1. G L O B A L M A L A R I A P R O G R A M M E ACTs as life-saving drugs HWG 16 January 2007

2. WHY SHOULD ACTs BE CONSIDERED AS LIFE-SAVING? Malaria mortality: in the absence of an effective treatment within 24 hours of the onset of symptoms, the progression to severe disease is associated with a high case fatality rate Malaria kills more than one million per year, mostly young children, for lack of access to proper treatment An estimated 10,000 women and 200,000 of their infants die as a result of malaria infection during pregnancy, and severe malarial anaemia contributes to more than half of these deaths.

3. Treatment of uncomplicated malaria with "ACTs" ANTIMALARIAL TREATMENT Cumulative Probability of a fatal outcome t (hours)

4. Experience with ACT implementation Study in KwaZulu natal already published More studies, not yet published, show similar convincing evidence

7. In this context, any interruption in supply will create a major crisis resulting in unacceptable regression 68 out of 76 (90% of) countries in need have adopted ACT GFATM covers approx. 85% of ACTs purchase in 2006 Low success rate of malaria grants in rounds 5 and 6: a number of countries with grants ending in 2007 Round 6 will provide for 32 million additional ACT treatments, out of 130 million requested in grant submission, leaving a substantial gap

8. 2 levels of consequences of an interrupted supply Direct, on mortality in vulnerable population Indirect, on health systems: –Impact on policy implementation, staff,… –Loss of confidence of the population

9. POTENTIAL UNITAID SUPPORT TO ACT IMPLEMENTATION IN 2007 Under GFATM grant with strong performance and high need GFATM grant coming to its end (natural termination) Not under GFATM grant but good infrastruct ure in place operational costs include the following: USD 340'000 for UNICEF Procurement 7-8% freight by air & insurance 1-2% taxes, administrative costs 3-5% warehousing in country 8-12% transport and distribution within country Potential next actions in 2007 programs require discussion between partners and countries to lay out options, assess costs and impact and define the operational models for each category of country I mmediate Actions Potential next actions for 2007 UNITAID will initially only fund commodities, i.e. no funds for operational costs neither for technical assistance Ethiopia, Indonesia, Ghana, Madagascar, Mozambique, Somalia, Sudan N&S, Zambia Burundi, Liberia GFATM grant terminated for performance