A Canadian-supported program designed as a “silver bullet” to fight malaria could actually be endangering lives and should be terminated, says international agency Oxfam.
The Affordable Medicine Facility for malaria (AMFm) subsidizes sales of the most effective medicine by unqualified shopkeepers and street vendors in seven African countries. In a briefing paper, Salt, Sugar and Malaria Pills, Oxfam says there is no evidence the facility has been effective at saving the lives of the most vulnerable or in delaying drug resistance.
Mark Fried, policy coordinator for Oxfam Canada, said: “CIDA took a gamble when it put $20 million into the facility last spring. Looking forward, our precious aid dollars should go to programs that have been shown to work, like Ethiopia’s which used trained community health workers and halved malaria deaths in the last three years.”
The board of the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria, which oversees the malaria program, will decide whether to extend or terminate it at a November 14-15 meeting. The malaria subsidy is financed by such donors as the Bill and Melinda Gates Foundation, the U.K. government and the Canadian government through the Canadian International Development Agency.
Using untrained and unsupervised drug sellers poses a very high risk of misdiagnosis, given that malaria incidence is decreasing and fevers are likely to be due to other causes, Oxfam said. Some studies show that 60 per cent of fevers are not malarial.
Dr. Mohga Kamal Yanni, Oxfam’s senior health policy advisor, said: “A shopkeeper selling salt, pepper and malaria medicines cannot tell if a child has malaria or pneumonia."
A Fund-commissioned evaluation shows that the malaria facility has increased availability and market share and decreased price of Artemisinin Combination Therapy (ACT), currently the most effective anti-malarial treatment. But it offers no evidence of how many confirmed cases of malaria have been treated or whether medicines are reaching the most vulnerable, like children living in poor and remote areas. The evaluation also ignored evidence of success of alternatives, such as Ethiopia’s and Zambia’s investment in community health workers.
Oxfam warns that uncontrolled sales of subsidised ACT could repeat the sad history of chloroquine, once a cheap and effective medicine and now rendered largely useless. Selling the medicine rather than providing it for free encouraged resistance because people living in poverty did not take a full course of treatment.
Kamal Yanni said: “The Affordable Medicine Facility for malaria is a dangerous distraction from genuine solutions like investing in community health workers and free medicine that have slashed the number of malarial deaths in countries such as Zambia and Ethiopia. The Global Fund board must act on the evidence and put a stop to the AMFm now.”