MALARIA: "Innovations in Health Care Financing and Service Delivery: Making Malaria Treatment Available".

The World Bank's Development Impact Evaluation Initiative (DIME), in collaboration with the Affordable Medicines Facility-malaria (AMFm) at the Global Fund, the Clinton Health Access Initiative (CHAI) and the Center for Disease Dynamics, Economics & Policy (CDDEP), is hosting a conference on "Innovations in Health Care Financing and Service Delivery: Making Malaria Treatment Available". This will showcase research implemented in conjunction with the World Bank and its partners, including studies carried out under the World Bank's Malaria Impact Evaluation Program (MIEP). The event will feature a keynote speech on December 8th by Nobel Laureate Kenneth Arrow titled "Seven years after 'Saving Lives, Buying Time' - New Challenges for Financing Malaria Diagnosis and Treatment." ... http://allafrica.com/stories/201112090837.html

MALARIA: Anti-malarial treatment available to millions of poor Nigerians at a fraction of its normal cost

 January 31, 2012   2 Millions of poor Nigerians will gain access to the most effective combination treatment for malaria at a fraction of its current cost, following the successful conclusion of negotiations between the United Kingdom Department for International Development (DFID) funded Partnership for Transforming Health Systems (PATHS2) and a variety of international and national stakeholders in Nigeria this week.
PATHS2, in collaboration with the Clinton Health Access Initiative (CHAI), will provide life-saving anti-malaria treatments to health facilities based largely in rural communities in the five Nigerian states of Lagos, Kaduna, Jigawa, Enugu and Kano, the latter state recently driven by terrorist bomb attacks.
A course of treatment will be provided for as little as 60 Naira (approximately 25 pence in Sterling), in comparison to previous costs of nearly 20 times as much, making the drugs affordable to even the poorest Nigerians, many of whom still subsist on less than US$1 a day.
The Affordable Medicines Facility for malaria (AMFm) is an innovative financing mechanism to expand access to affordable ACTs—Artemisinin-based Combination Therapies. ACTs are the medicines recommended by the World Health Organisation (WHO) as the most effective malaria treatment.
The AMFm is hosted and managed by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), with key financial support provided by UNITAID, DFID and the Bill & Melinda Gates Foundation, and with technical support provided by the Clinton Health Access Initiative (CHAI).
International manufacturers of ACTs receive a subsidy directly through the AMFm initiative almost to the tune of 95% which in turn is passed on by Nigerian pharmaceutical manufacturers, the First Line Buyers of ACTs. Acting as second line buyers, PATHS2 will distribute ACTs through primary health centres in the five Nigerian states in which it currently works, which have a total population of approximately 37 million, representing around 22% of the population of Nigeria as a whole.
Artemisinin-based Combination Therapies were introduced in Nigeria in 2005 for the treatment of uncomplicated malaria due to the increased resistance to chloroquine and sulphadoxine-pyrimethamine – also known as mono-therapies - which were older malaria medicines grown less effective due to the development of resistant strains .
PATHS2 has supported the significant reduction in prices of ACTs by bringing First Line Buyers and PATHS2 states together to discuss their requirement and support the signing of annual contracts between the states and First Line Buyers. The First Line Buyers are pharmaceutical companies in Nigeria who buy directly from WHO certified manufacturers outside the country. In Nigeria, there is currently no domestic manufacturer of AMFm drugs.
The First Line Buyer supported under AMFm will sell Artemisinin/ Lumefantrin (Pack of 24) for just 50 Naira to PATHS2 States health facilities and patients will get it for about 60 Naira, compared to its previous cost, which was as much as 2,000 Naira (£8-00). This pricing makes it the cheapest price available anywhere in the country.
It is estimated that 70% of all disease incidence in Nigeria is related to malaria. The World Malaria Report of 2008 recorded 57,506,430 cases of malaria across Nigeria, causing 225,424 fatalities.
http://www.news-medical.net/news/20120131/Anti-malarial-treatment-available-to-millions-of-poor-Nigerians-at-a-fraction-of-its-normal-cost.aspx

MALARIA: Ghana: mortality statistics

Kumasi, May 12, GNA - A total of 179 people died of the malaria disease in the Ashanti Region, last year, Dr Aaron Offei, the Regional Director of Health Services, has said.

This showed a significant rise in the number of deaths, compared with the 2009 figure of 169.
He said available records also indicated that hospital admissions caused by the disease went up from 33,694 to 34, 560 during the period and attributed this to the inability of the people to take preventable measures.
Dr Offei was speaking at the launch of the Affordable Medicine Facility for Malaria (AMFM) Campaign in Kumasi.
http://www.ghananewsagency.org/s_health/r_28700/health/ashanti-records-179-malaria-deaths

MALARIA: Africa: Cheap Malaria Drugs to Flood Africa Soon

Yinka Shokunbi : 30 April 2011
With the renewed determination of the international community to sweep out malaria out of Africa, a new initiative to put affordable and effective anti-malaria drugs within the reach of people in often remote communities in Africa is making rapid progress.
In four implementing countries - Ghana, Kenya, Madagascar and Nigeria - life-saving malaria treatment can now be bought in private stores and pharmacies for as little as 50 U.S. cents as against previous cost which was up to 20 times as much.
The Affordable Medicines Facility - malaria (AMFm) gets key financial support from UNITAD, the United Kingdom and the Bill & Melinda Gates Foundation, technical support from members of the Roll Back Malaria (RBM) Partnership and it is hosted by the Global Fund.
The initiative, which began last year, is being piloted in eight countries - Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (including Zanzibar), Uganda and Cambodia - to enable lessons to be learnt before a potential global rollout.
AMFm aims to make anti-malarial drugs, known as artemisinin-based combination therapies (ACTs), available as widely and cheaply as possible. About 225 million people fall ill with malaria every year and 780,000 die from the disease.
Although the World Health Organisation (WHO) specifically recommends ACTs as first-line treatment for Plasmodium falciparum malaria, the most deadly form of the disease, the drug accounts for only about one in five of all treatments taken for malaria and until recently, it has only been available for free or at low cost in public health facilities.
Most people buy anti-malaria treatments in private shops and pharmacies where ACTs were not available at an affordable price before the launch of AMFm. These shops sell older, cheap medicines such as chloroquine and sulfadoxine-pyrimethamine, which are no longer effective because the Plasmodium falciparum is increasingly resistant to them.
The objective of the AMFm programme is to drive out these ineffective therapies by bringing down ACT treatment costs drastically and making the drugs more accessible to millions of people.
According to the executive director of the Global Fund, Prof. Michel Kazatchkine, "We are making further progress in fighting malaria in Africa by providing affordable treatment to millions of people through the Affordable Medicines Facility for malaria," said executive director of the Global Fund.
"The Affordable Medicines Facility - malaria is a major step forward. It uses innovative financing methods to save lives by providing affordable and effective medicines to more people in need through the public, NGO and private sectors."
For the innovation to work, the Global Fund first negotiates a discounted price for ACTs with drug manufacturers and then pays most of the reduced price on behalf of importers from the private, NGO and public sectors, leading to an average sales price of less than 10 cents.
The reduced prices allow private wholesalers to sell the ACTs to retailers at a profit. Pharmacies and stores in turn sell the drugs to patients and caregivers with an additional mark-up, while keeping the retail price affordable.
The AMFm was introduced in the country in March 2011, ACTs that are not co-paid by the AMFm cost about 1,000 - 1,500 Naira (US$ 6.70 - 9.50) per adult treatment.
The Society for Family Health (SFH), a not-for-profit NGO started distribution of AMFm co-paid ACTs in Nigeria in March 2011.
Under AMFm, SFH will sell a full course of treatment for children aged under-five years in private health facilities and outlets at US$ 0.20. The adult course of treatment is expected to sell for US$ 0.80.
In the eight countries where the AMFm is being implemented, governments are supporting the initiative with public awareness campaigns and training for ACT providers.
http://allafrica.com/stories/201105021732.html

MALARIA: The Global Fund Proposes Joint Action to Prevent Theft of Medicines

10 December 2010


GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria will invite major international funders of drug supplies to developing countries, technical and law enforcement agencies and implementers of health programs to intensify joint efforts to prevent theft of medical drugs.
The Global Fund will invite the agencies to take concerted action to stem drug thefts, ranging from information-sharing and joint strengthening of procurement and distribution capacity in developing countries to applying stringent security measures around drug storage and transport. A preliminary meeting will be held in January to draw up a joint action plan.
Theft of drugs is an old and persistent problem in developed and developing countries alike, especially for drugs that may be cheap or free in the public sector but fetch high prices on the open market or in neighboring countries with different pricing policies. Problems are exacerbated by limited resources and imperfect distribution systems in many of the world’s poorest countries.
In past years, reports and allegations of large-scale theft of new, effective malaria drugs have received particular attention. The medicines, known as Artemisinin-based Combination Therapies (ACTs), are given out for free or very cheaply in public health centers and hospitals in a large number of countries but are sold over the counter in pharmacies and street stalls for US$8 or more per treatment. Typically, more than half of malaria drugs in African countries are not given out by doctors or nurses but are sold over the counter.
“Theft of medicines is a problem that affects all institutions investing in health services, and we must clamp down on it,” said Michel Kazatchkine, the Global Fund’s Executive Director. “However, no single institution can act on its own. We can only solve this challenge if we all work together.”
The Global Fund has demanded stricter control with drug warehousing and distribution in five African countries already based on reports of possible drug thefts. Lessons from these countries and from other organizations’ similar efforts will be shared and developed further over the coming months.
“The Global Fund tolerates no fraud and will do whatever it can to ensure that donor money reaches those it is intended for,” said John Parsons, the Global Fund’s Inspector General. “By convening the major parties involved in global drug procurement, we hope to achieve results each one of us would not be able to do on our own.”
In an initiative that complements the work to secure drug storage and distribution, the Global Fund is leading a US$216 million global innovation to finance improved access to ACTs by subsidizing the costs to buyers and patients in the private, non-governmental and public sectors.
The main purpose of this Affordable Medicines Facility-malaria (AMFm) is to ensure that older, ineffective malaria drugs are driven off the market by cheap, universally available ACTs. Retail prices of ACTs are expected to dramatically decline as a result of the combined effect of several factors, including: the reduced prices at which importers now buy ACTs under the AMFm; an increase of ACT quantities in each country; increased competition among sellers; and an increase in public information and marketing campaigns to increase awareness among buyers and patients of recommended prices in each country.
A potential additional benefit of driving down prices of drugs in the private sector is to reduce the incentive to steal drugs from public health services to sell them expensively in private stalls and shops. If successful and rolled out continent-wide, this innovation could curb a principal cause of theft of malaria drugs.
*****
The Global Fund is a unique global public/private partnership dedicated to attracting and disbursing additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria. This partnership between governments, civil society, the private sector and affected communities represents a new approach to international health financing. The Global Fund works in close collaboration with other bilateral and multilateral organizations to supplement existing efforts dealing with the three diseases.

Since its creation in 2002, the Global Fund has become the dominant financier of programs to fight AIDS, tuberculosis and malaria, with approved funding of US$ 19.8 billion for more than 600 programs in 145 countries. To date, programs supported by the Global Fund have saved 6.5 million lives through providing AIDS treatment for 3 million people, anti-tuberculosis treatment for 7.7 million people and the distribution of 160 million insecticide-treated bed nets for the prevention of malaria.

MALARIA: Demand for malaria drug soars

03 Aug 2010 Nature
From bust to boom to bust again: artemisinin, the key ingredient of front-line antimalarial drugs, is entering the third chapter of its turbulent history. A decade ago, the compound — available only from the sweet wormwood plant Artemisia annua — was scarce and expensive. But by 2007, the market was wallowing in a surfeit of the drug as farmers flocked to grow the crop. Now, as a US$343-million initiative starts to battle malaria through hugely subsidized medicines, suppliers are again worried that there will not be enough artemisinin to go around, while farmers, plant breeders and synthetic biologists are hoping that they can snap the drug out of its roller-coaster supply cycle.This year's problems began with what should be a malaria success story. The Global Fund to Fight AIDS, Tuberculosis and Malaria last month saw its first orders for cheap drugs under its Affordable Medicines Facility — Malaria (AMFm) initiative. Using subsidies, it plans to cut the price of artemisinin-based combination therapies (ACTs), which partner artemisinin with another drug to reduce the chance of malaria parasites developing resistance, as they have done to treatments such as chloroquine.Costly convenienceGovernmental public-health clinics already offer ACTs at just $1 per dose, but roughly 60% of patients with malaria opt for convenience and buy the drugs from local market stalls and private pharmacies — even though they cost many times more. The AMFm initiative, running as a two-year trial in seven African countries and in Cambodia, hopes to ensure that even the private sector will sell ACTs at $0.20-0.50 per dose. That should improve access to the drugs, and may stop patients buying cheap but ineffective chloro­quine or the single artemisinin therapies that are promoting resistance. It will also drive up demand for artemisinin.Artemisinin suppliers have seen this all before. In 2005, the World Health Organization declared that much more of the drug was needed to increase the production of ACTs. At the time, researchers led by Jay Keasling at the University of California, Berkeley, thought that synthetic biology could solve the supply problem. They hoped to modify the genomes of bacteria and yeast to produce a precursor of artemisinin. Fermenting the organisms in huge vats could yield a plentiful and inexpensive drug supply.Keasling's semi-synthetic artemisinin project received $42.6 million over five years from the Bill & Melinda Gates Foundation, and became a focus for biotech firm Amyris of Emeryville, California, which spun out from Keasling's lab. It successfully added or tweaked a dozen genes in yeast to make artemisinic acid (D.-K. Ro et al. Nature 440, 940-943; 2006), and gave a royalty-free licence to drug firm Sanofi-aventis, headquartered in Paris, to make semi-synthetic artemisinin on a commercial scale. Four years on, the product is still two years away, says the drug company, which is scaling up production to 100,000-litre vats, financed by another $10.7-million grant from the Gates foundation, and with assistance from the Institute for OneWorld Health, a non-profit organization in San Francisco, California.While this technology was being developed, farmers in China and Vietnam planted tens of thousands of hectares of Artemisia, and by 2007 the market was swamped. The price of artemisinin plummeted from more than $1,100 per kilogram to around $200 per kilogram (see 'Boom and bust for Artemisia farmers'), putting some 80 processing companies — and untold numbers of farmers — out of business.Even though artemisinin was being sold cheaply (compared with the price that Sanofi-aventis will set in 2012), millions of people in sub-Saharan Africa were still not getting access to the ACTs. "We have learned there is a lot more to it than cost," says Jack Newman, co-founder and senior vice-president for research at Amyris. Improving access to the medicines is as important as driving down their price — hence the idea for the AMFm, and its focus on the local businesses that sell treatments.If farmers grew enough Artemisia before, why not again? With food prices rising, the incentive to plant the crop this time is low, notes Malcolm Cutler, an artemisinin-industry expert and director of the consultancy FSC Development Services, near Gloucester, UK. His priority is to improve communication between growers, processors and drug companies, and to help farmers who must decide to plant Artemisia 14 months before that crop's drug will be produced.This year, the Assured Artemisinin Supply System (A2S2) initiative, supported by the international drug-purchasing facility UNITAID, began to give advance loans to the companies that extract artemisinin from plants, and to encourage drug firms to sign long-term contracts with them. About 10,000 hectares of Artemisia was planted this year, twice as much as in 2009. But recent floods in China and Vietnam, and a drought in East Africa, mean that yields of artemisinin for use in 2011 may be only two-thirds of what has been planted, says Cutler.Breeding boostYields could be vastly improved by planting new Artemisia strains. On average, one kilogram of its dried leaves yields some 8 grams of artemisinin. But at the National Institute of Agricultural Botany in Cambridge, UK, researchers have used selective breeding to create hybrid plants that produce up to 24 grams, says Colin Hill, chair of an Artemisia breeding consortium supported by the UK Department for the Environment, Food and Rural Affairs. These plants are now being grown and harvested commercially in Madagascar, and trialled in South Africa, Uganda, Zimbabwe and the United States, as well as in Britain.In an alternative approach, Ian Graham and colleagues at the University of York, UK, identified key Artemisia genes that could optimize agricultural yields, robustness or other desirable traits when the plant is grown in different areas of the globe (I. A. Graham et al. Science 327, 328-331; 2010). Graham says that the work has helped to create plants that produce up to 50% more artemisinin per kilogram of leaves than the best commercial variety. They expect to release seed to commercial growers in mid-2012.Despite the advances in plant bio­technology, Keasling says that semi-synthetic artemisinin is still sorely needed. Although it began as a way to make the drug more cheaply, the mass-produced semi-synthetic will be no cheaper than the plant-derived version — partly because Sanofi-aventis does not want to undercut farmers. Instead, it will be used to smooth out the cycle of boom and bust in crop-based artemisinin supply. "A stable and adequate source of artemisinin would be fundamentally important," says Silvia Schwarte of the World Health Organization's malaria programme.As Newman says: "If you suddenly need twice as much artemisinin, you just fire up another fermenter.
"http://www.nature.com/news/2010/100804/full/466672a.html
http://www.fightingmalaria.org/news.aspx?id=1486