Gates Foundation: Time to regroup on malaria and NTDs

Following the upheaval to public health programs caused by the COVID-19 pandemic, now is the time to regroup and get back on track to reach targets on reducing malaria and so-called neglected tropical diseases, according to Trevor Mundel, the president of global health at the Bill & Melinda Gates Foundation.

Devex spoke to Mundel in the lead-up to the Kigali Summit on Malaria and Neglected Tropical Diseases in Rwanda, set for Thursday.

“We need to get back to being on track for some of the elimination goals for NTDs,” he said.

Additionally, there is a global target to reduce the burden of malaria by 90% by 2030, and to reduce malaria burden by 50% in Commonwealth countries by 2023, which are goals that are not on target, he said.

Malaria countermeasures

The World Health Organization reported last year that progress on efforts to reach global malaria targets continues to flatline, with an estimated 627,000 people globally dying in 2020 from malaria — the highest figure in nearly a decade. The African continent accounted for the vast majority of global malaria deaths.

The most significant event to advance malaria goals this year is the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Mundel said. The organization aims to raise at least $18 billion.

“Global Fund has been so significant in terms of malaria funding and getting out malaria tools,” he said.

Last year, WHO recommended the broad use of the world’s first malaria vaccine. While this vaccine is a “wonderful achievement showing that a malaria vaccine would actually work,” Mundel said, it also has limitations, having only shown 36% effectiveness over four years.

In rolling out the vaccine, Mundel said it should not be seen as a panacea; there is still a need for other countermeasures such as bed nets and seasonal chemoprophylaxis, which is given to children to prevent infection during seasons with high malaria transmission.

“The vaccine needs to be deployed carefully,” Mundel said, “in conjunction with the other tools that are available right now.”

And there are hopes that an even more effective vaccine could be developed using messenger RNA technology, but that’s not expected to happen at the same pace that COVID-19 vaccines were developed.

“Malaria has got this unfortunate ability to subvert our immune systems in some way, which we don't fully understand,” Mundel said. “It's very important to get the next malaria vaccine studied in populations in high-endemic regions, particularly in Africa, as soon as possible.”

And while there is a new generation of tools, including the new vaccine, drugs, and insecticide-treated bed nets, they do come at a higher cost than previous control measures. “We need that extra funding to go into some of these transformative tools that we may initially have to pay a slight premium,” he said.

Climate change creates uncertainty around where and to what level malaria cases will materialize in the years to come, he said, but the displacement of people, fueled by climate change, also threatens progress in reducing malaria. That’s because when people are displaced, they may not have access to bed nets or other antimalarial tools.

A new declaration on NTDs

NTDs — which encompass viral, parasitic, and bacterial diseases such as dengue fever, trachoma, and leprosy — have a heavy burden in low- and middle-income countries, yet they are often overlooked by policymakers, resulting in low resources allocated to their control.

Progress on NTDs has stalled, and funding is precarious, Mundel said.

Stakeholders in the fight against NTDs are expected to sign a declaration in Kigali on Thursday that aims to ensure the diseases are eradicated, eliminated, or controlled by 2030. WHO has a road map outlining steps to achieve this. It will replace a declaration made in 2012 in London — where pharmaceutical companies, donors, endemic countries, and NGOs set a 2020 target on control, elimination, and eradication.

Mundel said that with this new declaration, pharmaceutical companies will reaffirm commitments around drug donations and other partners will commit to delivery of these drugs to “finish the job” on targets around NTDs.

Before the declaration in London, there was “sporadic and independent” activity in the NTD space. After the declaration, though, “everybody signed up for the same agenda,” he said. “It's worked incredibly well.”

NTDs like onchocerciasis and lymphatic filariasis are still years away from elimination, although some countries may reach that achievement individually, Mundel said, adding that Niger announced last year it had eliminated onchocerciasis, for example.

Investments in mass drug administration programs have also been threatened in recent years, he said. While they are enormously cost-effective in what they accomplish, Mundel said, they still require funding for distribution even when drugs are donated. While the U.K. has been a significant funder of NTDs, government aid cuts mean that millions have missed out on treatments.

And just like with malaria, new treatment options may come with a higher cost, Mundel said.

Update, June 23, 2022: This piece has been updated to reflect that onchocerciasis was eliminated in Niger and with the updated malaria reduction targets.