The Bill & Melinda Gates Foundation Malaria Eradication Strategy

 
 
The Bill & Melinda Gates Foundation
Malaria Eradication Strategy



Thomas Kanyok, Pharm.D.

December 3,
         3 2010



                          © 2010 Bill & Melinda Gates Foundation   |   1
Our Areas of Focus
foundation spending in 2009




                              22%

                   60%
                               16%




                                     2
How is the Global Health Program Organized?


                                INFECTIOUS                       HIV                           FAMILY
                                 DISEASES                                                      HEALTH



Discovery




                                                                             FAM
                                                                               MILY PLA
                                                   P
                                                   PNEUMO
V
Vaccine
    i Development
        D l     t




                                                                                                        NUTRITION
                              MALAR



                                        NOIDS




                                                                                                 MNCH
                    EDD




                                                                       HIV
                                                                TB
                                  RIA




                                                                                      ANNING


                                                                                                    H
                                            S



                                                          NIA
Vaccine Delivery




Policy & Advocacy



                          Strategic Portfolio Analysis & MLE
                                                                                                                    3
An Audacious Goal Set in October 2007
                  ƒ Every life is of equal value; accepting
                    malaria undervalues lives where it
                    persists
                  ƒ The cost of malaria control will
                    continue indefinitely
                  ƒ There will be an ongoing need to
                    adjust
                       j control measures as the
                    parasites and vectors adapt
                  ƒ The time is right for charting a long‐
                    term course to eradication, knowing
                    that it will take several decades,
                    sustained
                          i d commitment,
                                       i      andd an array
                    of new tools to reach such an
                    ambitious goal
                                     © 2010 Bill & Melinda Gates Foundation   |   4
Assumptions Guiding our Malaria
Strategy
ƒ Eradication pathway is unclear—ongoing research is needed
ƒ Need to learn from p  previous and current elimination efforts
ƒ Existing tools are insufficient to eliminate malaria—new
  tools and approaches are needed for eradication
ƒ Single bullet is unlikely—combined tools and approaches (a
  “toolkit”)
   toolkit ) is needed to interrupt transmission
ƒ Malaria elimination should focus on both P. falciparum and P.
  vivax (P.
        (P falciparum will be the first priority and easier)
ƒ Global eradication will take 30‐40 years due to the time
  needed to develop and deploy new tools



                                             © 2010 Bill & Melinda Gates Foundation   |   5
Global Actions to Eradicate Malaria
                            R&D to develop
R&D to improve               transformative
existing tools             eradication tools
     Model and test approaches for
  elimination and eventual eradication
                                                                    Malaria
                                                                  eradication
  Scale up and sustain deployment of
    optimal toolkits for control and
    eventual eradication of malaria

       Create an enabling environment

2010                Time                   2040
                                                  © 2010 Bill & Melinda Gates Foundation   |   6
Our Current Initiatives to Eradicate Malaria
                                                       Initiative 1. Vaccines

                           R&D to develop              Initiative 2. Drugs &
 R&D tot                    t
                            transformative
                                 f     ti                   Diagnostics
 improve                  eradication tools
 existingg tools                                    Initiative 3.
                                                               3 Vector Control
      Model and test approaches for             Initiative 4. Integrated
   elimination and eventual eradication         Interventions & Modeling
    Scale up and sustain deployment of
  optimal
    ti l ttoolkits
             lkit for
                   f control
                          t l and
                                d eventual
                                      t l
                 eradication
       C t an enabling
       Create    bli environment
                        i      t                I iti ti 5.
                                                Initiative 5 Policy
                                                             P li & Advocacy
                                                                    Ad

2010
 0 0               Time                      2013
                                                        © 2010 Bill & Melinda Gates Foundation   |   7
Vaccines: Objectives
              j        and Keyy Investments
        Objectives
          j                                 Keyy Investments

                                 Complete
                                     p      Phase III trial and submit dossier
1. Facilitate licensure and        for licensure
   appropriate uptake of RTS,S   Gather evidence of effectiveness
                                 Develop an investment plan for GAVI and
                                   others

2. Develop second‐generation     Determine
                                        i clinical
                                             li i l development
                                                    d l           and
                                                                    d
                                   regulatory plan for 2nd generation
   vaccines that can interrupt
   transmission                  Evaluate RTS,S
                                              , combination (p(prime‐boost))
                                 Explore novel constructs to interrupt
                                   transmission
3. Create research tools that    Develop P. vivax culture system
   can guide rational vaccine    Identify immunological correlates of
   development                     protection
                                                     © 2010 Bill & Melinda Gates Foundation   |   8
Drugs & Diagnostics: Objectives and Key
 Investments
         Objectives
          bj i                              Key Investments

1 Ensure
1. E      a stable
             t bl andd            Introduce biosynthetic artemisinin,
   affordable supply of quality     high‐yield plants
   assured artemisinin            Evaluate innovative financing models


 2. Prevent the spread of         Promote surveillance of and a
    artemisinin resistance                          p
                                     coordinated response  to drugg
                                     resistance
                                  Eliminate poor quality or counterfeit
                                     drugs and monotherapies

3. Develop new drugs that are
   not dependent on               Identify and develop endoperoxides and
   artemisinin                      novel mechanisms of action


                                                   © 2010 Bill & Melinda Gates Foundation   |   9
Drugs & Diagnostics: Objectives and Key
 Investments (2)
         Objectives                   Key Investments


4. Develop new drugs to     Develop hepatocyte culture systems
   interrupt transmission                   g culture of P. vivax
                              and blood‐stage
                            Develop drugs targeting liver stages,
                              gametocytes, and blood stage
                            Develop drugs for latent infection
                                                     infection,
                              prophylaxis, and mass drug
                              administration

                            Determine potential for diagnostic
5 Define diagnostics for
5.                           tests to detect low parasite levels
                                                          levels,
   elimination               improve malaria control, and
                             measure reduced transmission

                                            © 2010 Bill & Melinda Gates Foundation   |   10
Vector Control: Objectives and Key
 Investments
         Objectives                        Key Investments

                                 Identify and develop active
1. Preserve and improve the        ingredients for IRS and LLINs to
   impact of existing control      avoid resistance mechanisms
   tools                         Develop improved, longer‐lasting IRS
                                 Develop insecticides to be used in
                                   combination
2. Identify new tools and        Conduct earlyy p
                                                proof‐of‐principle
                                                proof p        p
   strategies
    t t i to  t enable
                    bl             studies of new paradigm tools
   elimination
                                 Identify novel behavioral & ecological
                                   targets
3. Prioritize candidate tools,
  alone or in combination        Create a Vector Control Development
                                   network for vector control groups
                                                  © 2010 Bill & Melinda Gates Foundation   |   11
Integrated
    g      Interventions & Modeling:
                                  g
Objectives and Key Investments
           Objectives                            Key Investments

1. Demonstrate the impact of           Capture
                                         p     and share lessons learned
   scaling‐up and sustaining high        from high‐transmission countries in
                                         reducing and sustaining control
   coverage
                                       Develop and apply a tool to assess
  2. Indentify countries where           feasibility of malaria elimination to
     elimination is most feasible        inform country decision making

3. Gather and disseminate              Capture and share lessons learned from
                                         countries in malaria elimination and
   evidence on effective strategies
                                         post‐elimination maintenance
   for elimination
                                       Support operational research on how to
4. Identify optimal packages of          integrate and deliver new tools
   existing and new tools for use in   Create a platform to support evidence‐
   specific transmission settings        based decisions & model optimal
                                         packages for elimination
                                                       © 2010 Bill & Melinda Gates Foundation   |   12
Policyy & Advocacy:
                  y Objectives
                      j        and Keyy
 Actions
         Objectives                           Key Actions

1. Maintain current and           Mobilize new donors for R&D
  encourage increased funding     Encourage continued funding
  for malaria R&D and               commitments by current donors
  implementation                    and governments
                                  Explore new partnerships for
                                    innovative financing
2.. Support
      pp implementation
              p             of   Support partners to track countries
                                                           countries'
   the Global Malaria Action       progress
   Plan (GMAP)                   Disseminate success stories about
                                   meeting GMAP targets
3. Build the evidence base to    Capture and disseminate lessons
  inform effective policy          learned on effective policies to
                                                 © 2010 Bill & Melinda Gates Foundation   |   13
Changes in our Malaria Strategy
           Previous focus                               Expanded focus

ƒ Reducingg the disease burden in               ƒ Interrupting transmission
    Africa                                        globally
ƒ   Malaria caused by P. falciparum             ƒ Modest investments in P. vivax
ƒ   D l vaccines
    Develop         i     tto lilimit
                                   it di
                                      disease   ƒ Develop vaccines that interrupt
    and death in populations most                 transmission and are appropriate
    affected                                      for both children and adults
ƒ   Development of artemisinin‐                 ƒ Drugs that interrupt
    based combination therapies                   transmission, have sustained
    (ACT ) tto ttreatt blood‐stage
    (ACTs)             bl d t                     prophylactic activity and target
    infections                                    the liver stage
ƒ    Developing
             p g new insecticides for           ƒ Improving or replacing existing
    existing tools (IRS and LLINs)                tools
                                                ƒ Vector behavior and ecology

                                                             © 2010 Bill & Melinda Gates Foundation   |   14
Changes in the Integrated Interventions &
Modeling Initiative
        Previous focus                  Expanded focus

 ƒ Measuring the effectiveness    ƒ Measuring the effectiveness
   of single interventions          of integrated interventions in
 ƒ Individual
   I di id l models
                  d l               diff
                                    different transmission
                                                     i i settings
                                                               i
 ƒ Raising general awareness      ƒ Integrated modeling platform
   about malaria                    and data sharing
 ƒ Strengthening global malaria   ƒ Ensuring sustained and new
   partnerships                     funding for R&D and
                                    i l
                                    implementationi
                                  ƒ Creating the right policy
                                    environment for malaria
                                    elimination


                                              © 2010 Bill & Melinda Gates Foundation   |   15
Complementary efforts by others

ƒ Finance the introduction of RTS,S
ƒ Invest in strategies focused purely on limiting disease in high‐
  risk populations including
ƒ Conduct basic research for new targets, parasite biology, and
  P vivax
  P.  i
ƒ Address remaining issues of severe malaria, malaria in
  pregnancy and the implementation of IPT
  pregnancy,
ƒ Develop and implement national plans for elimination
ƒ Help support the operational research agenda
ƒ Share data to strengthen modeling and analysis
ƒ Build capacity and invest in health systems strengthening


                                              © 2010 Bill & Melinda Gates Foundation   |   16
Closing Thoughts
ƒ Malaria eradication is feasible but will require a long‐term,
  sustained
     t i d effort
             ff t over severall decades
                                d d

ƒ Keyy lessons must be learned from the historyy of malaria
  • Research must be a central component
  • Efforts must be integrated into and build health services
  • Surveillance will be key to monitoring and evaluation and to
    finding and attacking malaria where it persists

ƒ R&D of new approaches and tools is the focus of the foundation’s
  strategy

ƒ Multiple partners, sustained commitment, and increased financing
  will be essential

ƒ Without the challenge of eradication, we will consign too many to
  live with and die from malaria forever
                                                  © 2010 Bill & Melinda Gates Foundation   |   17
Thank You




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