting the design right – we 
should not be doing it,” said Sir Richard.

Defenders of the malaria subsidy argue there is a need for greater involvement 
of the private 
sector, given that most people in the developing world buy their drugs 
commercially whereas the 
Global Fund’s programme predominantly gives money to government and non-
profit groups.

Michel Kazatchkine, a French doctor and Aids specialist, took over from Sir 
Richard this month. In 
addition to the malaria issue he has to address relations with Unitaid, a 
French-led initiative to 
support drug purchases for infectious diseases.



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