Global Health Policy

As the Global Fund’s November board meeting approaches – where the future of the Affordable Medicines Facility for Malaria (AMFm) hangs in the balance – there is much anxiety that AMFm will be terminated in 2013. The reason for such anxiety is clear: no donors have pledged funding commitments for after December 2012. But there’s another elephant in the room: the US government’s apparent lack of support, particularly its legislated “opt-in” stance on AMFm: “the Global Fund should not support activities involving the ‘Affordable Medicines Facility-malaria’ or similar entities pending compelling evidence of success from pilot programs as evaluated by the Coordinator of United States Government Activities to Combat Malaria Globally.” (Conversely, an opt-out stance would be to support AMFm unless no compelling evidence is presented.) This very specific and strict provision makes the AMFm’s continued survival all but impossible without an explicit endorsement by US Global Malaria Coordinator (currently Rear Admiral Tim Ziemer) who leads the US President’s Malaria Initiative (PMI) housed in the US Agency for International Development (USAID).

This is a joint post with Heather Lanthorn, a doctoral candidate at Harvard School of Public Health.

In mid-July, amidst the busy global-health month of July, in between the Family Planning summit and the AIDS conference, the near-final draft of the independent evaluation of the Affordable Medicines Facility - Malaria (AMFm) was released.

Published last week in The Lancet, a new study by the Institute for Health Metrics and Evaluation (IHME) finds that there were 1.2 million deaths from malaria in 2010, not 655 thousand as estimated by the WHO. Following its release, headlines began splashing uncritically: “Malaria kills twice as many as previously thought, study finds” (The Guardian) “Malaria deaths hugely underestimated” (BBC). Which set of estimates is correct? Or at least which is less biased? Given the 1.2 billion dollars by donors to malaria in 2010, is it unreasonable to demand to know with more certainty, how many people are dying from malaria?

News this month that an experimental vaccine cuts in half the risk of malaria in children in Africa is a welcome success story 20+ years in the making. It’s also a rare bright spot in the clinical trials labyrinth that stands between promising new medicines, vaccines, and diagnostic techniques and the one billion people in the developing world who suffer from one or more neglected diseases. Ninety other drug and vaccine candidates for neglected diseases are waiting in the pipeline for late stage clinical development. Under current arrangements, they will face lengthy, inefficient reviews in countries where the regulatory capacity ranges from weak to non-existent.