Dr Chris Hentschel interviewed in Kampala by AllAfrica.org

Africa: ’Gigantic Steps Forward’ in Fight against Malaria, AllAfrica.com

09 May 2007

Medicines for Malaria Venture (MMV), an international non-profit organization involved in the research and development of anti-malarial medicines, is hosting its seventh annual stakeholder meeting in Uganda this week. The meeting, titled "The Power of Partnership", will see various players in the global effort to combat malaria in Africa come together to discuss ways in which they can collaborate.

AllAfrica’s Helen Kilbey spoke to Dr Chris Hentschel, president of MMV, and Dr Steven Phillips, the medical director for ExxonMobil, a multinational oil company which supports anti-malaria initiatives.

Dr. Hentschel, could you tell me about Medicines for Malaria?

We’re an organization that discovers and develops and will be part of the delivery mechanism for innovative anti-malarial drugs... We’re an international NGO.

You have a strong focus on public- private partnerships - what kind of role do you see these kinds of partnerships having for Africa in the fight against malaria?

Their role is broader than just the fight against malaria - they are mechanisms that allow innovation to occur where there isn’t a market. Commercial research and development (R&D) for new drugs is incredibly expensive - unless there are very large markets it basically doesn’t happen, which is why it wasn’t happening with anti-malarial drugs.

What is the status of anti-malarial drug R&D at the moment?

We really have a breakthrough with the number of drugs we have, the number of new drugs that are coming through and that we hope will come through in the next two or three years, drugs that we hope will perform much better than the current drugs. This has been an investment that has gone on now for six or seven years. It’s been an investment largely financed through philanthropy or through the governments that have been involved, and it’s beginning to really bear fruit now.

So you are seeing results from your efforts?

Definitely.

What kinds of results are you seeing? How do you gauge how well you’re doing?

In terms of how we are doing with malaria on the continent, it has more to do with the scale-up of existing treatments rather than the development of new ones. To measure the development of new ones, you have to understand how research and development works and the many stages the new drug has to go through. We have... [more] drugs in advanced development... than we’ve ever had in history.

The fight against malaria involves many different approaches - bednets and chemical spraying being some of the major ones. What role does medication play in this picture?

Well, actually you need everything in the grand approach. You need to control the vectors and you need to treat patients. There are hundreds of millions of kids with malaria every year and they have to be treated... but hopefully there will be in due course a vaccine as well. So everything has to be done, not just the drugs.

One thing I would like to say is that people tend to think of drugs as just treatment; but in fact the new generation of drugs have a property... which means that they will actually prevent the infection from being passed on to others. So it’s a preventative measure as well as a treatment.

You’re hosting the annual stakeholder meeting in Uganda from May 7 to 9. What are the issues that you’ll be highlighting?

Whatever we do in R&D, we’ll only get a health impact working with the countries that have malaria. Uganda is such a country, in fact it has the highest rate of infection in the population in the world, which means that it is the region that has the most to gain from what we’re doing. We’ve got fantastic local support there, right through to the president of Uganda, so that’s the reason we’re going to be there.

What are you actually going to be discussing and what do you hope to achieve?

The main objective is to tell a broad range of people that we work with what we have achieved in the last year, and to ask them to keep supporting this effort, because research and development is not something that happens in one year, it takes quite a long time.

I mentioned the possibility of a vaccine - that started originally 20 years ago and to continue funding that work over 20 years isn’t the easiest thing to do, especially when there isn’t a commercial market. We’re not looking for funders for the next 20 years, but even over the next several years we want continued support.

How has your support been thus far?

Well, I think it’s been good, but we’re always looking for more - the plain truth is that if we had more resources and more money, we could do things faster... remembering that there are these Millennium Development Goals, trying to achieve certain things by 2015, so there’s pressure on everyone.

Do you think those goals can be met? How realistic are they?

That’s a very good question. The answer is that they will be met only if the world actually does what it said it was going to do. The rich world, the developed world has said that it would bring a lot of new resources to bear on these problems, and it’s started but has not really reached the level that was hoped for. Recently there was a conference in Berlin which reviewed progress, and basically I think the report said we could do better.

Do you think that accurately sums up the malaria eradication situation - "Could do better"?

That might be a slightly pessimistic way of looking at things - I think that as far as the bit that we’re involved in goes, the situation is pretty good, but there’s no doubt that for us to really succeed we are going to need new resources.

This is part of the purpose of the meeting in Uganda, because a lot of people there will be representatives of development agencies from all over the world, as well as philanthropists, and we need to engage African leadership as well. It’s very pleasing to know that the African Union, in its meeting in April, particularly stressed that at this AU level these health issues would pick up more importance than they have historically.

Dr Philips, you are medical director of ExxonMobil and you’re also on the board of the "Roll Back Malaria" partnership. What do you feel are the main problems that Africa is facing in the fight against malaria?

I think it’s safe to say that right now we’re in the most auspicious place in the last 50 years, in terms of being able to successfully attack malaria. The last 50 years have been fairly dismal, but what’s happened recently are three or four things that have been gigantic steps forward. The first is political will - both within the endemic countries in Africa and, as importantly, among many of the G8 leaders.

Secondly, resources dedicated to malaria have gone up some 20-fold in the last six or seven years. No one is saying that the resources are enough, but I think everyone now is saying that... if we can measure what we do as a hallmark of success, then this will beget a virtuous cycle of further funding.

Third, we now have first-line drugs that are highly effective; we have two or three other interventions that are highly effective; and, frankly, the world is now realising that malaria is not only a public health scourge in Africa, and not only is it a single disease that needs to be addressed very forthrightly, but that it’s almost a sentinel indicator of the success of Africa’s development, such a broad impact does it have on social and environmental issues.

I don’t think it’s properly appreciated in the world that the malaria parasite is different biologically and epidemiologically than all the other infectious diseases that are ravaging Africa. It therefore takes a much higher level of organisation and partnership to make inroads against it, than... diseases we read about all the time such as polio, measles and even HIV/Aids.

Fourth, the world is now, for the first time in 50 plus years, choosing actively to re-organise itself for the battle. Everything I’ve said has been evaded and not acted upon up until the last year or two.
Now all of these stars are really coming into alignment, and I think it’s safe to say there’s not been a higher degree of active not just cooperation but collaboration among the multi-laterals, bi-laterals and among the host governments in recent memory.

Why are things suddenly coming together?

I think it’s because malaria has gone from being the most neglected of neglected diseases, to one that is recognized as the number one child killer in Africa and an indicator of how we’re doing collectively as a global community. I really think we’re almost there; I think it’s up in neon lights. When [British Prime Minister] Tony Blair mentions the M word in a G8 meeting, when [U.S. President] George Bush mentions it three times in the State of the Union [address] and develops a presidential malaria initiative to fight it, and when the Gates Foundation raises its funding several fold... [the] impact is synergistic, not only in terms of resources, but in terms of the collective moral and political will of the global community.

How is it that everyone has suddenly realized that this is a problem that needs to be urgently addressed?

Let me give you a little personal example. When the [ExxonMobil] Foundation was looking six years ago at the strategies of our Africa Health Initiative, we had internal debates about whether we should go with one disease, or a number of diseases, or horizontally, as they say, across the health services. We did some focus group surveys at the village level in Africa.

News came back that people by and large weren’t concerned with malaria. They weren’t concerned about it because the incredible mortality and morbidity was taken for granted. They had a number of local names for malaria, but didn’t even identify it as a disease - it was very much accepted as a fact of life. So the challenge was why do you want to pick on a disease that is hardly even recognized as a problem at the root of where it is? [Now] the world has recognized the disease: the devastating impact, the toll.

ExxonMobil is a multinational corporation with profit as its bottom line. Why has the company become involved in projects trying to combat malaria? What does ExxonMobil get out of this?

You sound like a shareholder! We’re doing this for two or three compelling reasons: one is because malaria affects us operationally. Our ability to operate our gigantic facilities is very much dependent on healthy and productive people. So one incentive, frankly, is enlightened self-interest. The other one is that ExxonMobil is a big part of the energy equation for all of Africa... It is forecast that by the end of 2010 Africa will be responsible for fully 25 percent of the so-called ’net liquids’ production. So we’re long term players. For us to get invested in malaria in a way where we not only do good as a single company but we leverage that across NGOs, across governments... to get everyone to do more... we feel that it’s a grand investment.