See Background Chapter 6.10

6.10Malaria

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 creationof PPPs such as the Medicines for Malaria Venture (MMV) provides a new approach to innovative medicines discovery and development (see Chapter8.1). 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: