The “grand experiment” of the Affordable Medicines Facility-malaria (AMFm) — a pilot program that aims to get artemisinin-based combination therapies (ACTs) into rural areas of several African nations — “seems likely to end, its successes underrated and potential improvements not yet explored,” a Nature editorial says. In October, “an independent evaluation found that it had performed remarkably well on the main benchmarks of success, increasing the number of outlets stocking ACTs and lowering prices,” but last week “the Global Fund to Fight AIDS, Tuberculosis and Malaria decided to end the AMFm as a stand-alone program, by integrating it into the fund’s core system for awarding malaria-control grants to countries,” the editorial notes, adding, “This integration probably spells the end for AMFm, because there will be no new money for the program after the end of next year.”

The editorial outlines criticisms of AMFm, including what it calls “long-standing U.S. opposition” and the potential for overtreatment because not all patients are tested for malaria before receiving therapy. “There is plenty of scope for improving the AMFm’s approach, which is still young,” Nature writes, adding, “But it would be senseless to give up on the AMFm’s strategy of using the vast existing private-sector infrastructure in Africa to get good medicines where there were none before.” The editorial concludes, “Anyone who doubts the power of the continent’s private-sector distribution networks should consider how the free market has made Coca-Cola and other soft drinks available in even the remotest locations. That force should be harnessed equally for lifesaving malaria therapies” (11/22).