Reflections of the MMV Board: Successes, challenges and aspirations

2019
Robert Newman, David Bowen, Winston E. Gutteridge, Per Wold-Olsen, Yuli Ismartono, Konji Sebati, Gabriel Jaramillo, David Brandling-Bennett, Dennis Schmatz, Dominique Limet, Wendy R. Sanhai, Michael Ferguson, Elizabeth Linder

Photo by Andy Tyler. Standing from left to right: Prof. Michael Ferguson, Mr Gabriel Jaramillo, Mr Dominique Limet, Dr Dennis Schmatz, Mr Alan Court, Dr David Reddy, Dr David Brandling-Bennet, Dr Robert Newman, Ms Yuli Ismartono. Seated from left to right: Ms Elizabeth Linder, Ms Joy Phumaphi, Dr Winston Gutteridge, Ambassador Dr Konji Sebati, Mr Per Wold-Olsen, Dr Wendy Sanhai.

In celebration of MMV's 20th anniversary this month, Board members reflect on past successes, challenges and future aspirations for the role of MMV within the evolving malaria landscape. 

What do you believe has been the key to MMV’s success over the last 20 years?

Dr David Bowen, Independent Advisor, USA: MMV combines the idealism of a not-for-profit with the business savvy of the most successful corporations, pairing noble intentions with brilliant execution.

Ms Yuli Ismartono, Co-founder and managing editor of the weekly online AsiaViews portal, Indonesia: MMV’s unequalled dedication and commitment to eradicating malaria, which I see as the driving force behind its successful projects and programmes.

Ambassador Dr Konji Sebati, CEO, Innovative Pharmaceutical Association of South Africa (IPASA): MMV’s mission, vision, dedication, commitment and love for the work they do has been key to MMV’s success!

Mr Dominique Limet, Former Chief Executive Officer, ViiV Healthcare, UK: The key to MMV’s success over the last 20 years has been the unique blend of people, talent and capabilities driven by a passion for science, medicine and ultimately, ending malaria. Nothing, however, would have been achieved without the team’s very strong team work and partnership skills enabling collaboration with critical partners from the public and private sectors. Making such a matrix and virtual organization work is an outstanding achievement. 

Mr Alan Court, Senior Adviser to the WHO Ambassador for Global Strategy, USA: The key to MMV’s success is people and partnerships. First, recruiting the best of best in the market and building up the organisation from the base like a family with a strong focus on teamwork. Then, operating in partnerships as equals, giving credit where its due and constantly striving for better human interactions in aiming for and achieving a common goal. 

Ms Elizabeth J. Linder, Founder & CEO, The Conversational Century; Senior Consulting Fellow, Chatham House Director’s Office, USA/UK: MMV's partnership model has been the key to success. By bringing together existing knowledge and resources from industry, academia and local health systems and combining it with in-house expertise MMV has unlocked the largest antimalarial pipeline in history, where before there simply wasn’t one.

Dr Dennis Schmatz, Former Vice President, Head of Tsukuba Research Institute, Merck-Banyu Research Laboratories, USA: MMV uniquely brings together critical academic and drug development expertise and resources and aligns them with the needs outlined by global health professionals. 

Which of MMV’s achievements strikes you as the most significant?

Dr Robert Newman, Director, Aspen Management Partnership for Health, The Aspen Institute: Choosing MMV’s most significant achievement makes me feel a bit like a kid in a candy store. Though, if I must name one, I would say that it is the partnership with Guilin Pharmaceuticals to develop a pre-qualified version of intravenous (IV) artesunate. One of the highlights of my career was during my tenure as Director of the Global Malaria Program, when one day in late 2010, data showing the superiority of IV artesunate over IV quinine were published in The Lancet, we changed our recommendation to place IV artesunate as first-line treatment for severe malaria, and the Guilin IV artesunate product was pre-qualified by WHO. The aligning of those stars would not have been possible without MMV.

Dr Winston E. Gutteridge, Former Chief, Product R&D, Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization (Switzerland), UK: Registration of Coartem® Dispersible: When MMV was established in 1999, there was tremendous scepticism that it would fly. Academics were thought to see those who worked in the industry as inferior scientists who were only in it for the money and industry scientists believed that academics were only interested in living in their ivory towers. The registration of Coartem Dispersible in 2008, less than 10 years after MMV was set up, and its rapid deployment into disease-endemic countries, demonstrated that with MMV as one of the partners, such barriers to collaboration could be bypassed.

Mr Per Wold-Olsen, Chairman of MMV Board, former President of Human Health Intercontinental Region, Merck & Co., Inc., (Middle East & Africa), Sweden: MMV’s ability to simultaneously coordinate the delivery of new formulations while engaging in breakthrough basic science and full product development.

Ambassador Dr Konji Sebati: The United States Food and Drug Administration’s approval of the use of single-dose tafenoquine for the radical cure of Plasmodium vivax malaria is one of MMV’s key achievements. It is extremely significant as tafenoquine is the first new medicine for the prevention of relapse of P. vivax malaria in more than 60 years!

Mr Gabriel Jaramillo,  Former General Manager of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland: While many entities in this semi-multilateral space lose effectiveness and focus, MMVs greatest achievement has been its laser-focused management process which ranks highly when compared with its for-profit peers. 

Dr David Brandling-Bennett, Former Senior Advisor, Malaria, Bill & Melinda Gates Foundation, USA: During the past 20 years, MMV has transformed the malaria landscape from one where drug resistance was dominant with few promising new compounds, to one in which global malaria eradication can be achieved, with drug treatment and prevention playing a major role.

Wendy R. Sanhai, Ph.D., MBA,  Deloitte Consulting, LLP (Federal Strategy and Operations), Associate Professor (adj), Duke University, School of Medicine, USA: Development of the largest pipeline of anti-malaria drugs and delivery to the most vulnerable populations. 

Professor Sir Michael Ferguson, Regius Professor of Life Sciences and Associate Dean for Research Strategy, University of Dundee, Scotland: I am amazed by the way MMV has created a complete pathway from the laboratory to the clinic. Despite the complexities, MMV has brought the right ideas, the right technologies and the right people together to make it happen.

What has been the biggest challenge MMV has had to overcome over the last 20 years? How was it overcome?

Dr Robert Newman: Perhaps the greatest challenge that MMV has faced is shifting priorities from funding organizations. MMV has skillfully navigated these rocky waters by maintaining a strategically balanced portfolio that invested both in the development of medicines that could have a revolutionary effect on malaria – such as a medicine capable of single exposure radical cure and prophylaxis (SERCaP), and those with an evolutionary effect – such as pre-qualified products for seasonal malaria chemoprevention or treatment of severe malaria.

Dr Winston E. Gutteridge: Donor fatigue: As now with antibiotics, in 1999 the malaria control world was reeling because the standard drug then used all over the world to treat malaria, chloroquine, was failing. In the beginning, the key message given to potential MMV funders and researchers was that MMV would urgently seek to partner with academia and industry to get a safe and effective replacement. Once Coartem Dispersible and similar combinations became available, there was a tendency, especially amongst donors, to think “this job is done, what new challenge should we take on?” This challenge of donor fatigue was overcome by helping them understand that there is much more to malaria chemotherapy than the treatment of acute uncomplicated disease, including dealing with severe disease, treating pregnant women, preventing malaria relapses and carrying out seasonal malaria control, each of which requires its own particular chemotherapy.

Mr Per Wold-Olsen: Going from a “start up” to a fully functioning, well running, and ongoing “concern”, thanks to professional leadership.

Mr Gabriel Jaramillo: The realisation that simply inventing solutions is not valuable unless they are put to work. Expanding its mission from a research organization to include market access to its mission has been game changing in MMV’s success.

Dr David Brandling-Bennett: A big challenge for MMV has been securing the commitment of pharmaceutical partners to develop and make effective antimalarial drugs in spite of their limited prospects for profitability. MMV has done so by reducing the risk to partners and convincing them of the value of contributing to global malaria eradication.

Mr Dominique Limet: Ensuring that all 11 drugs developed by MMV and partners are properly used. The single goal of MMV is to reduce the impact of malaria on the people. None of us can be satisfied by “just” discovering and developing new malaria drugs if they do not eventually reach and cure the individuals in need. The continuous increase of MMV access activities and the better understanding of the local needs, including at the grass roots levels in the community, is the recipe to success.

Professor Sir Michael Ferguson: A constant challenge has been to balance donor needs with MMV’s overall mission. This has been achieved through transparency, flexibility, diplomacy and ultimately, by sharing common objectives. 

Ms Elizabeth J. Linder: As a communications person and non-scientist, I can see that it’s not an easy task to translate the complex science of anti-malarial R&D and integrate it into broader advocacy-based conversations that support fundraising. One way in which MMV has overcome this challenge is by taking a `human-centric’ approach to show how developments in the lab have a real and positive impact on the lives of people at risk of malaria.

How do you see the malaria landscape changing over the next 20 years and what role should MMV play?

Dr David Bowen: I hope that in 20 years we’re celebrating the beginning of the end of malaria – and if we are, it will be the tools, advocacy and leadership of MMV that have played a major part in getting there.

Ms Yuli Ismartono: With today’s rapid technological advances, I am optimistic that MMV and its partners will find the anti-malaria ‘magic bullet’ that will save millions in the developing world within the next two decades.

Wendy R. Sanhai: Climate change will invariably cause large-scale, systemic, environmental changes that will alter the spread of tropical (and other) diseases such as malaria. In this scenario, the WHO goal of eradicating malaria may not be achievable. MMV will need to step up its efforts to address challenges of resistance and increased demands from affected populations. 

Mr Alan Court: In the next 20 years, there will be more options to tackle malaria, from smarter diagnostics to vector control tools and genetically engineered mosquitos to vaccines. Further, I believe that 20-30 more countries will have eliminated malaria. In high burden malaria countries, transmission will have dropped and might become more focalised, as we see today in Haiti. Medicines will still be needed right up to the last push for eradication. In particular, medicines for mass drug administration that are safe, easy to manufacture, stable and easy to take for young children.

Dr Dennis Schmatz: Significant challenges remain as we work to defeat malaria and a number are on the horizon, for example, climate change may result in the spread of malaria to regions of the world that have previously been malaria-free. To make the biggest impact, MMV needs to remain focused on providing access of existing antimalarial agents to patients using innovative approaches. Also, due to the current absence of a fully effective vaccine, novel chemotherapeutic agents will have an important role to play in overcoming resistance, blocking transmission, as well as curing patients with acute, chronic asymptomatic and relapsing malaria. There is still much work to do and MMV is well positioned to contribute.