Since the 1970’s, prompt treatment with chloroquine (CQ) and other simple and inexpensive therapies has been a cornerstone of malaria control efforts around the world. By 2000, however, chloroquine-resistant malaria parasites were pervasive throughout many countries, rendering the drug largely ineffective and contributing to increased mortality in some areas. In response, many governments switched national first-line treatment policy to sulfadoxine-pyrimethamine (SP), but resistance to SP rapidly emerged soon after its introduction, jeopardizing not only patients with clinical illness but also the intermittent presumptive treatment strategy for pregnant women. In response to this crisis, the World Health Organization changed its guidelines to recommend artemisinin-based combination therapies (ACTs) as first-line malaria treatment in 2001 due to their high efficacy and ability to limit the development of further resistance.  The subsequent launch of the Global Fund to Fight AIDS, Tuberculosis began providing countries with the financial confidence needed to switch to these more expensive therapies. Today, nearly all malaria endemic countries have adopted ACTs as first-line treatment. With funding from the Global Fund, U.S. President’s Malaria Initiative, the World Bank and others, many of those countries have made substantial progress in delivering ACTs to patients through public health systems. However, due to their considerably higher cost (10 to 40 times higher than CQ), few of the many patients that seek malaria treatment in the private sector are accessing ACTs, and are instead continuing to purchase sub-optimal therapies such as SP and CQ or anti-pyretics.

Olivier Sabot et al ; S.D.