Bringing new drugs to the market to patients that need them

David Reddy
Dr David Reddy, CEO, MMV

Today, malaria continues to kill over 600'000 people each year. According to the World Health Organization (WHO), each year, over 600'000 people die from malaria and of these, 77% are children. In fact, malaria kills one child every minute. This means that by the time you have read this interview, six children will have died of malaria.

MMV, a leading public private partnership, was established to address this killer disease by discovering, developing and facilitating the delivery of new, effective and affordable antimalarial drugs.

As it celebrates its 15th anniversary this year, MMV is also celebrating its numerous successes. It has not only brought forward four new and effective antimalarial medicines, two of which are already saving lives, it has also established the largest portfolio of malaria drugs ever assembled. MMV continues to develop new medicines to cure and protect populations at risk of malaria, and to help ultimately eradicate this terrible disease.

In this interview, Dr David Reddy, MMV's Chief Executive Officer, speaks with Geneva International Cooperation about MMV, its priorities, as well as its impact and achievements.

1. If you had to explain MMV to someone coming from Mars, what would you say?

I think we have to start from the parasite. Malaria is caused by a parasite transmitted by a mosquito. If you look at the impact, there are around 630'000 people dying every year of malaria; 77% of those are children less than 5 years of age. There are also around 125 million pregnancies at risk every year because pregnant women are also affected by malaria.

A lot of people think the main problem is the mosquito, but actually the reservoir of the parasite is us, the human race. So in order to address the problem we need drugs to cure people from the disease, to stop the suffering and death it causes. And we also need to be able to develop strategies to effectively rid the human population of malaria, thereby eliminating the reservoir. That's a big challenge.

Medicines for Malaria Venture (MMV) was formed in 1999 because of a failure of previous efforts to address malaria. There was increasing drug resistance and investment by the pharmaceutical industry into new antimalarials was diminishing – there simply wasn't sufficient financial return to justify the investment. So somebody had to fill the gap. MMV was formed to use donor funding to incentivize partners, including pharmaceutical industry partners, to develop the next generation of antimalarial drugs.

In the last 15 years, we've worked hard to bring four new drugs to the market to patients that need them. We also have a strong portfolio behind us to address other unmet medical needs of malaria victims.

2. What are you working on at the moment at MMV?

There are a couple areas of focus. One of the key areas is paediatric formulations. We still need more medicines suitable for very young children because they can't take tablets, they need more accurate dosing and quite frankly it has to taste decent as well, which isn't a huge consideration for adults.

Relapsing malaria is another key issue. It's caused by a particular species of parasite, known as Plasmodium vivax. This parasite hides in the liver and relapses periodically. This has a huge impact on people's lives and also on economies. The current drug for this type of malaria is 14 days of treatment and we are now in advanced clinical trials for a one-dose cure with our partner GlaxoSmithKline (GSK). A one-dose cure would make an enormous difference in the treatment of relapsing malaria.

We're also looking at single-dose cures for the treatment of malaria and several more cures are now going into more advanced clinical studies. These drugs, because of their simplicity and activity against resistant strains could also be very important tools in malaria elimination programmes that are trying to get rid of malaria in certain areas. So we keep a strong eye on addressing the unmet medical needs now and in the future, including where we could actually pursue elimination and eradication of malaria.

We're also looking at more effective drugs to address severe malaria. Most antimalarial drugs are for patients who discover they have malaria and can go to a health clinic or a drug shop and access treatments that need to be taken over several days. But sometimes cases are far too severe and need immediate injectable treatment. So in partnership with UNITAID, we're working to increase access to a drug called injectable artesunate to treat severe malaria. Studies carried out a few years ago show that this drug is significantly more effective than the older treatment, injectable quinine. It saves more lives but is not being widely used. So we're working with partners to increase usage and in turn to save more lives.

We're also developing artesunate suppositories for children affected by severe malaria who can't take oral medicines. Some of these children are already in a coma, and need treatment that can keep them alive until they can get to a medical facility. This can be a matter of life and death. We and our partners are also in an advanced stage of discussion with the Regulatory Authorities to get these suppositories approved for the very youngest kids.

3. Once you developed new medicines, how do you ensure that those are affordable?

That's an important question! When we work with our pharmaceutical partners who will manufacture the drug, before we start investing government and philanthropic money in it, we sign an agreement that they commit to launching the new drug in all the malaria-endemic countries and at an affordable price. We determine, very specifically, what this price framework is, so there are no surprises.

The good thing is that our partners live up to their agreements. This means that drugs like the child-friendly Coartem® Dispersible developed with Novartis are made available at no profit. For a complete 3-day treatment for a young child the price is as low as CHF 0.45. This might still represent a lot of money in the context of the governments we're talking about, but it's affordable and 200 million treatments have already been delivered to 50 countries.

4. Why, in your opinion, do pharmaceutical companies engage in such a partnership?

There are, I think, three reasons. Firstly, it's part of the contract with society that large companies actually give back in certain areas and do things that do not focus on profit. There is an increasingly important contract with society around that. Second, employees of big companies are motivated by doing exciting things and the right things. So we find there is a huge willingness to work with us. People like it; it gives more meaning to what they do and it's really good for morale within the company. And finally, it can make good business sense, because if we're able to make progress, particularly in health, which leads to economic progress, these are the markets of the future. Companies can establish themselves now with good credentials. So if a company is thinking about the future, this is a great way to go.

5. What distinguishes MMV from other organizations working on malaria like DNDi, FIND, the Global Fund, RBM or the WHO?

First of all, we're all part of an ecosystem; you would be surprised how much we work together! But MMV has one specific role and that is malaria: we only focus on this one disease area and one intervention, medicines. The other organizations cut across multiple diseases areas and interventions. We're not vaccines, we're not diagnostics.

We focus on our core area of expertise and work with partners who complement us. So when we need to build diagnostics we work with a diagnostics entity, as we've done it in the past with FIND, for example. When we're working on strategies that could benefit from close collaboration with vaccine manufacturers, we work for instance with MVI. And then when it comes to access issues we collaborate with larger organizations, funders like the Global Fund or UNITAID. So we have our niche and then we bring in other partners as needed.

6. MMV celebrates this year its 15th anniversary. What has been your impact so far?

MMV is a small organization and most people working at MMV have had the opportunity to go into the field and see patients with malaria. And when you see little kids coming in who are just almost limp with malaria, you realize the need and the impact you can have.

For instance, one young girl called Saudat was in a Nigerian hospital, in a coma. She was given injectable artesunate. It was the first time this medicine had been used in that clinic. She came around within a day or two; after that she was on oral medication and then soon discharged. A colleague was lucky enough to have witnessed the impact of this drug. Her speedy recovery also encouraged the hospital to change their policy. Now we are working to ensure millions more patients like Saudat get the drug. We estimate that this drug alone may have saved 130,000 additional lives since 2010.

Working with Novartis on Coartem Dispersible, 200 million treatments, enough to treat 200 million people, have been delivered to 50 malaria-endemic countries since 2009. The amount of medicines is just staggering. When you think about the fact these medicines have a 95% efficacy in curing uncomplicated malaria, the impact you're having is enormous. Injectable artesunate on the other hand is reserved for the severe cases of malaria – and it really improves the recovery of these patients – it saves lives. And it's not just about death alone but a spectrum of debility. Patients who get severe malaria fever often suffer some degree of neurological impairment. So 200 million courses of treatment at an affordable price will have a massive impact.

The other thing is that this is not MMV alone. If you look at 15 years of progress, it's also summed up in our network of 300 partnerships we've developed in more than 50 countries. That's the strength of MMV's model. We're nothing without our partners.

7. Are you organizing some events in Geneva or abroad to commemorate this anniversary?

One of the key things we'll be doing is holding a stakeholders meeting early next year in Cambodia. This area of South-East Asia is where we are seeing malaria resistance. So it's really important we shine the spotlight on this and continue to invigorate our partnerships in the region. Also, hopefully, within the next several years we'll be introducing new drugs in the area. So it's a great place to celebrate our 15th anniversary, to reflect not only on what we've achieved but also on what still needs to be done.

Here in Geneva, it's mainly around communication but there is a strong desire from the organization itself to get together and celebrate ourselves, and just take stock of what 15 years have meant.

8. Is it important for MMV to be in Geneva?

Geneva is a very important area for us and also for global health. You've got the WHO here. So that means we have direct and immediate access to WHO colleagues to make sure that we're in line with public health needs. It also allows an ongoing conversation with them about progress and initiatives, not just policies. So it's really where the rubber meets the road.

The other thing is that many of our partners come through Geneva, visiting WHO as part of the World Health Assembly and we vigorously jump on the back of this and exploit every opportunity to get these guys into our office! There is nowhere else that this sort of thing happens.

Geneva is also an emerging biotech hub. I think it's fair to say there have been setbacks in the pharmaceutical industry as a whole in the region, but in terms of biotech it's all happening here. So we're really at the heart of the action – in the best position to develop new partnerships. There are new groups emerging and we've been benefiting from them. And we also increasingly benefit from the ability to recruit local talent in all fields. Another very good reason is the funding. As an international organization, we are entitled to tax deductions and that means there is actually a big injection of funding back for our mission.

So a number of very good reasons to be in Geneva!

9. Tell us about your career up until now. What brought you to MMV?

By birth, I am a New Zealander. I did my degrees in molecular biology, then I actually came to Switzerland to do a Post-Doc and ended up in the pharmaceutical industry. I spent 20 years in the pharmaceutical industry, mainly working in the area of virology. I was really fortunate to be able to enter HIV at the time progress was being made, and had to think differently about policy and the issue of public health. I then worked for a while on influenza through the 2005-2010 crisis, again with a strong global health emphasis. I found I really enjoyed the part of drug development and drug access. So when I was offered the job at MMV, I thought it was really focusing on what I loved doing. When I joined, it was already a very solid and high performing organization and it's been a pleasure leading it for the past 3 years! I am also now a Swiss citizen.

10. What are your impressions about living and working in Geneva?

The Geneva region is incredibly international. I think it's wonderful that we have this. At MMV, we have 24 different nationalities and 14 different languages. It's a great environment to work in and I just love the ease with which Geneva manages its diversity.