Experts and policy makers agreed on 19 January that a global subsidy for artemisinin-based combination therapies (ACTs) should be put into place as soon as possible to make effective malaria treatments affordable and accessible to all. Hosted by the Dutch Government, the high level RBM Finance and Resources Working Group meeting included representatives from GFATM, PMI, WB, UNITAID, WHO, UNICEF and the Gates Foundation as well as endemic and donor countries, foundations, NGOs and the private sector. It was anticipated that the resources required to back such a subsidy ( around US$ 250m yearly from 2009 onwards) could be secured before 2008 and that potential risks, such as market distortion, could be mitigated by ongoing and effective monitoring.
The Affordable Medicines Facility for Malaria (AMFm)
The AMFm is an innovative financing mechanism intended to expand access to affordable and effective antimalarial medicines through the public, private and NGO sectors. These medicines are quality assured artemisinin-based combination treatments (ACTs). The goal of the AMFm is to save lives by reducing malaria related mortality and, delaying resistance to effective malaria treatment.
The AMFm principles, objectives and technical design were developed by the Roll Back Malaria AMFm Taskforce based on the recommendations of Economy Nobel Prize winner Pr Kenneth Arrow's report "Saving lives, buying time" published in 2004. The RBM Board of November 2007 approved them and requested the Global Fund to Fight AIDS, Tuberculosis and Malaria to become the AMFm manager.
In essence, the AMFm will first negotiate substantial price reductions of the ACTs with the manufacturers and then co-pay the ACTs ordered by eligible public, private and non-profit first-line buyers. This co-payment will allow buyers to purchase the ACTs at the price of chloroquine, i.e. approximately USD 0.05 per treatment course. The AMFm will pay the difference betwen USD 0.05 and the negociated price.
Countries participating in the AMFm will also be encouraged to implement relevant supporting interventions to assist the responsible roll-out of the AMFm: such as training of the private drug providers and information campaigns highlighting the wide availability of affordable and quality assured ACTs.
In other words, the AMFm aims at:
- Increasing Affordability – by negotiating sale price reductions for ACTs with ACT manufacturers and co-paying the ACTs purchased by eligible buyers; and
- Increasing Availability – by undertaking supporting interventions to increase access to ACTs, displace less effective malaria treatments and increase use of ACTs amongst vulnerable groups.
The intention is that this will result in a retail price of USD 0.20-0.50 which is what most mothers in urban townships and rural villages are currently paying for less effective or ineffective antimalarials, because this ia all they can afford to pay for treating their children suffering from malaria.
The Global Fund Board of November 2008 approved to host and administer the AMFm. The AMFm is being introduced in a phased approach, with a first pilot phase ("Phase 1") being undertaken in nine countries for approximately two years. An independent evaluation will be conducted in the second half of 2011 to determine whether the AMFm pilot has been successful in achieving the four objectives of the AMFm. In April 2012, the Global Fund Board will decide whether to expand or terminate the AMFm, based on the results of the independent evaluation.
Funding for the co-payment is provided by three donors: UNITAID (USD 130m); United Kingdom (USD 66m) and Bill and Melinda Gates Foundatin (USD 20m).
Nine countries will participate in Phase 1 of the AMFm: Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Rwanda, United Republic of Tanzania (mainland and Zanzibar) and Uganda.
RBM Partnership which developed the design of the AMFm remains fully mobilized to support these nine countries with the roll-out of the supporting interventions, pharmaco-vigilance, operational research, monitoring and evaluation.