Response to: Bouwman, H. et al. Hallogenated pollutants in terrestrial and aquatic bird eggs: converging patterns of pollutant profiles, and impacts and risks from higher levels Environ. Res. (2013) http://dx.doi.org/10.1016/j.envres.2013.06.003.

Bouwman and coauthors present data and analyses of DDT and other halogenated pollutants in environmental samples and based on their data and analyses thereof, argue against the use of DDT for malaria control. Regrettably, the analyses, presentations, and interpretations of data presented by Bouwman and coauthors are biased and erroneous.

Subsidizing artemisinin-based combination therapies: a preliminary investigation of the Affordable Medicines Facility - malaria.

Background: The Affordable Medicines Facility - malaria (AMFm) is a subsidy mechanism to lower the price of, and hence increase access to, the best antimalarial medicines, artemisinin-based combination therapies (ACTs). While the AMFm stipulates that only quality-approved products are eligible for subsidy, it is not known whether those products, when actually supplied, are of good quality and comport with established pharmacopeial guidance on formulation and content of active ingredients. This study aimed to assess price and quality of AMFm ACTs, to compare AMFm ACTs with non-AMFm ACTs and artemisinin monotherapies, and to assess whether AMFm ACTs have been pilfered and diverted to a nearby country.

Implications of public-health insecticide resistance and replacement costs for malaria control: challenges and policy options for endemic countries and donors.

Millions of people rely on public-health insecticides for malaria prevention. Yet growing insecticide resistance may threaten malaria control programs through decreasing e ffectiveness and possibly unsustainable cost-increases. Insufficient investment by s takeholders in the search for new public-health insecticides in recent decades has left malaria control programs with limited alternatives with which to manage resistance and maintain program effectiveness.

International advocacy against DDT and other public health insecticides for malaria control.

A new international effort to control/eradicate malaria is accompanied by suggestions that malaria can be controlled without the use of dichloro-diphenyl-trichloroethane (DDT) and other insecticides. We review the underlying science of claims publicized by the Global Environment Facility (GEF), the United Nations Environment Programme, and the Stockholm Convention Secretariat (the Secretariat). Their claims stem from a $14 million GEF project that was conducted from 2003 to 2008 in Mexico and seven countries of Central America.

Drug procurement, the Global Fund and misguided competition policies.

In an effort to increase competition and decrease price, the Global Fund to Fight AIDS, Tuberculosis and Malaria recently began asking some grant recipients to use international competitive bidding processes for certain drug purchases. Unfortunately, for countries like Kenya, this request has caused more harm than good. After awarding the tender for its annual supply of the anti-malarial artemether-lumefantrine to the lowest bidder, Ajanta Pharma, Kenya experienced wide stock-outs in part due to the company's inability to supply the order in full and on time.

Pilot study of essential drug quality in two major cities in India.

Background: India is an increasingly influential player in the global pharmaceutical market. Key parts of the drug regulatory system are controlled by the states, each of which applies its own standards for enforcement, not always consistent with others. A pilot study was conducted in two major cities in India, Delhi and Chennai, to explore the question/hypothesis/extent of substandard and counterfeit drugs available in the market and to discuss how the Indian state and federal governments could improve drug regulation and more importantly regulatory enforcement to combat these drugs.

Physical and chemical stability of expired fixed dose combination artemether-lumefantrine in uncontrolled tropical conditions.

Background: New artemisinin combination therapies pose difficulties of implementation in developing and tropical settings because they have a short shelf-life (two years) relative to the medicines they replace. This limits the reliability and cost of treatment, and the acceptability of this treatment to health care workers. A multi-pronged investigation was made into the chemical and physical stability of fixed dose combination artemether-lumefantrine (FDC-ALU) stored under heterogeneous, uncontrolled African conditions, to probe if a shelf-life extension might be possible.

Antimalarial drug quality in the most severely malarious parts of Africa - a six country study.

A range of antimalarial drugs were procured from private pharmacies in urban and peri-urban areas in the major cities of six African countries, situated in the part of that continent and the world that is most highly endemic for malaria. Semi-quantitative thin-layer chromatography (TLC) and dissolution testing were used to measure active pharmaceutical ingredient content against internationally acceptable standards. 35% of all samples tested failed either or both tests, and were substandard.