As chloroquine resistance spread around the globe during the end of the 20th century, malaria and child mortality rates increased . Even then, people still used chloroquine because it was available and affordable. ACT was neither available nor affordable in the private sector until AMFm-subsidized packs reached the shelves of shops and pharmacies through the AMFm pilot.
No one denies that defeating malaria requires multiple tools, including insecticide-treated nets, indoor spraying of houses, and other vector control measures. But indisputably, the suite of interventions must also include easily-accessed and effective medicines real people can afford.
It is surprising to malaria control managers in Africa that the donors who generously funded the AMFm pilot would want to move on to other problems. Most health professionals who have been fighting malaria in Africa and have too often suffered from this old scourge agree that money for malaria control must not be wasted. Nor are they blind to other health needs. But AMFm has worked where nothing else does, and even at scale, it should be affordable globally if malaria continues to be prioritized.
The successes of insecticide-treated nets have been trumpeted by several stakeholders . But relative to the problem, the successes are modest. The malaria burden has not, for instance, been halved. If the global community does not persevere with all control measures, well-documented history says the gains made will surely be lost . An important part of continuing to make inroads in the malaria burden is expanding—not contracting—access to high-quality ACT for all who need it. Now, as has been the case for decades, and as the IOM committee observed, the private sector is a complimentary and important supplier of medicines for malaria in most settings in Africa.