6.10 Malaria
See Background Chapter 6.10
A.
Background
Malaria accounts for over one million deaths and up to 500 million cases a year. 1
Nearly 90% of cases and deaths occur in Africa. About 70% of these deaths occur in
young children. Pregnant women are particularly vulnerable to malaria — placing
both mother and child at risk. The economic consequences of malaria in Africa are
enormous. Malaria accounts for an estimated US$12 billion (about €9.8 billion) per year
in lost Gross Domestic Product (GDP) and a loss of 45 million years of productive life
due to deaths and disability.2 The number of malaria cases imported into Europe is
increasing and deaths occur due to a lack of recognition of the disease and sometimes
because of poor medical management.
B.
Control strategies
The control strategy for malaria involves controlling the mosquito vector and
providing effective curative treatment to infected individuals. Vector control can
include the use of insecticide-impregnated bednets, indoor residual household
spraying, and environmental and biological management. The success of these
measures is heavily dependent on ecological factors such as rainfall and temperature.
In many tropical environments it is extremely difficult to eradicate the vector. There is
no vaccine to date and those currently in development are not expected to be available
for some time. Moreover, they may not be highly effective. The EU provides support
for malaria vaccine development, for which a long-term commitment is necessary.
Effective case management requires accurate diagnosis and correct treatment with
effective medicines. Antimalarials such as chloroquine and sulfadoxine pyrimethamine
have proven to be useful in the control of malaria but widespread resistance make
these medicines useless in many areas. Newer treatments such as artemisinin-based
combination therapies are far more expensive, costing 10 to 20 times as much as the old
medicines. New affordable, safe and effective medicines are urgently needed to roll
back malaria. These new products should be aimed at treating young children and
pregnant women.
The pharmaceutical industry has largely disengaged from innovative drug R&D in
tropical diseases due to the lack of market incentives. Despite its frequency and
severity, malaria can be seen as a “neglected disease”(see Chapter 6.9). There have
been major advances in basic science in areas such as genetics and molecular biology
which allow a better understanding of the parasite and identification of possible
medicine target sites.3 Yet despite the advances in basic scientific knowledge, only a
few new medicines have been developed, because a funding gap exists between basic
science and translational research geared toward discovery and development of new
medicines.
The creation of PPPs such as the Medicines for Malaria Venture (MMV) provides a new
approach to innovative medicines discovery and development (see Chapter 8.1). In a
few years of operation, assisted by contributions of the private sector and with a total
expenditure of about US$50 million (about €40 million), MMV has built the largest
antimalarial medicines portfolio since World War II. Expenditures will increase
significantly as many medicines reach clinical trial phases. Collaboration with the
EDCTP will help support the cost of clinical studies and thus facilitate rapid progress.
MMV estimates that at least US$30-50 million will be required annually to maintain
and expand its portfolio.4
Despite all efforts taken to reduce the attrition rate of newly discovered compounds,
the lack of better tools to screen for safety, particularly with respect to reproductive
and developmental toxicity, means that many promising compounds may be discarded
at a late stage of development. Academic scientists, industry and regulators need to
team up to translate basic research into applied sciences which will lead to the
development of more cost-efficient experimental models for medicines discovery and
development. Creation and funding of new partnerships toward applied sciences for
medicines R&D are needed for the development of new medicines that will meet
public health needs (see Chapter 8.3).
Recent basic science discoveries have created promising opportunities for medicines
development but funding for translational and preclinical research must be provided
to bring these medicines to patients. As in the case of other neglected diseases, the EU
needs to find a mechanism to fund this translational and preclinical research.
1
Breman JG, Egan A, Keusch GT. The intolerable burden of malaria: a new look at the
numbers. Am J Trop Med Hyg 2001;64(1-2 Suppl.):IV-VII.
2
Arrow KJ, Panosian C, editors. Saving lives, buying time. Institute of Medicine of the
US National Academies of Science (IOM); 2004:1-326.
3
Global Malaria Control Strategy. Report of a WHO Study Group on the Implementation
of the Global Plan of Action for Malaria Control 1993–2000. Geneva: World Health
Organization; 1993. (WHO Technical Report Series, No. 839).
4
Annual report 2003. Geneva: Medicines for Malaria Venture; 2003. Available from:
http://www.mmv.org/filesupld/184.pdf