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New malaria drugs need subsidy, study finds

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2495 (Published 12 November 2008) Cite this as: BMJ 2008;337:a2495
  1. Peter Moszynski
  1. 1London

    An entire new class of effective antimalarial drugs will have little effect on the prevalence of the disease unless they are made more affordable. Research by the government of Uganda and the non-governmental organisation Medicines for Malaria Venture shows that such drugs are “too expensive and not widely available for millions in Africa.”

    In its first report on the antimalarial drugs market in Uganda, the venture says, “Replacing older classes of drugs with ACTs [artemisinin based combination therapies] is critical to ensure appropriate treatment of malaria, a disease that has grown resistant to a number of drugs, such as chloroquine (CQ) and sulphadoxine-pyrimethamine (SP).”

    Yet the study found that effective treatments are “not widely available in the rural areas of Uganda, particularly outside of government health facilities.” Artemisinin combination therapies can cost as much as 60 times the price of ineffective drugs, such as chloroquine. Although artemisinin combination therapies are supposed to be free at government pharmacies, they are often unavailable, and most people buy antimalarials from private outlets.

    The report also found that in Uganda an average family’s yearly artemisinin based combination therapy could cost up to 62 days of the household’s basic food bill and 91 days of average household income, which is why “only 50% of patients buy a full course of medicines, increasing the risk of resistance.”

    “Malaria is completely curable but too many people die because effective medicines are neither affordable nor available,” said Chris Hentschel, the organisation’s president. “This study provides powerful evidence to policy makers and donors to build a case for greater accessibility of effective antimalarials via all channels, public or private.”

    The study indicates that “switching to ACTs potentially leaves an increasing gap in access to effective treatment, as many people continue to buy CQ and SP from private sector outlets that do not sell ACTs.” Because the price of antimalarials is the main driver for purchase, “ACTs, which are much more expensive, remain out of reach to the vast majority of Ugandans.”

    The research found 174 antimalarial drugs available for sale on the market in Uganda. Artemisinin based combination therapies accounted for about 15% of registered drugs, and most outlets had an average of 6-9 different antimalarial drugs. Chloroquine and sulphadoxine-pyrimethamine, drugs with low efficacy, were widely found in all types of outlets.

    The price of chloroquine was 200-500 Uganda shillings (as little as £0.08; €0.09; $0.10), and the cost of artemisinin combination therapies was 9000-20 000 shillings.

    Although the study only took place in nine districts in Uganda, a spokeswoman for the venture, Jaya Banerji, told the BMJ that the findings were “of both African and global significance,” particularly as donor governments are discussing the establishment of a facility in Delhi for affordable drugs for malaria.

    She said that the only way that the new treatments would replace ineffective remedies was with massive subsidies from the private sector: “The only way we can make ACTs more accessible to the poor is if these are priced at the same level as chloroquine so that people can afford them.”

    Notes

    Cite this as: BMJ 2008;337:a2495

    Footnotes

    • Understanding the Antimalarials Market: Uganda 2007 is at www.mmv.org.

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