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A Major Transition in Malaria Treatment: The Adoption and Deployment of Artemisinin-Based Combination Therapies

Parasite resistance to conventional antimalarial medicines has led, in recent years, to a dramatic shift in malaria treatment. Sixty-seven countries with endemic Plasmodium falciparum malaria, 41 of them in Africa, have recently adopted the highly effective artemisinin-based combination therapies (ACTs). In 2005, 31.3 million ACT treatment courses were procured globally for public sector use, 25.5 million of them in Africa. However, in the 39 countries, and in particular the 21 African countries in which ACTs are being deployed, access to these medicines is still unacceptably low. After a period of market instability, the global manufacturing capacity for ACTs is now sufficient to meet the demand. However, increased and sustained financing will be necessary to extend the current levels of ACT coverage. Artemisinins as monotherapies are widely available in the private sector of 47 endemic countries, and their consumption will, if unabated, promote resistance to artemisinins and compromise the effectiveness of ACTs.

Received October 25, 2006. Accepted for publication November 7, 2006.

Acknowledgments: The authors thank Drs. Arata Kochi, Maryse Dugue, Peter Olumese, Pascal Ringwald, Wilson Were, and Sergio Spinaci, Francoise Mas, and Elise Pacquetet for ideas, helpful dialogue, and sharing information.

^* Address correspondence to Andrea Bosman, Global Malaria Programme, World Health Organization, Av. Appia 20, 1211 Geneva, Switzerland. E-mail: bosmana{at}who.int

Authors’ addresses: Andrea Bosman, Global Malaria Programme, World Health Organization, Av. Appia 20, 1211 Geneva, Switzerland, Telephone.: 41-22-791-3860, Fax: 41-22-791-4824. Kamini N. Mendis, Global Malaria Programme, World Health Organization, Av. Appia 20, 1211 Geneva, Switzerland, Telephone: 41-22-791-3751, Fax: 41-22-791-4824.

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