Last year saw a step-change in the global fight against malaria, as the world transitioned from the Millennium Development Goals to the bolder and more comprehensive targets of the Sustainable Development Goals (SDGs) for 2030. It also marked the first year of action under the guidance of the World Health Organization’s (WHO) strategic roadmap to maximise health outcomes. By 2030, WHO aims to reduce malaria infections and deaths by 90 percent and eliminate the disease in an additional 35 countries.
Medicines for Malaria Venture (MMV) is playing an important role in this global march to a malaria-free world.
MMV-supported drugs are estimated to have already saved the lives of over one million people in 50 malaria-affected countries between 2009 and 2016. This number continues to rise as more and more people have access to the effective and affordable medicines we have developed with our partners.
In one example, the first MMV co-developed product to be launched, Coartem® Dispersible (artemether-lumefantrine), was a child-friendly formulation co-developed with Novartis. Since its launch in 2009, over 300 million treatments have been distributed across 50 countries, making it the most widely used quality artemisinin-based combination therapy (ACT) for children.
Supported by UNITAID funding, MMV has worked intensively with partners to complete a three-year project, which set out in 2013 to transition six high-burden African countries to the use of injectable artesunate for severe malaria. By the end of the project, more than 90 percent of health facilities in these countries had switched from quinine to injectable artesunate. We estimate that the overall uptake of injectable artesunate across more than 30 malaria-endemic countries since prequalification may have saved 450,000 to 500,000 young lives.
In 2016 alone, MMV’s partner Guilin Pharmaceutical shipped over 73 million courses of Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SP+AQ) to countries in the Sahel region of West Africa. These courses were enough to protect 18 million children from malaria during the period of greatest risk.
Pyramax ® (pyronaridine-artesunate) paediatric granules, an important treatment for children suffering from Plasmodium falciparum or Plasmodium vivax malaria, was added to WHO’s List of Prequalified Medicinal Products in 2016. In 2017, pyronaridine-artesunate was then also added to the WHO’s Model List of Essential Medicines. These additions will facilitate the delivery of Pyramax granules to the very young–the population hardest hit by malaria.
Within the broader context of increasing global antimicrobial resistance, multidrug resistant P. falciparum malaria has emerged in the Greater Mekong Subregion resulting in high levels of treatment failure with ACT. Signs of potentially reduced sensitivity, and/or treatment failure with ACTs have also been detected in Africa. With this firmly in mind, our priority continues to be the development of novel, easier-to-take, next-generation cures for the ever-mutating malaria parasite. These medicines will not only improve patient compliance but could also potentially counter current and future parasite resistance.
With a view to eradicating malaria, MMV and partners are working to populate the drug research and development (R&D) pipeline with promising new, transformative antimalarial compounds to block transmission, protect against infection and stop the relapse of P. vivax. These include compound classes with novel mechanisms of action that will ultimately be partner drugs in combination therapies.
One example is MMV048–a novel antimalarial compound with important activity across the entire parasite lifecycle. The compound, researched in partnership with an international team led by the University of Cape Town, South Africa, was the first new antimalarial medicine to enter phase I studies in Africa. Preparations are now underway for the compound to enter a phase IIa clinical trial as a single dose in Ethiopia.
Other carefully selected compounds, like OZ439, KAF156, KAE609, and DSM265 are being rigorously tested and progressed through the pipeline; if successful, they too could contribute to the achievement of global strategic goals, and ultimately help eradicate malaria.
Although funding to fight malaria increased almost every year between 2005 and 2014, it is now stagnating at around 45 percent of the amount required for elimination. To meet the ambitious malaria goals by 2030, the global malaria community, of which MMV is a part, require increased commitments from donors to malaria control and elimination and the development of new interventions. In fact, it is estimated that US$100 billion will be needed to reach the 2030 malaria targets, with an additional US$10 billion to fund R&D for innovative antimalarials and insecticides.
The costs may seem great, but the return on investment is far greater. By the time the 2030 targets are realised, it is estimated that efforts to end malaria will garner a 40-fold return on investment; in other words, by 2030 over US$4 trillion of economic output would be unlocked. In Africa alone, the benefits would be as high as 60-fold. These include savings for both households and health systems as well as increased economic output generated by a healthy workforce.
MMV will continue to develop newer and better treatments for this terrible disease secure in the knowledge that ending malaria is one of the best investments in public health. If done right, in 15 years nearly 3 billion malaria cases could be averted and over 10 million lives saved. It’s an investment we can’t afford not to make.
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