When Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, said in 2007 that “any goal short of eradicating malaria is accepting malaria,” she helped to spark an industry wide shift toward ending the disease.
Prior to the 2007 forum on malaria, the global health community had been cautious about declaring full eradication the ultimate goal. Today, eradication shapes every aspect of malaria work from the foundation as well as the broader public health community.
The Gates Foundation has led the shift in approach and mobilized others to join efforts to end the disease. Partners of the Gates Foundation, including many based in the foundation’s global health hub, are aligning behind the idea that indefinite control is not a sustainable solution, since emerging resistance requires continuous investments in research and development.
“If we don’t eradicate malaria, we will constantly have to adapt our strategies whether it is ten years or 50 years or 300 years from now,” Bruno Moonen, deputy director for malaria at the Gates Foundation, told Devex.
“If we keep going the way we’re going, sure we’ll see some progress, but it’s unlikely that we will achieve elimination anytime soon,” Moonen said in a presentation yesterday.
He pointed to a graph capturing three potential trajectories for malaria: resurgence, maintaining current progress, and accelerating toward eradication. The Gates Foundation’s strategy is to bend the curve by closing the gap between where we are today — sustaining progress — and where we want to be — accelerating to zero.
This will require a comprehensive approach that attacks parasites and vectors, Moonen said, spelling out the equation: complete detection, plus complete care, plus complete prevention equals eradication.
The Gates Foundation is planning its malaria investments accordingly. To achieve and maintain elimination in low to moderate transmission areas, the foundation is funding organizations whose work could generate an immediate return on investment, such as the Mozambican Alliance Towards Elimination of Malaria and Malaria ZERO, which is focused on malaria in Haiti.
In high transmission areas, the Gates Foundation aims to prepare for the future, with research and development investments in drugs, diagnostics, vector control, and efforts to create the first vaccine against the parasite. To sustain the progress that has been made against malaria, the Gates Foundation also invests in R&D for vector control, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and advocacy and communications, including through its funding of Malaria No More.
While malaria is preventable and treatable, eradication requires new tools and has changed the way the foundation views product development, said Janice Culpepper, a senior program officer in infectious diseases at the foundation.
The three major product development partners for the Gates Foundation in its malaria elimination strategy are the Geneva-based nonprofit Medicines for Malaria Venture, the public private product development partnership Innovative Vector Control Consortium, and the Malaria Vaccine Initiative at the global health organization PATH, based in Seattle.
“The focus on elimination has changed the way the foundation is making investments and what its partners are doing,” David Brandling-Bennett, senior adviser for malaria at the Gates Foundation, told Devex. “We are shifting from ‘any drug was pretty good, any vaccine was pretty good,’ to ‘what is going to be a game changer in achieving this ultimately outrageous goal?’”
The Gates Foundation is able to take risks and make investments in a way that few other funders can, he said, but the malaria team still considers its investments carefully, taking products through a process of early discovery before deciding to continue with the investment.
An example of this is “Attractive Toxic Sugar Bait Stations,” a device supported by the Gates Foundation that kills 95 percent of mosquitoes that feed on it. While it started in discovery mode in one of the Gates Foundation’s Grand Challenges 10 years ago, its field trial in 14 villages in Mali produced the most dramatic results of any intervention the team has looked at, said Dan Strickman, senior program officer for vector control. Pilots are planned for the next two years. In November, the Gates Foundation will meet with investigators and the company behind the product to discuss next steps.
Moonen said in his presentation that ambitious goals spur innovation, outlining the Malaria Eradication Research Agenda, created following the 2007 malaria forum. That agenda includes five main points: a single exposure radical cure and prophylaxis, where the goal is to create a single dose malaria cure; a highly sensitive point of care diagnostic; transmission-blocking vaccines; new vector control tools; and health systems for eradication.
Stay tuned to Devex for more coverage on ways partners in Seattle and beyond plan to partner with the Gates Foundation around the goal of malaria eradication.
EDITOR’S NOTE: The reporter is in Seattle on the Innovating to End Malaria fellowship funded by Malaria No More. Devex retains full editorial independence and responsibility for this content.
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