Cheaper malaria drugs but more stockouts in Africa?

Richard Tren, Kimberly Hess and Roger Bate have written a fascinating commentary titled ‘Drug procurement, the Global Fund and misguided competition policies‘  just published yesterday in the Malaria Journal. In this commentary they outline how the Global Fund to Fight AIDS,Tuberculosis and Malaria recently began asking some grant recipients to use international competitive bidding processes for certain drug purchases, including artemisinin-based combination therapy (ACT). Unfortunately, this process, which aimed to enable countries to buy the best value-for-money drugs has backfired in Kenya, because companies that won tenders to supply drugs haven’t been able to come up with the goods, resulting in a stock-out crisis. The commentary lays out how GFATM enables countries to buy drugs, and the problems with this process that can lead to stock-outs. They describe in detail the processes by which Uganda has used this tendering process and ended up signing a contract with the same company that has had woeful supply problems in Kenya. The concern is that whilst some companies may be able to supply drugs cheaply, they may not be able to supply suitable quality drugs when they’re actually needed. Moreover, in the tendering process, price seems to be given more weight than drug quality or the potential of a company to supply drugs. Ultimately this means patients with malaria may not be able to obtain life-saving drugs when they need them. Finally, the authors comment that

‘GFATM is one of the most successful mechanisms for supporting malaria control programmes and is more open and transparent than almost any other multilateral or bilateral programme, but significant procurement policy problems within GFATM must be urgently addressed. Competition among suppliers will lower
prices and may raise quality, but only if minimum standards are required.’

We also recently pointed out in an editorial the problem of  shortages of artemisinin-based combination therapy in Africa at the point of care. The editorial was written after Gavin Yamey, one of the editors, returned from a fellowship in East Africa, where he noticed that the problem of ACT stockouts was all too common. In the editorial we reviewed the first two “waves” of successful malaria activism. In the first wave, activists highlighted the gap between the huge burden of malaria and the tiny amount of international development assistance dedicated to its control. Such advocacy helped motivate donors to increase their malaria commitments. The second wave focused on making sure that the extra funding was used to purchase highly efficacious artemisinin-based combination therapy (ACT) rather than monotherapies such as chloroquine, which are largely ineffective in Africa. We ended up by calling for a  “third wave” of activism, to highlight the widespread ACT stock-outs (shortages) across Africa, a crisis that can have deadly consequences.

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