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• W2158994952 abstract "We were perplexed to read the Viewpoint by Amir Attaran and colleagues (Jan 17, p 237)1Attaran A Barnes KI Curtis C et al.WHO, the Global Fund, and medical malpractice in malaria treatment.Lancet. 2004; 363: 237-240Summary Full Text Full Text PDF PubMed Scopus (180) Google Scholar because WHO has been making many of the same arguments for the past 3 years and fully supports the use of artemisinin-based combination therapy (ACT).Since 2001, WHO has been actively promoting the use of ACT in countries before resistance to currently used monotherapies reaches an unacceptable level. WHO works continually with national health authorities to review local data on drug efficacy and to discuss treatment policy updates. These efforts are already showing results. First, South Africa (KwaZulu Natal), Zambia, Zanzibar, and Burundi have switched to ACTs as first-line treatment since 2001, in line with WHO recommendations and with financial assistance from the Global Fund. Second, we expect that by the end of 2004 at least 16 African countries will have adopted ACTs as first-line treatment. And third, WHO's threshold for the unacceptable level of therapeutic failures has been lowered from 25% to 15% and countries will be strongly encouraged to modify their treatment policies accordingly.Although progress is encouraging, there are still major challenges to the adoption of ACTs, especially sustainable financing. Although with growing demand a price decrease can be expected in the coming years, the cost of growing the raw ingredient, Artemisia annua, means that ACTs will remain relatively expensive. Governments need to trust that sustainable funding from the Global Fund and other sources will be available before they can make the commitment—of up to US$2 per head per year—of switching to ACTs. WHO and its partners are developing a new mechanism to facilitate access to quality medicines and other products for malaria control. WHO will continue to work with the public and private sectors, and major institutions such as the Global Fund, to make ACTs more widely available through lowered costs, increased access, and technical cooperation.The Global Fund has appeared at a critical juncture for bolstering national efforts against malaria, and its Technical Review Panel has been thoroughly briefed by WHO on drug-policy issues. When faced with proposals including requests for suboptimal drugs based on current national policy, the Global Fund has generally stipulated a policy review within a short period of time as a condition for funding—rather than rejecting the proposal. As a result, WHO is able to work more effectively with decision-makers in countries to accelerate rational and feasible policy change.Cooperation in international health needs to strike a balance between respect for national autonomy and promotion of international policies and standards. A change in national malaria treatment policy is a sector-wide effort entailing significant investment in communication and coordination among many institutions and government agencies. It requires the selection of an appropriate combination, and then the training, communication, product registration, pharmaceutical management, monitoring, and pricing to support it.2Lwamafa DK Langi P Killian A Antimalarial drug treatment for malaria in Uganda.BMJ. 2003; (accessed Jan 21, 2004)http://bmj.bmjjournals.com/cgi/eletters/327/7425/1188#42937Google Scholar These processes must be led by national governments. WHO's role is to work with governments to provide technical expertise and advice on the best treatment policy options. We were perplexed to read the Viewpoint by Amir Attaran and colleagues (Jan 17, p 237)1Attaran A Barnes KI Curtis C et al.WHO, the Global Fund, and medical malpractice in malaria treatment.Lancet. 2004; 363: 237-240Summary Full Text Full Text PDF PubMed Scopus (180) Google Scholar because WHO has been making many of the same arguments for the past 3 years and fully supports the use of artemisinin-based combination therapy (ACT). Since 2001, WHO has been actively promoting the use of ACT in countries before resistance to currently used monotherapies reaches an unacceptable level. WHO works continually with national health authorities to review local data on drug efficacy and to discuss treatment policy updates. These efforts are already showing results. First, South Africa (KwaZulu Natal), Zambia, Zanzibar, and Burundi have switched to ACTs as first-line treatment since 2001, in line with WHO recommendations and with financial assistance from the Global Fund. Second, we expect that by the end of 2004 at least 16 African countries will have adopted ACTs as first-line treatment. And third, WHO's threshold for the unacceptable level of therapeutic failures has been lowered from 25% to 15% and countries will be strongly encouraged to modify their treatment policies accordingly. Although progress is encouraging, there are still major challenges to the adoption of ACTs, especially sustainable financing. Although with growing demand a price decrease can be expected in the coming years, the cost of growing the raw ingredient, Artemisia annua, means that ACTs will remain relatively expensive. Governments need to trust that sustainable funding from the Global Fund and other sources will be available before they can make the commitment—of up to US$2 per head per year—of switching to ACTs. WHO and its partners are developing a new mechanism to facilitate access to quality medicines and other products for malaria control. WHO will continue to work with the public and private sectors, and major institutions such as the Global Fund, to make ACTs more widely available through lowered costs, increased access, and technical cooperation. The Global Fund has appeared at a critical juncture for bolstering national efforts against malaria, and its Technical Review Panel has been thoroughly briefed by WHO on drug-policy issues. When faced with proposals including requests for suboptimal drugs based on current national policy, the Global Fund has generally stipulated a policy review within a short period of time as a condition for funding—rather than rejecting the proposal. As a result, WHO is able to work more effectively with decision-makers in countries to accelerate rational and feasible policy change. Cooperation in international health needs to strike a balance between respect for national autonomy and promotion of international policies and standards. A change in national malaria treatment policy is a sector-wide effort entailing significant investment in communication and coordination among many institutions and government agencies. It requires the selection of an appropriate combination, and then the training, communication, product registration, pharmaceutical management, monitoring, and pricing to support it.2Lwamafa DK Langi P Killian A Antimalarial drug treatment for malaria in Uganda.BMJ. 2003; (accessed Jan 21, 2004)http://bmj.bmjjournals.com/cgi/eletters/327/7425/1188#42937Google Scholar These processes must be led by national governments. WHO's role is to work with governments to provide technical expertise and advice on the best treatment policy options." @default.
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• W2158994952 title "Response to accusations of medical malpractice by WHO and the Global Fund" @default.
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