David Reddy speaks with Marcus Papadopoulos of Politics First magazine, about the successes scored against malaria and the new challenges emerging in this fight.

1. In 2015, what is the situation regarding malaria in disease-endemic countries?

According to the latest World Malaria Report, which was released at the end of last year, there were 198 million cases of malaria worldwide with approximately 584,000 deaths in 2013. The range of deaths, however, is from 357,000 and 755,000, and 78 per cent of these deaths occur in children under the age of five. Further to that, ninety per cent of malaria-related deaths worldwide occur in Sub- Saharan Africa.

2. What role is Medicines for Malaria Venture playing in those countries and what have you achieved to-date?

Well, Medicines for Malaria Venture (MMV) is a leading product development partnership (PDP) in the field of antimalarial drug research and development. Our 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. Since its foundation in 1999, MMV has developed and brought to registration five new medicines with its partners: Coartem® Dispersible (artemether-lumefantrine), a child-friendly formulation developed with Novartis; Pyramax® (pyronaridine-artesunate), codeveloped with Shin Poong; Eurartesim® (dihydroartemisinin-piperaquine) with Sigma-Tau; Guilin’s artesunate injection for the treatment of severe malaria, Artesun®; and Guilin SP-amodiaquine tablets for 1-5 year olds – for seasonal malaria chemoprevention.

Since 2009, over 250 million courses of Coartem Dispersible treatment have been supplied to 50 malaria-endemic countries. Further to that, since prequalification in 2010, an estimated 25 million vials of artesunate injection have been delivered, saving 80,000 - 165,000 additional lives.

In addition to that, with the largest portfolio of antimalarial R&D projects ever assembled, of over 65 projects, MMV has nine new drugs in clinical development addressing unmet medical needs in malaria, including medicines for children and relapsing malaria, and drugs which could support the elimination/eradication agenda.

3. Are you satisfied with the role that governments whose countries are suffering from malaria are playing?

The last decade has seen a significant transition in the ways that countries are responding to malaria. In the late 1990s, many countries confronting malaria did not have fully functional malaria control programmes – and in many cases, there was inadequate staffing and role definitions, and few national strategic plans to fight malaria. Significant new international resources (including Global Fund and PMI) have been better mobilized in the past 10-15 years to support programmatic strengthening and introduce greatly improved tools to prevent and treat malaria.

Furthermore, coordination mechanisms (such as Roll Back Malaria’s sub-regional network meetings) have catalysed efforts to develop “country roadmaps” that chart both operational and strategic pathways to controlling malaria. Governments at the most senior level in malaria-endemic countries in Africa and Asia have recently stepped up and made high profile commitments – to which they are holding themselves accountable – through initiatives such as African Leaders Malaria Alliance and Asia Pacific Leaders Malaria Alliance.

All of that said however, there is still a wide degree of variation in the quality (and resourcing) of distinct NMCP programmes throughout Africa. And while some country governments have made great strides in rolling back malaria, others have not experienced the same significant reductions.

Recognising the long lead times that are required to achieve genuine health system strengthening, more champions in the malaria community are advocating an accelerated drive to eliminate the disease and shift the focus from “control” to “elimination” in most places where the disease is present. More governments are now taking on board that challenge and building in elimination roadmaps to their strategic health plans.

4. Can you cite some further statistics which demonstrate the malignant nature of malaria.

Well, 3.2 billion (almost half the world’s population) are living at risk, and in areas of high transmission, a child can suffer from malaria up to five times a year. Without treatment within 24 hours, malaria can progress to severe illness sometimes leading to death. Emerging artemisinin resistance is a major concern: parasite resistance to artemisinin, the key compound in WHOrecommended combination treatments for uncomplicated malaria, has been detected in five countries of south east Asia: Cambodia, Laos, Myanmar, Thailand and Vietnam, in some cases leading to treatment failure. If we do not develop alternatives today, we may be left with nothing to treat patients in the future and we will see a reverse in the gains made so far.

5. Finally, can you tell us what MMV is planning to do this year in the fight against malaria.

MMV is focused on three key areas of work: facilitating access to approved medicines, developing single-dose cures and advancing the science of eradication. We are extremely grateful for the support of UK DFID, the Bill and Melinda Gates Foundation, Wellcome Trust and other donors who are supporting this critically important work.