George Jagoe
Executive Vice President, Access & Product Management, MMV
To make malaria elimination a reality, we need to accelerate progress in prevention and therapeutic drugs. That requires greater investment and focus, says one expert in the field.
If the world is serious about eliminating malaria, the status quo is not an option. The challenges posed by the disease are simply too complex — so continuous innovation in targeted prevention and treatment is not just desirable; it is vital.
George Jagoe, Executive Vice President of Access and Product Management at Medicines for Malaria Venture (MMV) — a not-for-profit organisation working to deliver a portfolio of accessible malaria medicines — explains: “I’m reminded of the wise warnings from Alan Magill, the late visionary Director of Malaria Programmes at the Gates Foundation. He paraphrased the Red Queen in Alice in Wonderland: we would have to run as fast as possible just to stay in place, and if we want to move in a more promising direction, we’d have to run twice as fast. That was prophetic: today, the burden of malaria is far off the targets that WHO’s Global technical strategy established in 2015.”
Saving lives is the first order of
business – it’s why the first drug
we co-developed was child friendly.
How ACTs revolutionised malaria treatment
Which is not to downplay some remarkable anti-malarial breakthroughs over the years. One of these was the first artemisinin-based combination therapy (ACT) developed for children, which MMV developed with pharma company Novartis — 500 million doses have now been distributed. “ACTs were a game-changer in malaria treatment,” says Jagoe. “Coupling artemisinin drugs with another antimalarial made them life saving, efficacious and fast acting, with long post-treatment protection.”
Vector control innovation has also been critical – the introduction of long-lasting insecticide-treated bed nets (LLINs) has contributed massively to saving lives, especially for children. “And now there are malaria vaccines for the youngest children, a remarkable breakthrough in helping reduce mortality in a huge at-risk population,” notes Jagoe. “But today’s LLINs and vaccines alone won’t bend the malaria elimination curve to zero.”
A strategy to get the malaria elimination agenda back on track
To accelerate progress, MMV stresses the importance of investing in R&D for next-generation medicines, while extending the useful life of ACTs; scaling up access to the preventive intervention trio of chemotherapy, vector control and vaccines; and prioritising protection of the most at-risk groups (i.e., children under 5 and pregnant women).
“Saving lives is the first order of business – it’s why the first drug we co-developed was child friendly,” explains Jagoe. “And it’s why our Malaria in Mothers and Babies (MiMBa) strategy is accelerating the validation of antimalarial medications in clinical trials in pregnant women and women of child-bearing potential.”
But to wipe out malaria transmission and accelerate the path to elimination, reservoirs of the parasite in asymptomatic carriers have to be prioritised – in other words, clearing out infections in people who don’t realise they are carriers. “As long as anyone in a village or city is carrying malaria, we won’t get close to elimination,” admits Jagoe.
The impact of injected prevention and single-dose cures
MMV continues to work with its partners to bring innovations to market that facilitate adherence, offer barriers to resistance and hold the promise of community-wide parasite reservoir reduction. “There are molecules in early development which may offer protection from infection for months on end if injected. The idea of long-acting injected (LAI) prevention is incredibly exciting, particularly if it can be used across the full community – in adults as well as in children. The speed with which LAIs may break the cycle of transmission remains to be seen, but is very promising.”
Separately, the development of single-dose cures would also be ground-breaking because they would improve compliance rates, reduce risk of resistance and make mass oral treatment campaigns a reality. “Alongside injectable prevention, a lot of our drug development work involves pursuing single-dose cures,” notes Jagoe. “Drug discovery is hard. You have to be patient and accept failures. But I believe we’re on the eve of breakthrough tools that could have the kind of acceleration effect we’ve been hoping to see for a long time.”
