The extent of the illegal sector, the presence of many unregistered products even in the legal private sector, and the widespread problem of counterfeit drugs gives some sense of the difficulty of regulating drugs in these countries and their neighbors in Africa and Asia. While governments work toward greater control—with the aim of more rational drug use by their citizens—the current mix of distribution systems will not be changed quickly.

Global health programs have recognized malaria as a priority for decades. The most visible efforts have come through national malaria control programs with international support centered around the World Health Organization and its regional offices, but with considerable bilateral assistance from a number of countries. Particular lines of research have been driven consistently by funding from a select group of national science agencies including those in the United States, United Kingdom, France, and China; and from foundations, in particular, the Wellcome Trust and the Rockefeller Foundation. With sponsorship from several U.N. agencies, the WHO-housed Special Programme for Research and Training in Tropical Diseases (WHO/TDR) has worked for the past 28 years to develop and promote the best use of pharmaceuticals and other malaria control measures. In the last 10 years or so, the number of organizations and collaborations devoted to malaria has grown impressively (Table 1-3). The boost in funding from the Bill & Melinda Gates Foundation has had a major impact on existing initiatives, in taking new directions in malaria research and control, and in raising the public profile of malaria. The Global Fund to Fight AIDS, Tuberculosis and Malaria has also provided a central focus for international funding.

The programs and initiatives most directly relevant to this study—related to the development and deployment of effective antimalarial drugs—are described briefly below.

Since it was started in 1975, the Special Programme on Research and Training in Tropical Diseases (TDR; a joint program of UNICEF, the World Bank, the U.N. Development Program and WHO, and housed at WHO) has organized research and development for new antimalarials, as well as supported research on the best ways to encourage the use of effective interventions of all types. TDR has leveraged its own modest budget by recruit-

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)