One of the world's largest health funding agencies — the Global Fund — made two big decisions Thursday.
The fund appointed Dr. Mark Dybul as its new executive director. Dybul is best known for leading the international fight against HIV during the Bush's administration through the President's Emergency Plan For AIDS.
The fund's board also decided the fate of a controversial $225 million project that subsidizes the cost of the most effective malaria drugs in Africa.
The fund says it will discontinue financial support for the Affordable Medicines Facility-malaria program, or AMFm, after a one-year transition period. Countries that wish to continue using subsidies will have to divert money from their regular malaria work to pay for them.
There has been a vigorous debate in the global health community about AMFm.
Advocates, such as Barry Bloom of Harvard School of Public Health, say the pilot project has reached its major goal. It's gotten the best malaria drugs to more people by reducing their cost through collective bargaining and payments to manufacturers.
Critics, on the other hand, claim that AMFm is wasteful. They say the program has put the drugs in the hands of the untrained people, such as shopkeepers and private pharmacists who've given the drugs to people even when they don't have malaria. One study even reported a gross overtreatment of malaria in many countries participating in the AMFm.
Here's how the Global Fund describes plans for the project:
During a transition period in 2013, the lessons learned from the operations and resourcing of Phase 1 of the AMFm, such as manufacturer negotiations and the co-payment mechanism, will be integrated into core Global Fund processes.... Under the new, integrated model, eligible countries will be able to allocate funding from their core Global Fund grants and determine how the money should be spent.
"This raises an awful lot of worries," Bloom tells Shots. "I'm concerned that its decision is more determined by politics and ideology than a focus on how to deal with kids and adults with fevers in poor countries."
Bloom says it's unclear if each country now has to bargain with drug manufacturers on its own, and thus will lose their collective bargaining power to keep the price of malaria drugs low.
He also says the Global Fund didn't address a major problem with malaria in Africa — diagnosing it properly before beginning treatment. "I had hoped that the Global Fund would create a pilot project for linking diagnosis to treatments," he says. "They could have done a lot better."
Earlier this week, Stanford University economist and Nobel laureate Kenneth Arrow, also voiced his support for AMFm in The New York Times. "This initiative is an interim measure to ensure that fewer children die for lack of effective anti-malarials," he wrote. "The risk is that efforts to develop and implement "the perfect" will end up killing 'the good' in the process."
Update on Friday afternoon. A representative from the Global Fund sent us this statement:
Following a transition period, co-payments for anti-malarial drugs will no longer be available through a separate funding mechanism hosted by the Global Fund. Instead, through the integrated model approved by the Global Fund Board, all eligible countries that wish to expand access to ACTs and malaria diagnostic testing will be able to allocate funding from their core Global Fund grants to a private sector subsidy. Under this integrated model, the Global Fund Secretariat will continue to centrally negotiate prices and make direct payments to manufacturers on behalf of buyers in those countries.