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Drug resistance due to parasite mutation was a key driver of malaria's resurgence in sub-Saharan Africa in the 1990s. Southeast Asian countries demonstrated the efficacy of a new but expensive treatment and, together with a Swiss pharmaceutical company, developed the first fixed-dose artemisinin-based combination therapy (ACT) for malaria. Few countries claimed they could afford to adopt this drug as a first line treatment. Advocates, malaria scientists and United States Congress ultimately exposed the folly of continuing to fund outdated drugs like chloroquine and sulfadoxine-pyrimethamine, and donor agencies moved to meet the huge need for ACTs.

The results have been a mixture of success and systemic failure. The United States Government, World Bank and the Global Fund to Fight AIDS, TB and Malaria have substantially increased malaria control funding and through the World Health Organisation and Roll Back Malaria Partnership provided technical assistance to help countries change treatment guidelines to ACTs and devise strategies to finance them. As of September 2007, ACTs are listed as first-line treatments for uncomplicated malaria in every national treatment policy in sub-Saharan Africa where they are needed. The Global Fund is helping to deliver 264 million ACTs, backed by an unprecedented $471 million allocation for malaria control (42% of total allocations) in its most recent round of grants (Round 7). Largely as a result of these efforts, some African countries are reporting localized declines in malaria cases and deaths.

Roger Bate is a resident fellow at AEI.

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