Fighting malaria from Geneva

"Ever since the COVID-19 pandemic, if not before, we have become aware of the importance of a multilateral approach to tackling the health crisis," says Jürg Lauber, Permanent Representative of Switzerland to the United Nations in Geneva. Health is an interdisciplinary topic that also touches on human rights and development cooperation.

Geneva, known as the world's health capital, is home to numerous stakeholders whose work is closely linked: Switzerland is a founding member of the WHO, which has its headquarters in Geneva. The Global Fund to Fight AIDS, Tuberculosis and Malaria, and UNAIDS (the Joint United Nations Programme on HIV/AIDS) are also based here, alongside numerous non-governmental organisations such as Médecins Sans Frontières/Doctors Without Borders. And then there are the pharma and private companies as well as a large number of medical start-ups.

"In Geneva, key stakeholders work together successfully and find real-world answers to global health problems," says Lauber. For example, when it comes to defeating malaria. Medicines for Malaria Venture (MMV), a public-private partnership, coordinates the research, development and introduction of new antimalarial medicines from its base in Geneva.

The organisation's network, which also receives support from the SDC, is made up of around 400 pharmaceutical, academic, NGO, authority and endemic-country partners. Working together in this way helps to reduce costs and gives those in need access to affordable, quality-controlled medication. To date, the MMV has helped launch 12 new antimalarial medicines, and almost 3 million lives have been saved in the process.

One of the projects the MMV is working on at present involves facilitating access to antimalarials by pregnant women, one of the main risk groups. Because of the risk to both the mother and her unborn child, pregnant women are given preventive treatment using sulphadoxine-pyrimethamine (SP). "Right now, there are many obstacles to accessing this particular medication," says Maud Majeres Lugand, MMV's Associate Director of Social Research. These include stock-outs and the difficulty of reaching clinics.

An MMV project funded by Unitaid seeks to enable African manufacturers to produce this antimalarial medicine. Lugand explains that one of the problems in countries badly affected by malaria is that substandard SP is widespread and sometimes mistakenly used to treat the disease rather than as a preventive measure. "The availability of locally produced and quality-controlled SP could help force products of lesser or unknown quality off the market," says Lugand.

Supporting African manufacturers should help the continent to become self-sufficient, as well as improving the stability of global supply. "During the corona crisis, we saw how serious it is when global supply chains are interrupted."

At present, Africa imports up to 90% of its antimalarials, despite the fact that it is the continent with the largest demand. Nigeria is most badly affected: 26.8% of all cases of malaria occur there. The MMV has already signed cooperation agreements with African manufacturers to produce SP for the preventive treatment of pregnant women ‒ two in Kenya and one in Nigeria. One of these ventures is about to secure WHO prequalification, which confirms that medicines have met acceptable quality and thus opens the door to their market launch.

As soon as the WHO has given the green light, donor organisations like the Global Fund come into play. It is the most important multilateral financing instrument in the fight against malaria, tuberculosis and HIV, and raises just under USD 4 billion a year from various sources. One of its main tasks is to seek strategic partners and suppliers that can become involved in procuring the medicines ‒ provided the latter have been recommend by the WHO.

Scott Filler, who is responsible for the malaria programme at the Global Fund, says: "We have a very lean secretariat, which means we rely all the more on our partners with specific core competencies." They include the MMV, which develops products and ensures that "there are sufficient drug projects in the research and development pipeline to cover demand."

Once a medicine has been rolled out on the market, it still has to get to those who need it in remote areas. In order to go this 'last mile', the MMV works with local NGOs. "Even the best medicine would never reach the patients were it not for the numerous partnerships," is Lugand's conclusion.

«Medicines for Malaria Venture» (MMV)