In April 2001, the World Health Organization (WHO) issued new recommendations for malaria treatment, and this new approach was widely communicated in 2002:

"WHO, on the advice of international experts, recommends the introduction of combinations of drugs to replace single drugs in the treatment of Plasmodium falciparum malaria. WHO recommends in particular the use of drug combinations containing artemisinin compounds-artemisinin-based combination therapy-ACT for short." This change is particularly critical in countries where resistance to currently used drugs is rising, leading to increased mortality. Today, over two years since expert consensus was reached on ACT, the implementation of this recommendation remains limited, and ACT is available only to a fraction of the people who need it. As a result, vast numbers of malaria patients, particularly in Africa, continue to receive ineffective treatment and many die unnecessarily. Malaria continues to be the leading cause of death among children under five in Africa.

Doctors Without Borders/Médecins Sans Frontières (MSF), the Mailman School of Public Health of Columbia University, WHO, and UNICEF are co-organizing a symposium at Columbia University in New York City, April 29-30, 2004, to address the challenges of implementing ACT. The meeting focuses on how to make ACT a reality for the people who live in parts of the world where malaria continues to claim the lives of more than one million people each year. The event will bring together policy makers, researchers, medical care providers, suppliers, and buyers of ACT, from both endemic and donor countries, to help overcome remaining barriers and speed up the use of ACT.

Despite consensus on the need to implement ACT, important barriers to the widespread use remain:

• the lack of adequate funding to ensure a sufficient supply of ACT and access for patients to this more expensive treatment;
• the lack of urgency and political will among international and national policy makers, donors, intergovernmental institutions, and non-governmental organizations to help implement more expensive malaria treatment;
• the long lead times involved in scaling up production of ACTs.

These obstacles can and must be surmounted with a sense of urgency commensurate with the magnitude of the malaria crisis.

Participants at this symposium have an important role to play in helping to provide more effective malaria treatment to those in need, particularly recognizing that most people are treated for malaria at home or in their communities. By working cooperatively to better identify and understand the nature of the existing barriers to ACT implementation and by developing strategies to overcome them, the co-organizers hope this symposium will contribute to turning the tide against this preventable and treatable disease. Urgent solutions need to be found to support changes in national protocols in endemic countries, to fund effective treatment, and to ramp up the production of ACTs. The co-organizers of this event recognize that expanding access to ACT is increasingly a matter of life or death for people at risk of malaria, and therefore are committed to discontinuing support for the use of ineffective medicines and actively working toward the implementation of ACT as quickly as possible.

It is time to ACT NOW.

Signed,

Médecins Sans Frontières (MSF), the Mailman School of Public Health of Columbia University, WHO, and UNICEF