To mark the inception of the “European Year of Development” and explore a renewed global health agenda for malaria post-2015, Novartis recently organized a debate in the European Parliament on eradicating malaria through innovation. Other speakers included representatives from the European Parliament, the European Commission, the Kenya Medical Research Institute and Medicines for Malaria Venture.
The fight against malaria is arguably the most successful campaign of its kind, according to Member of European Parliament Nirj Deva. Thanks to the widespread distribution of impregnated nets, treatments and rapid diagnostic tests, mortality figures have dropped by 47% between 2000 and 20131.
Development policies need to be inspired by innovation and enterprising spirit.
Dr. Elizabeth Juma, Senior Research Officer and Public Health Specialist at the Kenya Medical Research Institute, outlined the economic setbacks associated with malaria. In malaria-endemic countries, up to 50% of household expenditure2 on health is spent on malaria. Since many sub-Saharan economies depend on agriculture, this means the disease negatively impacts this economic activity, resulting in productivity and revenue loss.
The link between health and development
Countries that have reached pre-elimination and elimination phases are often those where health systems and income levels have improved. “In the real hotbeds of malaria, key issues do exist around poverty and infrastructure,” noted David Reddy, CEO, Medicines for Malaria Venture (MMV). “This is where new tools, such as insecticides with a very long life and single-dose cures, are needed. What would be ideal would be to have medicines and vaccines that block transmission from one person to another.”
A message echoed by Dr. Linus Igwemezie, Head of the Novartis Malaria Initiative. “Research & Development is a must because malaria has beaten every medicine that was thrown its way,” he said. Treatments exist but new medicines would help us to move closer to elimination. These include drugs for fighting increasing resistance to current treatments and a complete cure that would enable patients to be cleared from all malaria parasites, and stop transmission to other humans.
Partnerships enable stakeholders to contribute their best assets
One key to making faster progress is to pull resources together and to work in partnership – enabling NGOs, governments, academia and the private sector to contribute their best assets toward the elimination of malaria.
Over the years, Novartis has developed an extensive network of partnerships with academic and non-for-profit organizations, which has led, in just six years, to the discovery of two compounds currently in clinical development. Partnerships are also at the core of MMV’s work. The organization currently collaborates with 28 pharmaceutical companies, 13 biotech companies and 56 universities and has launched five medicines for malaria to date in collaboration with its partners.
From left to right: Dr. David Reddy, Medicines for Malaria Venture, Véronique Lorenzo, DG Development and Cooperation, European Commission; Dr. Linus Igwemezie, Novartis Malaria Initiative; Dr. Elizabeth Juma, Kenya Medical Research Institute
Health is primarily a government responsibility
In order to make further progress toward malaria elimination, more resources are needed to strengthen national health systems. This is absolutely critical for drug delivery or healthcare services to function. Governments should be in the lead of these efforts as stressed by Véronique Lorenzo, Head of Unit for Education, Health, Research and Culture in DG Development and Cooperation, European Commission. “Health is a government responsibility and donors will never substitute for governments,” she said. It also falls on governments to ensure public information campaigns take place around the introduction of new technologies and medicines to fight malaria. But efforts to educate and build awareness across 54 countries in Africa is a herculean effort and this is an area where governments and communities can get involved and have a bigger impact.
“Policy, sometimes, stands in the way of progress instead of enabling positive change,” explains Véronique Lorenzo. “For instance, why should it take an additional two years to obtain national approval? Or why is policy sometimes disconnected from regulatory action? Although the WHO recommends using combination therapies, some countries are still today approving monotherapies”. In some instances people who do not have malaria are being treated for malaria. A point also raised by Inmaculada Penas Jimenez, DG Research and Innovation, European Commission, who called for the need for “proper diagnostics to identify whether the person is suffering from malaria or pneumonia.”
Leveraging the private sector
Responding to the final question on how to attract private funding, Véronique Lorenzo argued that fostering innovation and investment in infectious diseases research is perhaps the most important area where the private sector can contribute. “We need to work better at leveraging the private sector. Increasingly there is an effort from the private sector to go beyond its business mandate and go into CSR. But we haven’t yet harnessed the full energies of this,” she concluded.
Onwujekwe, O., Chima, R. and Okonkwo, P. (2000) ‘Economic burden of malaria illness on households versus that of all other illness episodes: a study in five malaria holo-endemic Nigerian communities’, Health Policy, 54(2), pp. 143-59.