Financing Medical Innovation in Africa

"Money v mosquito", The Economist, November 1st 2007.

Malaria remains a huge public health problem. With the development of drug resistance to quinine related drugs, the development of a new curative agent in artemisinin is an important development. However, experience indicates that without care in its application, artemisinin too will become ineffective as the Plasmodia develop resistance to the drug. The use of artemisinin combination therapies (ACTs), which mix the active ingredient with another drug, should prove effective to stave off the evolution of such resistance. Unfortunately artemisinin is expensive, at least in terms of African finances, and the ACTs are more so. Therefore a new financing mechanism is being developed.

A group of donors and international agencies, including the Gates Foundation and the World Bank, is now promoting a plan (which is yet to be funded) for subsidising ACTs. The Affordable Medicines Facility-malaria (AMFm), as the scheme is called, aims to subsidise the purchase of ACTs to the tune of $1.4 billion-1.9 billion over five years. The plan's boosters believe that would make prices competitive with chloroquine. They also think that artemisinin-only drugs—which would not receive the subsidy—would then be priced out of the market. The board of Roll Back Malaria, a group that co-ordinates international efforts against the disease, is due to vote on the matter this month.

Several years ago I wrote in Issues in Science and Technology:

After the creation of the Tropical Disease Research Program in 1975, new institutions were created to further encourage research on global health problems, notably the Global Forum for Health Research, the Council on Health Research and Development, the International AIDS Vaccine Initiative, and the Initiative on Public-Private Partnerships for Health. Still, the key to providing more technological innovations appropriate to developing nations and to building their health science capacity probably lies in creating more public and political support for existing institutions while improving their policies and programs.

I can't predict whether the AMFm will be approved, nor whether it will be effective if approved. But I think it illustrates the kind of thinking that we need. It would be a mechanism that would tap international financing to support a public good, and do so in a way that encourages further innovation by the pharmaceutical industry (which funds 40% of health research worldwide) oriented towards the diseases of poverty.