USAID’s Position on Treatment of Malaria
USAID fully endorses the recommendation of WHO and the RBM partnership that: “treatment policies for falciparum malaria in all countries experiencing resistance to monotherapies should be combination therapies, preferably those containing an artemisinin derivative (ACT)”.
USAID Policies and Technical Programs
- Since the 1980s, USAID has been addressing the problem of increasing resistance to antimalarials in Africa. In the 1980s and 1990s, USAID provided some of the first technical assistance in Africa to collect data on chloroquine resistance and to identify health systems gaps in provision of prompt and effective treatment.
- At country level USAID works actively with governments to improve treatment policy. This has been a key activity since the 1990s when African governments were very slow to recognize the need to change from chloroquine to more effective drugs. USAID supports the right of countries continues to set their own drug press for policy change and case management policies and works to adapt policies consistent with WHO guidance, as well as provide technical assistance to strengthen systems for the delivery of effective antimalarials.
- USAID has been and continues to be a leader in supporting WHO to provide clear and relevant guidance on the measurement of antimalarial resistance and the formulation of improved treatment strategies. USAID funded the safety and efficacy work necessary to recommend and pre-qualify ACT, the development of consensus among RBM partners on ACT financing, and improvement in the quality of ACT production in East Asia.
- At present USAID is providing malaria and pharmaceutical expertise to the RBM partnership to establish a “facility” or capacity to support countries through forecasting, coordinated procurement, standardization and quality assurance, support for regulatory action, and stimulation of the production side.
- USAID has commissioned the National Academy of Science’s Institute of Medicine to establish, with RBM, an expert committee on financing and procurement of ACTs. The report from this committee is due in April 2004 and USAID is anticipating it will provide guidance on actions that USAID and the RBM partnership can take to expand production of ACTs and reduce prices.
- USAID typically does not purchase drugs or medicines other than in exceptional or emergency circumstances for any of our programs. Outside of our contributions to the GFATM, our resources are limited, and can be more effectively used for building the systems to procure, manage and use the drugs. In the rare cases when we do purchase drugs, we work with a country’s malaria treatment policy. We therefore do everything possible to make sure a country is not deploying ineffective drugs.
Antimalarial Drug Resistance and ACTs
- USAID firmly supports the RBM recommendation that countries adopt ACT as first-line treatment, both as an efficacious medicine and to contribute to slowing drug resistance.
- The GFATM resources have helped overcome a major barrier to ACT deployment—the higher cost of these drugs. Several challenges still remain which the RBM partnership and USAID are working to address. One major challenge is to expand production of ACT from a current 15-20 million doses worldwide to the rapidly needed 100s of millions of doses of good quality at affordable prices. Artemisinins are plant-based, so an 18-24 month lead time can be expected.
Child Survival and Malaria Treatment
- There is no doubt that the continued use of ineffective mono-therapies, such as chloroquine, after demonstration of resistance in the 1980s and 1990s, has contributed to the slowing in the reductions in child mortality over that period. Malaria contributes over 20% of child deaths in sub-Saharan Africa; ineffective treatment of malaria is a major barrier to the success of USAID child survival efforts.
- ACTs have been shown an effective option for the treatment of drug resistant malaria. USAID is committed to accelerating wide-scale access to and appropriate use of ACTs for the treatment of falciparum malaria.
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