African Experts Discuss Need for Better Regulation of Medicine

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In most African countries, pharmaceutical drugs are poorly regulated or not regulated at all, posing huge risks for those who depend on them to stay healthy. But for the first time, the topic has gotten the attention of African officials, who holding a scientific conference on the topic in South Africa.

Access to safe and effective medicine can be touch and go in Africa, where the market abounds with drugs that are fake or expired.

That can have disastrous consequences, says Margareth Ndomondo-Sigonda, a Tanzanian who oversees pharmaceutical issues for an African Union agency, the New Partnership for Africa’s Development, or NEPAD.

“The situation that you see in Africa is that most of the medicines circulating in our market, more than 30 percent, either does not meet the standards, meaning that it cannot treat the disease that it is intended to, or it is falsified, meaning that it is not a real medicine,” Ndomondo-Sigonda said. “Could be that it does not have the necessary active ingredients, and therefore it may not treat or it may even cause harm to the patient instead of actually treating the disease that is intended.”

She is one of hundreds of experts who gathered in Johannesburg this week for the first-ever scientific conference bringing together pharmacists, health workers, governments and civic organizations to discuss how to better regulate the drugs that make it to health facilities across Africa.

Ndomondo-Sigonda says that most African nations lack the capacity to effectively police medicines. Nations are considering tightening and refining their testing protocols and collaborating on testing, among other interventions.

Experts also noted the role that law enforcement authorities can play in cracking down on fake drugs. While this is sure to be a long and costly process, NEPAD’s head science advisor Aggrey Ambali says these measures may end up making drugs cheaper for consumers.

If countries cooperate to test drugs, he says, they can save money. And if local drug producers are made aware of the new guidelines, they can compete more effectively.

“Without actually having the actual numbers, but the pointers are there that if this were to succeed, I think there are opportunities of trying to find ways of cutting costs which can actually be reflected in the final price of the medicine,” said Ambali.

Ndomondo-Sigonda says consumers can protect themselves now by being selective about where they buy their drugs and sticking to trustworthy health facilities.

“The minute they go and buy medicines in the open markets, that is where the problem starts, because the products in the open markets, they are not assured because you do not know where they source them from and you have a huge potential for buying counterfeit medicines in such markets,” she said.

That fact was illustrated in 2011, when the World Health Organization reported that in Nigeria, the continent’s largest pharmaceutical market, nearly two-thirds of drugs used to fight malaria were fake.

via African Experts Discuss Need for Better Regulation of Medicine.

–Anita Powell
Source: VOA News

SMS for Life Uses Mobile Phones to Increase Access to Essential Antimalaria Medications

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SMS for Life harnesses everyday technology to improve access to essential malaria medicines in rural areas of developing countries. It uses a combination of mobile phones, SMS messages and electronic mapping technology to track weekly stock levels at public health facilities in order to:

  • Eliminate stock-outs
  • Increase access to essential medicines
  • Reduce the number of deaths from malaria

SMS for Life is an innovative public-private partnership led by Novartis and supported by the Tanzanian Ministry of Health and Social Welfare, IBM, Medicines for Malaria Venture (MMV), the Swiss Agency for Development and Cooperation (SDC), Vodacom and Vodafone. The project comes under the umbrella of the global Roll Back Malaria Partnership.

How Malaria Parasites Stick to Sides of Blood Vessels

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Malaria Test Tanzania

At the hospital in Korogwe, Tanzania, mothers are waiting in line with their young children to have the children tested for malaria. The aggressive parasite kills one million people each year of which the majority is children below the age of five. Photo: University of Copenhagen.

Researchers have identified how malaria parasites growing inside red blood cells stick to the sides of blood vessels in severe cases of malaria. The discovery may advance the development of vaccines or drugs to combat severe malaria by stopping the parasites attaching to blood vessels. The results are now published in the scientific journal Nature.

Though researchers have known for over a century that red blood cells infected with malaria parasites can kill their host by sticking to the sides of blood vessels, the binding mechanism associated with the most lethal forms of malaria was unknown. Now, in a study published in Nature, the researchers show that the parasite binds a protein in blood vessel walls called endothelial protein C receptor (EPCR), which is involved with regulating blood coagulation and the inflammatory response.

Malaria parasites grow in red blood cells and stick to the endothelial lining of blood vessels through a large family of parasite proteins called PfEMP1. This way, the parasite avoids being carried with the blood to the spleen, where it would otherwise be destroyed. One of the most aggressive forms of malaria parasite binds in brain blood vessels, causing a disease called cerebral malaria.

In 2012, three groups of researchers, including the teams at the University of Copenhagen and Seattle Biomedical Research Institute, showed that a specific type of PfEMP1 protein was responsible for cerebral binding and other severe forms of malaria infection. However, until now, the receptor to which it binds remained unknown, and the next big question was to determine which receptors the infected red blood cells were binding to.

“The first big challenge was to generate a full-length PfEMP1 protein in the laboratory,” says Assistant Professor Louise Turnerat the University of Copenhagen. “Next, we utilized a new technology developed by Retrogenix LTD in the United Kingdom to examine which of over 2,500 human proteins this PfEMP1 protein could bind to.” Of the 2,500 proteins screened, a receptor called endothelial protein C (EPCR) was the single solid hit.

“A lot of work then went into confirm this binding in the lab and not least to show that parasites from non-immune children with severe malaria symptoms in Tanzania often bound EPCR,” she continues.

“It was a true eureka moment,” says Assistant Professor Thomas Lavstsen. “Under normal conditions, ECPR plays a crucial role in regulating blood clotting, inflammation, cell death and the permeability of blood vessels. The discovery that parasites bind and interfere with this receptor´s normal function may help us explain why severe symptoms of malaria develop.”

Malaria parasites disrupt the important functions of blood vessels

Red blood cells infected with Plasmodium falciparum malaria bind to the endothelial lining of blood vessels in vital organs, such as brain, lung, and heart leading to disease complications with a high risk of deadly consequences. Source: Seattle Biomed

Red blood cells infected with Plasmodium falciparum malaria bind to the endothelial lining of blood vessels in vital organs, such as brain, lung, and heart leading to disease complications with a high risk of deadly consequences. Source: Seattle Biomed

Red blood cells infected with Plasmodium falciparum malaria bind to the endothelial lining of blood vessels in vital organs, such as brain, lung, and heart leading to disease complications with a high risk of deadly consequences. Image ourtesy of Seattle Biomed[/caption]Severe malaria symptoms such as cerebral malaria often result in minor blood clots in the brain. One of our body´s responses to malaria infection is to produce inflammatory cytokines, but too much inflammation is dangerous, describes Professor Joseph Smith, from the Seattle Biomedical Research Institute.

“ECPR and a factor in the blood called protein C act as a ‘brake’ on blood coagulation and endothelial cell inflammation and also enhance the viability and integrity of blood vessels, but when the malaria parasites use PfEMP1 to bind EPCR, they may interfere with the normal function of EPCR, and thus the binding can be the catalyst for the violent reaction,” he explains.

“Investigating this question is the next step to learn about how malaria parasites cause disease.”

Towards an intervention

The discovery that malaria parasites bind EPCR may advance vaccine and drug interventions to treat severe malaria. Dr. Matthew Higgins from the University of Oxfordexplains:

“Now that we know the pair of proteins involved, we can begin zooming further in to reveal the molecular details of how malaria parasites grab onto the sides of blood vessels. We want to know exactly which bits of the parasite protein are needed to bind to the receptor in the blood vessel wall. Then, we can aim to design vaccines or drugs to prevent this binding.”

Children who have suffered from severe malaria can experience poor hearing and reduced learning capacities later in life. Photo: University of Copenhagen.

Malaria and Hearing

Red blood cells infected with Plasmodium falciparum malaria bind to the endothelial lining of blood vessels in vital organs, such as brain, lung, and heart leading to disease complications with a high risk of deadly consequences. Image ourtesy of Seattle Biomed

Vaccine research will also benefit immediately from the discovery, since scientists can already now test the effectiveness of different vaccine candidates at preventing PfEMP1 from binding ECPR. “Over the last decade, we have come to appreciate that specific PfEMP1 proteins are associated with different severe forms of malaria,” explains Professor Thor Theander at the University of Copenhagen. “Together with The National Institute for Medical Research Tanzania, we are in the process of preparing phase I trials for a vaccine to prevent parasite binding in the placenta and malaria during pregnancy,” he explains. This new discovery holds the potential for also developing a vaccine to reduce the heavy burden malaria disease inflicts on children.  “It will be a long haul, but with these results, we can get started right away,” he says.

Source: University of Copenhagen

Malaria Testing

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QUESTION

My daughter is in Kigoma, Tanzania and has the symptoms of Malaria. She was given Duo Cotecxin and it seems to have started making her feel better. But after reading up on all the different types of Malaria parasites I am wondering if a blood test reading at a clinic would be recommended or is it too late for an accurate reading now that she is on meds?

ANSWER

I am always very nervous about people given malaria medication without a proper blood test-based diagnosis. The symptoms of malaria can sometimes be very general, and I have recently seen some data from elsewhere in Tanzania whereby clinics are giving virtually everyone who comes in with a fever malaria medication, even if the blood tests are negative! This is a sure way to develop resistance to malaria drugs, plus exposes people to the potential side effects of medication that they may not need, while also failing to diagnose or treat them for whatever other condition they may also have.

In your daughter’s case, since she is feeling better, it may be that she did indeed have malaria. Regardless, now that she is taking the treatment, she should make sure to finish the full dose of pills. It still could also be worth going in for a blood test. In any case it will put your mind at rest, and if there are still traces of the parasite in her blood, then you will know for sure that she had malaria. Moreover, it might tell you which type of malaria she had. While P. falciparum is the most common form of malaria in sub-Saharan Africa, cases of other types, such as P. vivax and P. ovale, are being reported more and more frequently.

These two types can form liver stages (called hypnozoites) which can stay dormant for weeks, months or even years after the initial infection. During this period, the patient will experience no symptoms; then, when the hypnozoites activate and re-enter the blood again, the patient will get a “relapse” of the malaria symptoms. The only drug available to kill these liver stages is primaquine; as such, if your daughter is positively diagnosed with P. vivax or P. ovale malaria, she should be aware of the possibility of a relapse, and perhaps discuss with a doctor the possibility of taking primaquine.

I hope she recovers fully and enjoys her stay in Kigoma—I spent almost a month out there last year!

Malaria Deaths by Country

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QUESTION

Where are the most deaths of malaria?

ANSWER

Over 90% of the deaths from malaria occur in sub-Saharan Africa, and in children under the age of five. According to the World Health Organisation’s 2011 World Malaria Report, the countries with the five highest numbers of reported malaria deaths for 2010 are (and number of reported deaths): Kenya (26,017 deaths), Democratic Republic of Congo (23,476), Tanzania (15,867), Burkina Faso (9,024) and Uganda (8,431).

However, it is important to note that this indicates the number of reported deaths that were confirmed as malaria; there are other countries in Africa which may have similar levels of malaria mortality but insufficient health infrastructure for accurate diagnosis of cause of death or reporting. Even in countries where reporting levels are high, causes of death are not always accurately determined.

Where There is No Medicine, Let Alone a Doctor

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Remote or poorly accessible communities create special challenges for delivery of health care.

There were goats in my classroom this morning. Quite adorable kids, but unfortunately not the right species for my health survey. The school is located in Bunda District, sandwiched between Lake Victoria and the long western arm of Serengeti National Park, which stops only a few kilometers from the lake’s shoreline.

This zone of the Serengeti, the so-called Western Corridor, is a crucial stop-over point in the famous circular migration of wildebeest, zebra and other animals, following the rains around the vast grasslands. However, its relative remoteness means it doesn’t see quite the same surge of visitors as other parts of the park; still, every day fancy 4x4s and shiny tourist vans pull up to the Ndabaka Gate, full of foreigners paying $50 a day in park fees alone, for the unique experience of seeing Africa’s magnificent wildlife in one of the world’s most awe-inspiring natural landscapes.

goat tanzania

A kid goat sitting under a desk in a primary school in Tanzania. Photo: CJ Standley

There is little indication here in the village of the vast turnover of foreign currency occurring just a few kilometers to the east. The proximity to Lake Victoria, with its bounty of fish and permanent water supply, allowing year-round irrigation of crops, ensures that few children in this area are severely undernourished.

However, the lake is also a source of disease. The reedy fringes are the perfect habitat for certain species of freshwater snail, which transmit intestinal schistosomiasis; stagnant pools are also ideal nursery grounds for mosquito larvae.

Sanitation infrastructure is basic at best, with some houses possessing a pit latrine in a corner of the compound but many families simply doing their business in the tall papyrus groves right on the lakeshore. Most water for cooking, drinking and washing is collected directly from the lake, usually by children, and once their chores are done they play barefoot in the muddy alleys between huts: shoes are only worn for special occasions, sometimes not even for school. As a result, prevalence of schistosomiasis is high, malaria is an everyday burden and transmission of hookworm is rife.

What health care options exist for this community? The closest doctors are probably at the district hospital in Bunda, about a 20 minute drive north along the fast, tarmac road running between Mwanza and Musoma. However, to get to the main road, the villagers have to negotiate several kilometers of dirt track, rough and pitted, its ruts filled deep with water and mud during the rains. Closer by, there are shops which may stock basic medical items, such a few tablets of paracetemol or other generic painkillers, but sourcing malaria treatment requires again a trip to Bunda, or Lamadi, a town almost equidistant to the south.

The village does have a community health worker, but without funds or drugs, or indeed robust training, the help he can offer is limited. Tanzania has been trying to implement a national programme for the control of basic intestinal worms, and so about once a year, a team may sail through and distribute albendazole to all the children who happen to be attending school that day. Given that absenteeism rates run high, this is hardly providing blanket coverage. Moreover, the source of infection is not addressed; with high rates of transmission, re-infection is almost inevitable. What solutions can there be for remote, rural villages like this?

Kimi Island aerial Stothard

An aerial picture of Kimi Island in Lake Victoria, Uganda. Itinerant fishing communities can be seen at both ends of the island. Photo: JR Stothard

Perhaps some lessons can be learnt from Uganda. The Lake Victoria shoreline there consists of thousands of islands, each with one or more fishing shanty-towns, solely accessible by boat. Access difficulties here are even greater than in Tanzania, yet progress is being made. The Ugandan National Control Programme for Neglected Tropical Diseases has combined interventions for soil-transmitted helminthes (like hookworm) and schistosomiasis, training community medicine distributors in every possible village in the methods for administering treatment for both conditions. At the same time, educational workshops have been held to educate communities as to how to reduce transmission.

Over the last 8 years the programme has successfully reduced the burden of infection in many places, and the programme has expanded to include treatment for other neglected tropical diseases, such as lymphatic filariasis.

Yet, challenges remain. For example, as we see in Tanzania, rates of malaria prevalence are also high in Uganda, yet are not directly tackled by the neglected tropical disease teams; other branches of the Ministry of Health are responsible for the distribution of bednets and Coartem. However, the basic health infrastructure required is the same: mobilization of drugs/equipment, training of health personnel at the village level and education for the community themselves in order to change behaviours that may result in greater infection risk.

Last year I was lucky enough to participate in surveys of island communities in the Sesse Islands, as part of a much wider monitoring effort (funded by the Global Network of Neglected Tropical Diseases). Across the board, we observed villages where increased efficiency of health service delivery could make a huge difference.

Nyatwali children

The children who participated in our health survey, at their primary school in Tanzania. Photo: CJ Standley

It’s not hard for me to see parallels with my study village near the Serengeti. There are existing initiatives to de-worm school-age children; there is a community health worker; there is a basic need for prevention alongside treatment. All that is needed is for efforts to be more coordinated and packaged alongside education about the diseases.

Recognizing this need, the Bunda District Education Office has been incredibly supportive of our inquiries into designing a curriculum to teach the primary school children and their parents in the village about parasites and disease prevention. If all goes to plan, once we hold the workshop, the kids in attendance will be people, not goats!


“SMS for Life” Malaria Initiative for Tanzania Announced

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In commemoration of World Malaria Day 2011 (25 April), organizations in an innovative public-private initiative announce the nationwide roll-out of a unique malaria treatment access initiative, “SMS for Life,” across the United Republic of Tanzania. The roll-out follows a successful pilot project where mobile and electronic mapping technology was used to track the stock levels of anti-malarial drugs at health facilities to manage supplies of these essential treatments.

Launched in 2009, the “SMS for Life” pilot ran across three districts in Tanzania, ensuring access to essential malaria treatments for 888,000 people. 99% of health facilities involved avoided stock-outs of the artemisinin-based combination therapy (ACT), one of the main anti-malarial medicines.2 “SMS for Life” will now be deployed across 5,000 health facilities in 131 districts in Tanzania, covering a population of over 40 million.

Under the auspice of the Tanzanian Ministry of Health and Social Welfare, this roll-out is led by Novartis and supported by Vodacom, Medicines for Malaria Venture (MMV) and the Swiss Agency for Development and Cooperation, all under the umbrella of the global Roll Back Malaria Partnership.

Malaria kills about 800,000 people each year, the vast majority of whom live in sub-Saharan Africa where the disease is a leading cause of death for children under five, claiming the life of a child every 45 seconds.2 Although malaria is preventable and treatable, life-saving medicines do not always reach the patients who need them, particularly those living in remote areas. Stock-outs are a major hurdle in the maintenance of access to essential malaria treatments.

H.E. Dr Hadji Hussein Mponda, Minister for Health & Social Welfare in Tanzania, said “the simple truth is that if there are no effective malaria treatments available in the health facilities then people will likely die, especially young children and pregnant women who are most at risk of the disease. Reducing antimalarial drugs stock-outs saves lives, and so we are delighted that the SMS for Life programme that improves stock position information will now be rolled-out across Tanzania and we welcome this innovation.”

“SMS for Life” has demonstrated that we can overcome the longstanding problem of stock-outs at the health facility level. This flexible scheme can be implemented quickly and at relatively low cost in any country to track any medicine,” said Jim Barrington, “SMS for Life” Program Director and former Chief Information Officer at Novartis. “It’s rewarding to see how a unique partnership, which combines the specific skills and experience of its various members to deliver an innovative use of everyday technologies, positively impacts the lives of malaria patients, their families and communities. “SMS for Life” also has great potential to be implemented in all malaria endemic countries and within other disease areas.”

In addition to the roll-out in Tanzania this year, two further pilots will start. Kenya, with funding from Novartis via the global employee survey donation program, will implement a five district pilot to track ACTs and rapid diagnostic tests (RDTs), in addition to collecting weekly case management data. MMV, through partnership with University of Oxford, will provide technical support for the implementation and evaluation of the pilot project. Ghana, with funding from Swiss TPH, will implement a six district pilot to track malaria medicines, an antibiotic and RDTs. Accurately monitoring the amount of essential medication, such as ACTs and quinine injectables, available in a given location, reduces the risk of shortages and stock-outs and ensures that treatments are available to malaria patients, even in the most remote areas, where and when they are needed.

Each week, automated SMS messages are sent to staff at participating healthcare facilities, prompting them to check the stock of anti-malarial medicines, and reply with an SMS detailing current stock levels. These messages are collected in a central web-based system that provides the District Medical Officers and other users with real-time stock level information, accessible via the Internet or their mobile phone. Using this information, District Medical Officers are able to redistribute essential medicines to where they are most needed and coordinate emergency deliveries to health facilities if necessary.

The Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC) Business Action on Health Awards Review Committee has recently selected the “SMS for Life” program as a Finalist for the Technology for Health award.

About “SMS for Life”
“SMS for Life” is an innovative public-private partnership that harnesses everyday technology to improve access to essential malaria medicines in rural areas. It uses a combination of mobile phones, SMS messages and electronic mapping technology to track weekly stock levels at public health facilities in order to eliminate stock-outs, increase access to essential medicine and reduce the number of deaths from malaria.

“SMS for Life” was initially piloted across three districts in the United Republic of Tanzania, covering 129 health facilities and 226 villages, representing 1.2 million people. When launched in 2009, 26% of all health facilities did not have any ACTs in stock, but by the end, 99% had at least one ACT dosage form in stock. In addition, 888,000 people in the three pilot districts had access to all malaria treatments at the close of the pilot, versus 264,000 people at the start, which helped to reduce the number of deaths from malaria.

About the partners
Under the Tanzanian Ministry of Health and Social Welfare and the National Malaria Control Programme (NMCP) is the Directorate of Preventive Services. NMCP is the custodian of all malaria prevention and control activities in the country. The NMCP is the owner and main user of the ‘SMS for Life’ solution and coordinates all project activities in the country, including planning, implementation & evaluation of the project. The NMCP also makes sure that all the districts selected are fully engaged in the process.

Novartis drives the overall initiative and has taken the lead in defining the solution, sourcing the partners, establishing a steering committee, liaising with the Ministry of Health in Tanzania and RBM Partnership Secretariat and providing all the resources and funding necessary to complete the pilot in Tanzania.

Medicine for Malaria Venture (MMV) is, along with SDC, one of two funders of the country implementation of the solution. They also manage funds from SDC, giving them the role of managing all project funding. In addition, MMV is coordinating the national training program and is contracting technology deployment required to affect this rollout.

The Swiss Agency for Development (SDC) is the second and major funder of the Tanzanian nationwide roll-out. Its grant is managed by MMV.

Vodacom, a local Tanzanian Mobile operator is providing, in addition to promotional materials like tshirts, smart phones with Internet and data access for use by all District Medical Officers and Malaria Focal persons.

Vodafone supported the design, development and the implementation of the technical solution for the Tanzanian Pilot in 155 health facilities until its completion in February 2010.

IBM supported the overall management of the pilot project and the provision of an on-line collaboration tool, “Lotus Live”. The tool allowed all the project partners to coordinate their inputs.

RBM Partnership Secretariat facilitates oversight, including the work of the steering committee and leads advocacy activities. It helps provide ongoing guidance throughout the project, placing it in the broader context of RBM’s activities.

About RBM
The Roll Back Malaria (RBM) Partnership is the global framework for coordinated action against malaria. It provides a neutral platform for consensus-building and developing solutions to challenges in the implementation of malaria control interventions and strategies. RBM is a public-private partnership that also facilitates the incubation of new ideas and lends support to innovative approaches.

The Partnership promotes high-level political commitment and keeps malaria high on the global agenda by enabling, harmonizing and amplifying partner-driven advocacy initiatives. Founded by UNICEF, WHO, the World Bank and UNDP and strengthened by the expertise, resources and commitment of more than 500 partner organizations, the Partnership secures policy guidance and financial and technical support for control efforts in countries and monitors progress towards universal goals.

Source: World Health Organization (WHO), Roll Back Malaria

African Leaders Malaria Alliance Receives $250K Grant to Help Fight Malaria

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The African Leaders Malaria Alliance (ALMA), an alliance of 39 African leaders, has been awarded a $250,000 grant to help with its campaign to combat malaria.

ALMA, chaired by Tanzanian President Jakaya Kikwete and recently elected Deputy Chair, Ellen Johnson Sirleaf, President of Liberia, was launched in 2009 as a collaborative effort for African leaders to work together with the African Union, United Nations and other local and international partners to combat malaria in Africa. The alliance seeks to complement efforts that address the challenges of malaria and aims to raise malaria awareness at the global, national and local levels.

The grant is from the ExxonMobil Foundation, and will support ALMA’s advocacy and communications efforts, as well as technical assistance to governments.

“We are thrilled and grateful to be awarded a grant from the ExxonMobil Foundation, a long-time ally in Africa’s efforts to fight malaria,” said ALMA Executive Secretary Johannah-Joy Phumaphi. “We have recently seen great success in the fight against malaria and we must all remain steadfast in our efforts.”

The past year has seen enormous progress in the battle against malaria in Africa, due in large part to the collaborative work of ALMA, which has been instrumental in accelerating access to and the use of malaria control interventions such as mosquito nets. The World Health Organization’s World Malaria Report 2010 reports 80 percent net coverage and an additional 10 percent coverage when indoor spraying is included. Its focus now is to sustain this coverage and to eliminate preventable malaria deaths by 2015.

Sub-Saharan Africa is the region most affected by malaria in the world, with 90 percent of malaria mortality occurring there. Malaria also accounts for 40 percent of hospital admissions in this region and is a leading cause of workplace and school absenteeism. When accounting for direct costs and lost economic productivity associated with the disease, malaria costs the African economy $12 billion in lost GDP annually.

Source: Business Wire

Malaria Drug Tariff’s Hindering Malaria Relief

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The Malaria Taxes and Tariffs Advocacy Project (M-TAP), a two-year research and advocacy program recently released a report that shows the vast majority of the world’s malaria-endemic countries continue to maintain import tariffs on essential commodities used in the fight against malaria, including bednets, anti-malarial medicines, insecticides used in indoor residual spraying (IRS), IRS pumps, and rapid diagnostic tests.

Just six countries—Guinea, Kenya, Mauritius, Papua New Guinea, Tanzania, and Uganda—have taken action to remove all tariffs on ACs in the decade since the Abuja Declaration identified import tariffs and domestic taxes on ACs as a significant barrier to access. By contrast, 18 malaria-endemic countries currently maintain tariffs on all five AC categories reviewed by M-TAP, and 24 countries maintain tariffs on three or more ACs.

via M-TAP Releases New Tariff Data for 76 Countries.