expensive and do not discriminate between a true clinical case of malaria and illness of another cause in someone with a chronic but asymptomatic malaria infection, which is common in high-transmission areas. Work is progressing toward appropriate rapid diagnostics for such areas, but validated tests are not yet available.

The main purpose of bilateral and multilateral aid is to provide benefits to nations (or groups within them) who have been identified as appropriate beneficiaries of the particular type of assistance given. A global subsidy takes away the opportunity to select beneficiaries. In the case of ACTs, this means that some nations as well as certain individuals within virtually every nation will benefit when they could afford to pay the full price or something between the fully subsidized and nonsubsidized price.

Concerns may arise that a global subsidy for ACTs sets a precedent for other drugs or health interventions. The main precedent would be to subsidize other antimalarials which international consensus deems should either supplant ACTs or serve as another first-line therapy. If economic conditions in endemic countries are substantially unchanged when that time comes and the new product meets appropriate cost and cost-effectiveness criteria, it would be difficult to exclude it from subsidies.

On the other hand, the possibility that a global subsidy for ACTs would lead to pressure to subsidize drugs for treatment of other diseases should be a lesser concern. A few key factors related to malaria and its treatment, taken together, are unique among the major diseases. These factors are:

• Predominance of self-diagnosis and treatment of a life-threatening disease, with private sector drug purchasing, for an unpredictable need at the level of the individual or family

• Negligible market for drug in wealthier countries, so minimal opportunity for tiered pricing (particularly because ACTs are not appropriate for prophylaxis for travelers)

• Lack of a viable replacement for artemisinins as first-line drug

• Need for drug change because the historically effective drug has failed rather than extending a new medical benefit (as with the provision of long-term treatment for HIV-infected individuals); the major aim of replacing current antimalarials is to prevent further deterioration of clinical management

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)