What is the current choice? In the view of the IOM Committee, it is unacceptable that cheap, effective drugs with a single medical purpose are currently unavailable to people whose lives would be saved by them. Failure to prevent the premature loss of our relatively few effective drugs through the simple expedient of coformulated drugs (currently, ACTs) also is unacceptable. The strategy offered in this report is a way to preserve the effectiveness of antimalarials for all global citizens—a true global public good. With coordinated policies, funding, and implementation, progress can be made. Without rapid adoption of ACTs, we will only continue to lose lives and lose ground.

The subsidy must be applied high up in the ACT supply chain, above the level of individual countries. To assure the greatest international access, the public and private sectors of all endemic countries should be eligible to purchase ACTs at low, subsidized prices. In the future, subsidies could apply to other new combination antimalarials that meet technical criteria and are considered equivalent in their therapeutic promise to ACTs.

Funds must be committed toward the global purchase of artemisinins in the 2- to 5-year time frame to encourage new companies to begin and producing companies to ramp up production. Once funds are committed and the conditions of purchase developed, potential producer companies should be actively solicited and provided with information and, if needed, technical assistance. If upgraded production facilities are needed, the International Finance Corporation (a sister institution of the World Bank) could provide needed funds. WHO should be prepared to assist companies in making their products “pre-qualified” and eligible for purchase through an international procurement process.

Front Matter (R1-R20)

Executive Summary (1-16)

Part 1: A Response to the Current Crisis1 Malaria Today (17-60)

2 The Cost and Cost-Effectiveness of Antimalarial Drugs (61-78)

3 The Case for a Global Subsidy of Antimalarial Drugs (79-111)

4 An International System for Procuring Anitmalarial Drugs (112-122)

Part 2: Malaria Basics5 A Brief History of Malaria (123-135)

6 The Parasite, the Mosquito, and the Disease (136-167)

7 The Human and Economic Burden of Malaria (168-196)

8 Malaria Control (197-251)

9 Antimalarial Drugs and Drug Resistance (252-298)

Part 3: Advancing Toward Better Malaria Control10 Research and Development for New Antimalarial Drugs (299-311)

11 Maximizing the Effective Use of Antimalarial Drugs (312-328)

Acronyms and Abbreviations (329-333)

Glossary (334-346)

Index (347-364)