The Affordable Medicines Facility-malaria began as a pilot program in 2010 to “provide a ‘co-payment’ to the manufacturers of [artemisinin-based combination therapies (ACTs)], thereby allowing commercial wholesalers and private or government health services to purchase the drugs at a fraction of the already low negotiated price,” Kenneth Arrow, a Nobel laureate in economic sciences in 1972 and an emeritus professor of economics at Stanford University, writes in a New York Times opinion piece. The program subsidized ACTs — a newer, more effective malaria treatment — to “sell [them] as cheaply as [less-effective] chloroquine in Africa’s private pharmacies and shops, where half of all patients first seek treatment for malaria-like fevers,” he states. “Strikingly, it has worked,” Arrow writes, noting a recent independent review of the program published in the Lancet.

“Still, it may not end well for AMFm,” Arrow says, noting the Global Fund to Fight AIDS, Tuberculosis and Malaria, which administers AMFm, is meeting this week “to consider what comes next.” He continues, “The recommendations on the table are to cut back, not expand, the subsidy program,” and he notes “[c]ritics have said that the evaluation of the pilot program is not definitive because it was not designed to count the number of children’s lives saved” and it allows people access to ACTs without a definitive malaria diagnosis. Arrow says the next “version” of AMFm “could be improved, perhaps by encouraging the effective use of diagnostic tests,” and notes malaria-control managers recently “voiced unanimous support for continuing and expanding the program and warned of serious consequences if ACT prices rose.” He concludes, asking, “[I]n what world does it make sense to abandon a simple program that saves lives?” (11/13).