Cristina Donini
Executive Vice President, Head of Research, Early Development and Modelling, Medicines for Malaria Venture (MMV)
Cristina Donini, Head of Research and Early Development at Medicines for Malaria Venture (MMV), shares her concerns around antimalarial drug resistance (AMDR) and outlines innovative strategies to advance malaria care and protect vulnerable populations.
What are the current challenges in malaria treatments?
Complex drug regimens, resistance to medications and weakened healthcare systems. Microbes are masters of survival: they mutate and evade drugs, and the emergence of partial artemisinin resistance threatens our most effective treatments. Early warning signs like delayed parasite clearance are appearing in several African regions. It’s a race against time and every delay increases the risk of losing control over the disease.
How serious is antimalarial drug resistance, and what could happen if we don’t act?
The threat is extremely serious. Although artemisinin combination therapies (ACTs) – which pair fast-acting artemisinin with a longer-lasting partner drug – remain effective, signs of delayed susceptibility of the parasite are emerging. This calls for heightened vigilance. If we fail to act promptly, we risk losing some of the tools that have controlled malaria for decades. This would be catastrophic.
How does AMDR fit within antimicrobial resistance (AMR)?
AMDR is a subset of AMR but is often overlooked. Parasites are microbes too, and resistance spreads similarly. AMDR must be recognised as a top global health priority, especially in regions where malaria remains endemic and health systems are fragile.
What options are available for malaria drug resistance, and how do we know they work?
We’re diversifying strategies by using multiple first-line therapies and expanding access to alternative combinations. Switching or combining therapies can slow the parasite’s adaptation and extend drug effectiveness. Adding a third drug strengthens defence, protecting partner drugs and making resistance harder to develop. We’re also exploring strategies to block transmission of resistant parasites at source. These approaches help contain resistance while new therapies are being developed.
Can you tell us about MMV’s multi-layered strategy to combat resistance?
Artemether-lumefantrine (AL) is the most common of ACTs, but we aim to reduce reliance on a single treatment to reduce drug pressure on the family of ACTs. In collaboration with partners like Novartis, GlaxoSmithKline, Merck and others, we’re advancing novel combinations with high-resistance barriers. Our strategy includes medicines with new mechanisms of action and optimising existing therapies – offering a stronger, more sustainable defence than traditional methods.
How does collaboration help ensure new medicines reach those who need them most?
Collaboration is central to MMV’s mission. As a product development partnership, we work with academia, industry partners, and governments to ensure new malaria treatments reach those in need. Academics bring early-stage discovery programmes, MMV accelerates drug development with industry partners, and governments help scale access. No single organisation could achieve this alone.
What innovations could secure the future of malaria treatment?
Bold science is key if we want to eliminate, rather than control, malaria. One major challenge is ensuring patients complete treatments, so simpler drug regimens are critical. Imagine a single-dose cure or a long-acting injectable that prevents malaria for months. Or an AI-driven approach that designs new medicines faster. These breakthroughs could dramatically shorten drug development timelines and transform malaria care.
Why is sustained funding so critical?
History shows that when efforts slow, resistance quickly returns, threatening years of progress. As resistance emerges, sustained funding is essential to develop next-generation medicines. Eliminating malaria requires consistent support from donors, governments and communities.
What keeps you motivated amid complex global challenges?
I’ve had the chance to visit hospitals in Africa, and it’s deeply moving to see how malaria impacts families and communities. Malaria is both a consequence and a cause of poverty, trapping people in cycles of illness and hardship. As a registered pharmacist, my mission is to help deliver life-saving medicines. It’s a long journey, but knowing our work is changing lives keeps me going.
Ask me how sustained funding can stop malaria resistance: [email protected].
