The Global Fund Votes to End Separate Funding for AMFm

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Over a million people die from malaria each year. Malaria is curable, but it is not cheap. Due to this, the Global Fund instigated the Affordable Medicines Facility-malaria (AMFm) in 2010. This program delivered the first subsidized Artemisinin-based Combination Therapies (ACTs) to African countries. The Global Fund started and funded AFMm as a separate program in hopes of providing infected individuals more affordable ACTs. The Global Fund hopes to prevent the usage of low dose anti-malaria drugs that do nothing but increase the likely occurrence of drug resistance. In November 2012 the Global Fund voted to change the structure of funding for AMFm because the program has not proven that medicines have reached the most at risk population, children under five. The Global Fund’s grant system will now fund AMFm. The Global Fund voted correctly when deciding to move AMFm under grant funding. The AMFm program has proven costly, shown no productive results, and raised serious doubts that the subsidized medicines have reached their intended and appropriate patients.

When the Global Fund first started the Affordable Medicines Facility-malaria program, many hoped that the program would help stem the malaria outbreak. AMFm’s main purpose required delivering the effective ACTs to areas of Africa that needed medicine. While ACTs have a high cost, they have proven more effective, according to WHO, the World Health Organization. So AMFm helps subsidize ACTs so that more infected individuals can purchase effective medicines and heal their malaria infected bodies. Streamlining the medicines available, the Global Fund hopes to overcome malaria forming a resistance to ACTs. When malaria forms resistance to drugs like ACTs, no other medicines currently available can cure malaria. ACTs are the best medicine to cure malaria. AMFm also opts to subsidize ACTs because when cheaper, more effective medicine is available, infected individuals will likely buy the better medicine.

While AMFm has only been effective for two years, in 2011 alone they were able to subsidize 60 percent of all ACTs. AMFm received 463 million dollars to subsidize these ACTs. The Global Fund, along with the Bill and Melinda Gates Foundation, funded a study to determine the AMFm’s effectiveness during its first year. The study, published in the Lancet, pointed to the AMFm program hitting the Global Fund’s benchmarks. Access to quality-assured ACTs increased 26-52 percent in six of the eight countries examined.

AMFm has good reason to want ACTs provided at reduced rates, but medicine cannot be guaranteed to reach intended receivers. Shopkeepers buy ACTs, at a reduced rate, so that they may sell ACTs affordably. So while the availability of ACTs has increased within the countries examined in the Lancet’s study, there is no guarantee that medicine reaches sick individuals1. An Oxfam senior health advisor, Mohga Kamal-Yanni, was quoted in an article in Nature1, “You don’t need a huge independent evaluation to calculate that a huge subsidy will permit shopkeepers to buy and sell more of a drug,” she says. “Sales don’t mean anything unless you know who the sales are for.” If one has money then they can buy ACTs. No testing necessary. Now better technology enables testing before distributing subsidized medicine. The next obstacle would be determining who has the ability to test for malaria. The shopkeepers, who distribute the medicine, are not educated enough that they could accurately perform malaria testing.

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Oxfam, in a recent article, Put an end to risky malaria program, advocated ending AMFm. The first issue Oxfam had with AMFm was the lack of regulation. If someone with a fever can come and buy an ACT and take it, without being tested for malaria, this causes a potential for more drug resistant malaria. ACTs, when taken appropriately by a sick individual, are effective at ridding the body of malaria. When used too much, malaria forms a resistance and becomes a super bug. Misdiagnosis, caused by overuse of ACTs, is counterproductive. Technology has now reached a point where it is plausible to test potentially infected individuals. This way, antimalarials, such as ACTs, will only be used for definite cases. In an interview with Dr. Toby Leslie,she discusses the question of plans to reduce misdiagnosis. Dr. Leslie cited that improved awareness of malaria, better use of microscopy tests and increased use of rapid diagnosis tests can decreased misdiagnosis. Many individuals diagnosing malaria are shopkeepers who have no doctoral knowledge of what malaria looks like.

In November of 2012, the Global Fund voted to remove AMFm as a separately funded program. This was a wise move because the money put into the program, while showing results, was not showing true results. The medicine not having been proven to reach the targeted population, or even children under the age of five. ACTs were also being used by anyone who could afford them. There was no regulation on the subsidized medicine. In essence, AMFm could have been funding the malaria resistance campaign. Then where would infected individuals be if the ACTs were unable to cure them? The world would be back at square one and malaria would make a stronger and more intimidating comeback.

1. Maxmen, Amy. "Malaria plan under scrutiny." Nature. 490.7418 (2012): 13-14. Web. 5 Feb. 2013. <http://www.nature.com/news/malaria-plan-under-scrutiny-1.11509>.