not usurp the role of national governments, which retain responsibility over national drug policy and regulatory matters. Centralized procurement will only be effective if countries view it as facilitating their national malaria goals and objectives.

In September 2003, the IOM Committee on the Economics of Antimalarial Drugs cosponsored a meeting with the World Bank and the Roll Back Malaria Partnership to discuss the financing and procurement of ACTs. This chapter is based in large part on discussions that took place at that meeting, and the resulting meeting report (World Bank/Institute of Medicine, 2004).

The chapter discusses the pros and cons of different levels of international procurement of ACTs, and some possible institutional arrangements. For now, the hypothetical organization discussed would only procure ACTs; however, in the future, it also could procure second- and third-generation combination antimalarial treatments. The need for some form of centralized, coordinated procurement is widely acknowledged and relatively uncontroversial. The open questions are these: where should the agency be located? Does it require the creation of a new entity, or can it operate within an existing organization? To what degree should it also manage the international subsidy as opposed to partnering with another group that performs that function? The biggest challenge for an ACT procurement group will be to solidly liaise with the private retail sector in endemic countries. This report strongly endorses the principle of procurement at a high level in the distribution chain (possibly at the level of purchase from manufacturers), but it does not take a position on how it should be organized or administered.

THE BASICS OF DRUG PROCUREMENT

Tasks of Centralized Procurement Organizations

Supranational centralized procurement is attractive because it allows countries to participate in and benefit from a more focused and efficient effort than any single country could individually mount. Even if their drug policies differ, all malarious countries face common challenges. Every country with endemic falciparum malaria will need at least one ACT as first-line treatment for uncomplicated cases. The number of available ACTs in the short-to-medium term will probably number half a dozen, produced by 10-20 manufacturers capable of delivering ACTs of acceptable quality. Therefore, an international procurement organization would likely be charged with the following tasks in greater or lesser degrees of collaboration with governments and WHO, depending on the task:



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