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The scramble for ACTs: How good intentions can go badly wrong

MalariaWorld received a request from Africa Fighting Malaria (AFM) to alert its subscribers to the recent publication of its policy paper titled: 'The Global Fund's Malaria Medicine Subsidy: A nice idea with nasty implications'...

AFM's survey and an examination of Affordable Medicines Facility for Malaria (AMFm) demand and supply records reveal some serious anomalies. For instance: 

  • Though malaria is mainly a childhood disease, 70 percent of AMFm treatment orders are for adult doses.

  • Three ACT manufacturers are also acting as first‐line buyers in Nigeria, Ghana and Uganda with potential conflicts of interest.

  • Zanzibar, a country that has almost zero malaria transmission, has ordered over 240,000 AMFm ACT treatments.

  • AFM's survey in West Africa revealed AMFm products being sold in non‐AMFm countries. The threat of leakage of AMFm drugs to non‐AMFm countries is real and requires urgent action.


Though AFM's survey was limited in scope, it revealed that oral artemisinin monotherapies remain on sale and are often sold at prices below the subsidized AMFm ACTs. No rapid diagnostic tests were offered or sold to our survey administrators nor were any prescriptions or other evidence of definitive diagnosis of malaria demanded. 

In its report and on the Africa Fighting Malaria website AFM publicizes leaked documents that confirm the scale and seriousness of the problem of inequitable distribution of ACTs.

In AFM's opinion the response from the Global Fund Secretariat to the global supply problems, as evidenced in one of the leaked documents, is inadequate. The Global Fund Secretariat appears preoccupied with continuing the funding for AMFm Phase 1 and with measures to avoid ‘reputational’ harm.

The private sector can and should play an important role in public health, but it remains to be seen whether or not the benefits that have arisen from the AMFm could have been achieved through alternative mechanisms and potentially at lower cost. In other words, the evidence to date suggests that the opportunity costs of the subsidy have probably been considerable.

The Policy Paper is attached to this article.

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