This is why we are firm there should be no messing about with the drug. That's fine in theory, says Snow. But in practice, if Malarone is really to make a difference, it must be administered at village, not district, level. In the countryside, microscopes and trained clinicians are a faraway dream. Thus, even if the drug is free, with such a strict and costly protocol, it is unaffordable.
Snow has a different proposal.
I would make Malarone available as quickly as possible with the knowledge that it won't last for ever, that you're maybe just buying a few years. That would shorten Malarone's effective life. It would also undermine any plans Glaxo has to make a little money by selling it as a prophylaxis to western travellers. But it might, says Snow, bridge the gap until a more affordable drug, or combination of drugs, comes along. David Nabarro, of the World Health Organisation's Roll Back Malaria Programme, says Snow's strategy makes sense for Malarone at GBP 24.