would currently meet worldwide needs. It ends with a discussion of how such a subsidy might be financed.

The Case for an Antimalarial Subsidy of Any Kind
The Humanitarian Case: Saving Lives

The primary reason for subsidizing antimalarials is to increase access to ACTs (and other drugs in the future) with the aim of reversing the recent upward trend in deaths and illness from drug-resistant falciparum malaria. Despite WHO’s recommendation that ACTs be adopted as the first-line treatment for uncomplicated falciparum malaria where drug resistance has already reached significant levels (defined as greater than 15-25 percent failure to cure in standard clinical tests), few countries of sub-Saharan Africa that meet this definition of drug failure have named ACTs as their first-line malaria treatment. The few that have made the change have done so only after securing means to finance at least the public portion of the cost for a few years (i.e., drugs sold through the private retail sector are not subsidized). Other countries have made other decisions, e.g., switching to sulfadoxine-pyrimethamine (SP), or chloroquine plus SP, as first-line treatments (both regimens are in the same price range as chloroquine), merely postponing the inevitable change to ACTs for the time being.

Informally, knowledgeable individuals from endemic countries readily disclose that cost is the main factor preventing governments from switching to ACTs. Even if the prospect of funding exists, e.g., through the Global Fund, governments are wary about changing because of the uncertain sustainability of financing in the longer term. This has led to the continuing spread of chloroquine resistance to current high levels in many countries. The current dilemma clearly supports a subsidy of some type that would make the choice of adopting ACTs as first-line antimalarials a financially feasible option for countries unable to do so under existing circumstances. The fact that no country in Africa has adopted ACTs as first-line treatment without external funding indicates that widespread coverage will not be achieved across the continent without a global plan and a subsidy available to all countries. Currently, not enough money is available through the Global Fund or bilateral agencies to accomplish this.

Creating a “Public Good:” Buying Time against Drug Resistance

In addition to the humanitarian rationale, there is an economic rationale for international subsidies of ACTs. Treating any contagious disease creates a “positive externality” by reducing the chances that other people



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