For more than 50 years, low-cost antimalarial drugs silently saved millions of lives and cured billions of debilitating infections. Today, however, these drugs no longer work against the deadliest form of malaria that exists throughout the world. Malaria deaths in sub-Saharan Africa—currently just over one million per year—are rising because of increased resistance to the old, inexpensive drugs. Although effective new drugs called “artemisinins” are available, they are unaffordable for the majority of the affected population, even at a cost of one dollar per course.

Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance examines the history of malaria treatments, provides an overview of the current drug crisis, and offers recommendations on maximizing access to and effectiveness of antimalarial drugs. The book finds that most people in endemic countries will not have access to currently effective combination treatments, which should include an artemisinin, without financing from the global community. Without funding for effective treatment, malaria mortality could double over the next 10 to 20 years and transmission will intensify.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON THE ECONOMICS OF ANTIMALARIAL DRUGS
• BOARD ON GLOBAL HEALTH
• Reviewers
• Preface
• Acknowledgments
• PROJECT CONSULTANTS AND COMMISSIONED AUTHORS
• Executive Summary
  • INTRODUCTION
  • THE CURRENT MALARIA SITUATION
  • DRUG RESISTANCE AND THE NEED FOR COMBINATION THERAPY FOR MALARIA
  • THE ECONOMICS OF ARTEMISININS AND ACTs
  • THE CASE FOR A GLOBAL SUBSIDY FOR ANTIMALARIAL DRUGS: THE CORE RECOMMENDATION OF THIS REPORT
  • THE NEED TO MAINTAIN RESEARCH AND DEVELOPMENT FOR NEW ANTIMALARIAL DRUGS
  • IMPROVING ACCESS AND THE PROMISE OF INTEGRATED MALARIA CONTROL
  • THE CURRENT CHOICE
  • RECOMMENDATIONS
• PART 1. A Response to the Current Crisis
  • 1. Malaria Today
    • INTRODUCTION TO THE STUDY
    • THE ROLE OF THE ARTEMISININS IN MALARIA CONTROL
    • MALARIA TODAY
    • DRUG FLOWS AND PRICING OF ANTIMALARIALS
    • INTERNATIONAL ORGANIZATIONS AND MAJOR INITIATIVES IN MALARIA CONTROL
    • REFERENCES
    • APPENDIX 1A THE TEHIP STUDY
    • REFERENCES
  • 2. The Cost and Cost-Effectiveness of Antimalarial Drugs
    • The Immediate Problem of ACT Affordability
    • The Cost of Producing ACTs and Future Prices
    • The Global Cost of ACTs and Future Antimalarials
    • COST-EFFECTIVENESS OF ACTs AND OTHER ANTIMALARIAL DRUGS
    • CURRENT LEVELS OF GLOBAL FINANCING FOR MALARIA CONTROL
    • PROJECTED FINANCING NEEDS FOR GLOBAL MALARIA CONTROL
    • REFERENCES
  • 3. The Case for a Global Subsidy of Antimalarial Drugs
    • INTRODUCTION
    • FINANCING A GLOBAL SUBSIDY OF ACTS
    • CONCLUSION
    • REFERENCES
  • 4. An International System for Procuring Antimalarial Drugs
    • INTRODUCTION
    • THE BASICS OF DRUG PROCUREMENT
    • PROPOSED MALARIA MEDICINES AND SUPPLIES SERVICE
    • REFERENCES
• PART 2. Malaria Basics
  • 5. A Brief History of Malaria
    • MALARIA'S GLOBAL SAGA
    • MILESTONES IN ANTIMALARIAL DRUG DISCOVERY AND DRUG RESISTANCE
    • REFERENCES
  • 6. The Parasite, the Mosquito, and the Disease
    • THE MALARIA PARASITE AND ITS LIFE CYCLE
    • THE ANOPHELES VECTOR
    • PATHOGENICITY, IMMUNITY, AND DISEASE
    • CLINICAL FEATURES OF FALCIPARUM MALARIA
    • NON-FALCIPARUM MALARIA
    • REFERENCES
  • 7. The Human and Economic Burden of Malaria
    • INTRODUCTION
    • THE HEALTH BURDEN OF MALARIA IN AFRICA
    • THE ECONOMIC BURDEN OF MALARIA
    • REFERENCES
  • 8. Malaria Control
    • INTRODUCTION
    • HISTORICAL OVERVIEW
    • BASIC PRINCIPLES OF MALARIA CONTROL
    • INSECTICIDES AND INSECTICIDE RESISTANCE
    • INSECTICIDE-TREATED BEDNETS AND INDOOR RESIDUAL SPRAYING
    • OTHER VECTOR CONTROL MEASURES
    • TREATMENT AND CHEMOPREVENTION
    • DIAGNOSTIC METHODS
    • MALARIA VACCINES
    • INTEGRATED CONTROL PROGRAMS AND SPECIAL SETTINGS
    • MALARIA CONTROL PROGRAMS AND DRUG POLICIES
    • CONCLUSION
    • REFERENCES
  • 9. Antimalarial Drugs and Drug Resistance
    • CLINICAL MALARIA AND THE AIMS OF ANTIMALARIAL DRUG TREATMENT
    • ANTIMALARIAL DRUG CLASSES
    • MECHANISMS OF ACTION AND DRUG RESISTANCE
    • ARTEMISININS
    • ANTIMALARIAL DRUG RESISTANCE
    • ASSESSING ANTIMALARIAL DRUG EFFICACY AND RESISTANCE
    • REFERENCES
    • APPENDIX 9-A Descriptions of Specific Antimalarial Drugs
• PART 3. Advancing Toward Better Malaria Control
  • 10. Research and Development for New Antimalarial Drugs
    • INTRODUCTION
    • ANTIMALARIAL DRUG RESEARCH AND DEVELOPMENT
    • THE WALTER REED ARMY INSTITUTE OF RESEARCH
    • CONCLUSIONS
    • REFERENCES
  • 11. Maximizing the Effective Use of Antimalarial Drugs
    • INTRODUCTION
    • OVERCOMING ECONOMIC BARRIERS
    • MAKING ANTIMALARIALS SAFER AND MORE USER-FRIENDLY
    • EDUCATING STAKEHOLDERS
    • REFERENCES
• Acronyms and Abbreviations
• Glossary

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. HRN-A-00-00-00012-00 between the National Academy of Sciences and the U.S. Agency for International Development (USAID) and the Bill and Melinda Gates Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for this project.