London School of Hygiene & Tropical Medicine Malaria Centre

Anniversary Feature #4 | 20 Years of Malaria Economics

Malaria Centre anniversary logo

Malaria Centre anniversary logo

31 July 2018
By Kara Hanson and Catherine Goodman

Economists have been centrally involved in the Malaria Centre from the outset, contributing evidence to support a series of key policy recommendations over the past two decades.  This has been achieved through work in two broad areas:  analysis of the cost-effectiveness of malaria control, and understanding the demand and supply of malaria commodities and services.  

 Cost-effectiveness modelling by Catherine Goodman, Paul Coleman and Anne Mills demonstrated that malaria control interventions were highly cost-effective. As global investment in malaria control expanded, spearheaded by the creation of Roll Back Malaria in 1999, LSHTM economists demonstrated the cost-effectiveness of changing first-line drug in the presence of resistance; introducing rapid diagnostic tests; and artemisinin treatment for severe malaria.  Prevention studies included strong programmes of work on the cost-effectiveness of insecticide-treated bed nets (ITNs), preventing malaria in pregnancy, and seasonal malaria chemoprophylaxis in children. This work continues today, with economists contributing to trials of next generation nets (David Bath and Catherine Pitt) and seasonal malaria vaccination (Silke Fernandes).   

The role of the private sector in delivering malaria control interventions has been a strong focus for Malaria Centre economists.  Kara Hanson and colleagues studied the voucher programmes for ITNs in Tanzania, contributing to the heated debates about ITN distribution at that time. Catherine Goodman’s work documenting the importance of the private retail sector as a source of antimalarial medicines in Tanzania was used in the development of an audacious proposal from the US Institute of Medicine to subsidise artemisinin-based combination therapy (ACT) in the private sector, which led to the creation of the Affordable Medicines Facility – malaria (AMFm).  The methods for studying markets that we developed were adopted on a large scale through the ACTWatch project and the Independent Evaluation of AMFm in 7 countries, and informed the subsequent decision of the Global Fund to integrate subsidies for private sector distribution of ACTs into its country programmes.  The Malaria Centre researchers’ experience of engaging with the private sector was distilled in the guidelines they drafted for Global Fund country applicants on working with the private sector for malaria case management.