E-DRUG: AMFM - the Affordable Medicines Facility for Malaria
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[No, AMFM is not a new radio station. The "Affordable Medicines Facility -
malaria" (AMFM) is the successor of the "Global ACT subsidy" working group.
This idea to subsidize ACTs was innovative and interesting, but has so far
not been able to reach a global consensus or substantial funding for it to
be implemented. So a name change - AMFM.
A report "the right drug at the right time" by the All-party Parliamentary
Malaria Group of the UK House of Commons supports AMFM. The Global Fund
Board has decided to host AMFM. WB]
http://www.rollbackmalaria.org/globalsubsidytaskforce.html
After publication of the Institute of Medicine Report in 2004 "Saving Lives
Buying Time", the Roll Back Malaria (RBM) Partnership decided to examine
further the ACT subsidy concept. In September 2005 the RBM Finance and
Resource Working Group asked the World Bank to develop a detailed proposal
for the design and operation of such a global ACT subsidy. Further to an
open tender process, the World Bank contracted Dalberg Global Development
Advisors to conduct an initial study on the feasibility and possible
financial mechanisms of a global ACT subsidy.
An Expert Workshop and Consultative Forum on a High-Level Buyer Subsidy for
Artemisinin-Based Combination Therapies (ACTs) took place in Amsterdam on 18
and 19 January 2007. In Amsterdam the malaria community approved the
principles of a global subsidy and suggested the creation of a RBM Task
Force to steer the project.
Meeting on 7 February 2007 the RBM Executive Committee approved the creation
of the Global ACT Subsidy Task force.
The RBM Global ACT Subsidy Task Force met in Washington on 13 March and in
Geneva on 9 May 2007. The Task Force Members agreed to submit a set of
objectives, design principles and next steps to the RBM Board for their
approval.
At the 12th RBM Board Meeting 10-11 May the RBM Board endorsed the global
ACT subsidy objectives and design principles described in the pre-read
submitted to them by the Global ACT Subsidy Taskforce; expressed continued
support for the introduction of a global subsidy for ACTs according to those
principles and objectives; and approved the continuation of the RBM Global
ACT Subsidy Taskforce as the only RBM mechanism to forge consensus on and to
guide the finalization of a detailed technical proposal including governance
and hosting arrangements, funding requirements, formal linkage with and
costing of supporting activities, and any other outstanding operational
issues. A detailed technical plan for launching the subsidy will be
submitted to the 13th RBM Board meeting in November 2007.
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[From Global Fund website]
Decision Point GF/B16/DP14:
The Board acknowledges the letter from the Roll Back Malaria ("RBM")
Partnership, dated August 16, 2007 requesting the Global Fund to consider
hosting the Affordable Medicines Facility - malaria ("AMFm").
Based on the information provided to date, the Board supports in principle:
. the objectives and principles of AMFm; and
. the idea of investigating with no presumptive decision the appropriateness
of hosting the AMFm as a Global Fund business line, considering the
complementarities and synergies of the Global Fund's objectives and business
model with many design elements of the AMFm.
To facilitate a final Board decision on hosting the AMFm, the Board requests
the Secretariat, under the oversight of the PSC, to develop and present to
the Board at its Seventeenth Meeting a report and a possible business model
and plan for hosting the AMFm within the Global Fund, taking into account
operational and architectural considerations and consultations with the RBM
Taskforce, UNITAID, key recipient countries and other relevant stakeholders. The intended mechanism should seek to increase broad access to ACTs especially among those at highest risk.
The budgetary implications of this decision point in 2008 amount to US$
675,000, which includes an allocation for 2 staff positions.
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http://www.malariaconsortium.org/data/files/pages/the_right_drug_at_the_righ
t_time_lr.pdf
The All-Party Parliamentary Malaria Group (see Website:
www.appmg-malaria.org.uk)
Executive Summary
Malaria kills more than a million people a year, mostly those living in the
poorest countries of the world. It can be treated very successfully, but increasing resistance to older cheap drugs means that the right drugs cost the patients several dollars (varying from $0.5 to $10) per treatment. This may not seem much, but is out of reach of those who need them most.
This report for the All Party Parliamentary Malaria Group focuses on a
fundamental gap in delivering effective malaria control to those most in need: effective and high quality treatment that is affordable and available where it is needed. Specifically, it looks at an idea to bring down the price of artemisinin-based combination therapies (ACTs) through an
Affordable Medicines Facility to ensure widespread use and to discourage use
of single drugs which may accelerate development of resistance to artemisinin derivatives. This idea has been developed into a proposal to set up the Affordable Medicines Facility - Malaria (AMFM), which will provide a co-payment at the factory gate to allow first-line buyers to
purchase effective antimalarials at prices comparable to those of
ineffective older drugs, such as chloroquine. The report describes the rationale and design of the AMFM, and explores some of the risks associated with either promoting or not supporting it.
The conclusions of the report are that:
1. The APPMG has decided on the basis of the evidence presented that the
concept of the AMFm is sound, and it is right to proceed.
2. The APPMG considers that the mechanism still needs more work to make it
able to deliver its objectives to greatest effect and to ensure a market mechanism to provide competition and incentive to drive down prices, but that there cannot be a delay in initiating the Facility given the extremely poor current access to effective antimalarials and the real risks of allowing continued use of inappropriate drugs. Improvements to the mechanism can best be made on the basis of early implementation experience.
3. The APPMG recognises that subsidies and the Facility alone are not
sufficient to ensure availability and use of effective antimalarials by those who need them most. There is a huge need to strengthen health systems in countries most affected by malaria in order to make them better able to provide prompt and effective treatment of this common and treatable disease.
4. The APPMG expects that the financial requirements for the AMFm will taper
down in a few years, as the market for effective antimalarial drugs matures and stabilises.
Three recommendations arising from these conclusions are:
1. Coordinated international support of the AMFm
For the AMFm to be successful it will need buy-in from multiple funding
partners to cover the cost for long enough to achieve its purpose. It will also need full support from user countries. The Roll Back Malaria Partnership needs to create unity of purpose in fostering the AMFm, both encouraging support and tackling remaining challenges in perfecting the
design.
2. Addressing developing country pharmaceutical manufacturing capacity.
Further in-depth consultation is needed urgently with governments and
pharmaceutical manufacturers in developing countries, both to explore ways to encourage a competitive market that will lead to unsupported price reduction and to avoid anticipated bottlenecks if recipient countries perceive that their own industries are at a disadvantage.
3. Monitoring and evaluation Monitoring and evaluation need to be intensive, particularly in the first few years. This is a new approach carrying some risks. We believe these risks can be managed to do little
harm, but they should not be swept under the carpet. Public scrutiny and
transparency of management are key to making the AMFm work.