I’ve learned a bit more about ACTs since my previous post on them. A 2004 Institute of Medicine report called Saving Lives, Buying Time recommended subsidizing ACTs to make them affordable to those who need effective malaria medicines while using combination therapy to prevent resistance, or to “buy time” before malaria is resistant to this treatment, too. I had expected to find affordable ACTs here, but found that variety made by Novartis (Coartem) cost about $8.60 and the variety made by an Indian company (Lonart) cost $3.60. It turns out that the effort is just now rolling out, set to begin in July 2010. ACTs are now supposed to be 95% subsidized; it will be interesting to see if things change by August.
The chef of the family with whom we are staying recently got malaria and spent the money for Coartem. His Coartem box contained 18 tablets. His pharmacist instructed him to take one tablet at night and one in the morning every day for three days; fortunately Noel read the fine print that indicated that he was actually supposed to take three pills in the morning and three pills at night for three days. It is not hard to imagine how confusing those 18 pills would be to someone who could not read; an adult literacy rate of 65% in Ghana means that a lot of people who get malaria cannot read those instructions. It’s cool that a professor and classmate of mine are working a trial to determine if images explaining dosages result in improved adherence.
And then there is one of our friends, a Ghanaian man educated at prestigious universities in the United States. He finds bed nets uncomfortable and annoying but knows that malaria takes 7-10 days to manifest itself inside humans. His solution was to buy a bunch of Coartem in a country where it was subsidized by the government and to take some every two weeks. And when I say some I don’t mean the full course! As I explained in my previous post, not taking the full dose can allow malaria to develop resistance to the treatment. I can’t blame my friend and am myself guilty of not always following full courses of medicines. But it’s certainly a thought-provoking concept. Will making effective treatment affordable also lead to more misuse of the treatment? Will the Affordable Medicines Facility for malaria actually manage to “buy time” while “saving lives?”