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5 Questions on the Future of Malaria

In honor of World Malaria Day, FSG director Sebastien Mazzuri interviewed Andrea Lucard, executive vice president, external relations at Medicines for Malaria Venture (MMV) and FSG client, to hear her perspectives on the ongoing global fight against malaria.

According to the 2014 World Malaria Report, there were 198 million cases of malaria worldwide with approximately 584,000 deaths in 2013. Seventy eight percent of these deaths occur in children under the age of five, and 90 percent of malaria-related deaths worldwide occur in Sub- Saharan Africa.

FSG: It is amazing to think about how much progress MMV and your partners have made in reducing the burden of malaria in disease-endemic countries over the past 15 years. What is the MMV team celebrating on World Malaria Day and your 15th anniversary?

Andrea: When MMV came on board in 1999, the pipeline of antimalarial drugs was very limited in the global malaria field. In disease-endemic countries, resistance to currently available drugs was spreading, which was a true public health emergency. We set a goal for ourselves in the next 10 years, to release one new antimalarial drug. Fast forward to today, and we have 5 products approved or prequalified by the World Health Organization. We have done this together with our partners, and there is now an arsenal of drugs available for the global malaria fight. From an organizational standpoint, MMV had 2 people when it started, and it counts now more than 60 people and over 250 partners. We do work all around the world. Last, we had great achievements in pure drug development, but we also worked with partners to increase and accelerate delivery where these products are most needed.

FSG: What do you think are the greatest challenges facing the coalition of actors who are trying to eradicate malaria?

Andrea: The first challenge is to find the right combination of tools needed for elimination and eradication. From a drug development standpoint, new compounds are needed to fight P. vivax malaria (one of the five malaria parasites affecting humans, which is known to cause relapsing infections), to treat pregnant women, and to provide inexpensive, high-quality prophylaxis options. The second challenge is the question of resistance. In addition to signs of resistance to artemisinin (the most widely used compound to treat malaria today), we are also getting signals that the malaria parasite is becoming resistant to the partner drugs in combination regimen. This is a very serious and concerning issue, which requires basic science work, as well as innovative delivery solutions. Moving with the speed of the parasite is not straightforward. And speaking of delivery, finally, there is a lot of work that still needs to be done with government and non-government stakeholders to make sure that these great drugs get to the patients who need them in disease-endemic countries.

FSG: What are MMV’s continued aspirations to tackle these challenges?

Andrea: From a drug development perspective, MMV needs to continue to develop high-quality, affordable drugs to counter resistance and address the specific vulnerable populations I mentioned before. And we need to do it at a fast pace. We have developed innovative assays and human challenge models that allow us to accelerate drug development, and we need more ways to understand how we can do even better there. On the delivery side, we can help influence the technical understanding of policy makers, for example by getting them information back from the field at the speed needed to make useful decisions.

FSG: What resources are needed to address those challenges?

Andrea: If you look at malaria writ large, the needs to sustain progress achieved to date and make further inroads into elimination of the disease are huge – they run in the billions. You need everything from Research and Development to training health workers in the field. This is an enormous ask from the global community. But the return is greater than the resources invested in the first place, for example through productivity improvements that allow for economic development in disease-endemic countries. The problem is that resources come from one pocket and benefits get into another one! The funding gap is quite large, and if resistance really takes hold, it will be a very big problem because surveillance will need to come in addition. On the drug development side, there is a gap too but it is not immense. The challenge is to try not to duplicate efforts. This is very important: the consolidation of knowledge in MMV’s portfolio increases the capacity to make decisions that are not duplicative, for example by influencing the direction that our partners are taking through robust scientific evidence. We are saving money, time and efforts for our partners.

FSG: Who or what inspires you personally to keep working to eradicate malaria?

Andrea: What keeps me going is that we are making progress! It is a very big fight involving lots of people globally, and everybody counts. At MMV in particular, I am inspired by the work done by my colleagues – on the science of course, but also people working behind the scene, for example in business development, or lawyers. Really a lot of people are doing work that is less visible but that allows these drugs to be available faster. And finally, there is so much integrity on so many fronts. We are prepared to think as a learning organization, focused on the goals with tremendous integrity in our decision making and in driving genuine operations among our partners. We are not doing it by ourselves, and I am proud to be part of this fabric.

Medicines for Malaria Venture (MMV) is a leading product development partnership (PDP) in the field of antimalarial drug research and development. MMV’s mission is to reduce the burden of malaria in disease-endemic countries by discovering, developing and facilitating delivery of new, effective and affordable antimalarial drugs.

Sebastien Mazzuri

Managing Director