year (Narasimhan and Attaran, 2003). This figure is for all aspects of control (insecticide-treated nets, household spraying, and other preventive measures), and not just treatment. The amount that would have gone toward the cost of antimalarial drugs would be some fraction of the total.

Foundations have, for many years, contributed to global public health initiatives. In recent years, the Bill and Melinda Gates Foundation has entered at a level surpassing any other such efforts, spending close to US$1 billion per year on a variety of programs, some funded independently, and some through existing programs (e.g., the Gates Foundation is a major donor to the Global Fund, MMV, GAVI, and a number of other initiatives). This single entity is spending well over half of the amount spent by all governments and multilateral institutions together.

The advent of the Global Fund to Fight AIDS, Tuberculosis and Malaria represents the other big change in the funding landscape for global health. In their first three rounds of grants (from mid-2002 through the end of 2003), the Global Fund approved US$2 billion in 2-year grants to about 100 of the world’s poorest countries. About one-quarter—US$475 million—was allocated to malaria projects, although very little so far involves funding the purchase of ACTs.

PROJECTED FINANCING NEEDS FOR GLOBAL MALARIA CONTROL

In April 2000, more than 20 African heads of state met in Abuja, Nigeria for the first-of-a-kind political summit on malaria. It was one of the seminal events of the Roll Back Malaria (RBM) partnership. The African leaders called on the world community to allocate substantial new resources—at least US$1 billion per year—toward reaching the RBM goal of halving malaria deaths by the year 2010. Development partners also were called upon to cancel the debt of poor and heavily indebted nations so that more resources could be released to address malaria and otherwise alleviate poverty. In addition, the Abuja summit sought resources to support R&D for the whole range of malaria control measures.

The derivation of the US$1 billion was not stated explicitly, but this amount does not seem to overstate how much is needed. In the following year, 2001, the Commission on Macroeconomics and Health published a comprehensive and systematic analysis of how much it would cost to “scale up” a set of “priority” interventions for the world’s poor (“priority” being defined by acceptable effectiveness, cost-effectiveness, and overall cost, with costs representing incremental costs over existing expenditures).

Malaria was singled out for individual analysis as one of the most important illnesses (in terms of both the burden of disease and its costs to society) to be addressed by increased resources for worthwhile interven-



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