Is showering a country with low-cost malaria drugs the best way to stem the disease? As a US$463-million pilot programme to test the strategy in seven African countries winds down, public-health experts are questioning whether the approach makes sense given shrinking global health budgets and a steady decline in malaria prevalence.
Although no official decision has been announced about whether to continue the programme, known as the Affordable Medicines Facility – Malaria (AMFm), many of those familiar with it have told Nature that it must change or be phased out after this year.
“For me, the problem is that it has not been proven that the AMFm made a difference to malaria,” says Alan Court, senior adviser to the United Nations special envoy for malaria. “There has to be a public-health purpose or else there is no purpose.” Court is chair of the working group expected to recommend a path for the programme’s future on 14–15 November during a board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is based in Geneva, Switzerland, and oversees the AMFm.
When the AMFm was conceived in 2004, malaria rates in developing countries were skyrocketing, in part because the malaria-causing parasite Plasmodium falciparum had become resistant to the drug chloroquine. Officials worried that resistance would also develop to artemisinin — a newer and more effective drug— if people did not combine it with other therapies, but such combinations were much more expensive than either chloroquine or artemisinin alone ... more ...