21 July 2020

Partner Spotlight: Five Questions With Medicines For Malaria Venture

The COVID-19 pandemic has jeopardized hard-won gains in women’s, children’s and adolescent health. Though women and children are at less risk from the virus itself, the knock-on effects—such as limited access to vaccines and sexual and reproductive health resources—are projected to do immense harm. Every Woman Every Child believes that women and children must be placed at the center of COVID-19 recovery plans. In that spirit, we have launched a new “Five Questions” feature to feature partners who are working to make sure that no one from these vulnerable groups is left behind.

1.What is your organization’s primary concern with the global pandemic as it relates to women, children and adolescents?

Medicines for Malaria Venture (MMV) discovers, develops and delivers antimalarials for at-risk and underserved populations including women, adolescents and children, with the goal of supporting the ultimate eradication of malaria. A primary concern for MMV at this time is disruption to malaria programmes and delivery of life-saving tools and interventions.   

The World Health Organization (WHO) estimates that the tally of malaria deaths in sub-Saharan Africa in 2020 caused by the disruption of COVID-19 on the provision of malaria services could reach 769,000, with 70% of projected deaths among children under the age of 5. This is nearly double the death toll reported in 2018, and would represent a return to malaria mortality levels last seen in the year 2000. Indeed, between 2000 and 2015, malaria death rates among children under 5 had fallen by 65% as a result of increased investments against malaria and the increased delivery of malaria control tools. 

Already, a recent survey conducted across 106 countries by the Global Fund to Fight AIDS, Malaria and Tuberculosis has indicated that 73% of malaria programmes have faced disruptions to service delivery, with 19% facing high or very high disruptions. MMV is concerned that the reported challenges to supply chains, malaria testing, as well as cancelled or delayed malaria prevention activities, will negatively impact all beneficiaries of malaria programmes, though particularly pregnant women and children under 5, as they are the populations most at risk. The challenges include:

Challenges to malaria testing 

During the COVID-19 crisis children, adolescents, women, and others presenting with fever may be less likely to receive the right— or any—diagnosis, which could result in the absence of care or inappropriate treatment. This could be due to the unavailability of health care workers and diagnostic tools, and the fear of contracting COVID-19 at health facilities, which could reduce the instances of seeking care. 

Indeed, the testing and treatment of people with fevers, particularly children, depends on the availability of health workers, who might be unable to travel, sick or scared to expose themselves without protective equipment.  

Healthcare workers in malaria-endemic countries also often lack the diagnostic tools to distinguish between diseases. This is likely to be exacerbated during the pandemic. The similarities in symptoms between COVID-19 and malaria (e.g. fever, headaches, muscles pain, diarrhea) would increase the risk of an inaccurate diagnosis. 

Furthermore, possible disruptions in the supply of diagnostic tools could increase presumptive treatment and increase demand for antimalarials. This practice is less than ideal, as it increases the incorrect use of antimalarials, the probability of antimalarial stockouts,  and the risk of drug resistance. 

These risks are likely to reduce the effectiveness of malaria programmes, resulting in increased cases and deaths. 

Disruptions to prevention and treatment activities

Disruptions in global drug supply and distribution chains as a result of national responses to COVID-19 could also compromise access to lifesaving medicines needed by women, adolescents and children for both the treatment and prevention of malaria. 

In particular, by disrupting global supply chains, the COVID-19 pandemic could undermine the provision of preventive interventions that protect children and pregnant women from malaria, such as Seasonal Malaria Chemoprevention (SMC) and Intermittent Preventive Treatment in pregnancy (IPTp). 

SMC refers to the administration of full treatment courses of a combination of antimalarial medicines to children during the malaria (rainy) season in areas of highly seasonal malaria transmission to prevent malarial illness. If everything goes as planned, SMC has the potential to protect over 22 million children from malaria in 2020 alone.

IPTp is a full therapeutic course of antimalarial medicine, sulfadoxine-pyremethamine, (SP) given to pregnant women at routine antenatal care visits. IPTp with SP reduces malaria episodes, maternal and neonatal mortality, maternal and fetal anaemia, placental parasitaemia, and low birthweight. Low birthweight is associated with a negative impact on early childhood development. In 2018, about 11 million pregnancies in sub-Saharan African countries were at risk of malaria infection and 872,000 children were born with low birthweight. 

It is therefore critical that malaria-endemic countries minimize any disruptions of malaria prevention and treatment during the COVID-19 response. The stakes are high. Unless action is rapidly taken, twenty years of progress could be wiped out. Robust, concurrent responses to both malaria and COVID-19 are needed to sustain efforts to prevent, detect and treat malaria, while preventing the spread of COVID-19 and ensuring the safety of those who deliver and receive health services.

2. What concrete actions are you taking to advance/safeguard the goals of the EWEC Global Strategy during this time, specifically for ending all preventable deaths among women, children and adolescents by 2030?

Malaria killed more than 400,000 people last year, mostly African children under 5. MMV has continued its core work as programmed for 2020, which aims to give populations at risk of malaria including women, adolescents, and children, a better chance to achieve health and well-being. At the same time, to address threats posed by COVID-19, MMV has swiftly mobilised to safeguard the activities that help protect these populations.

For example, with the massive global increase in demand for antimalarial drugs chloroquine (CQ) and hydroxy-chloroquine (HCQ) as possible interventions for COVID-19, and its consequential impact on the antimalarial supply chain, MMV has been working with major suppliers to safeguard access to critical malaria medicines by mapping out supply chain risks. 

MMV has worked closely with partners such as WHO to provide guidance to countries on how they can adapt interventions such as SMC campaigns to be safely maintained in the context of the COVID-19 response. This year’s SMC campaign has the potential to reach over 22 million children and protect them from malaria infections, and any disruption to this work could lead to unnecessary additional deaths. MMV has also been closely monitoring the supply chain of manufacturing, shipment, and delivery of sulfadoxine-pyrimethamine and amodiaquine (SP-AQ), for SMC to ensure that the June-November distribution campaign season is not at risk. 

The COVID-19 pandemic has caused disruptions to global supply chains. In Africa, between 70 and 90 percent of pharmaceuticals are imported, and African countries have faced constraints such as lengthy lead times for the supply of essential medicines. By 2020, MMV had entered into an agreement with three African manufacturers to produce quality-assured SP for IPTp, which will help to minimize interruptions in the supply of this critical medicine where it is needed most. 

The MAM@Scale programme supported by MMV, aims to increase access to artesunate rectal capsules in rural areas of Zambia. In the wake of the coronavirus pandemic, the MAM@Scale programme is adapting in order to tackle COVID-19, by contributing to national guidelines on the role of Community Health Workers in the context of COVID-19.

3. How are you supporting national COVID-19 response and recovery efforts, particularly in ensuring that women, children and adolescents remain at the center of such efforts?

MMV is leveraging its R&D and access expertise to support the global COVID-19 response and to adapt national malaria responses in this context. Women, children and adolescents are likely to benefit from these efforts. As part of this work:            

  • MMV’s Pandemic Response Box, containing 400 diverse drug-like molecules active against bacteria, viruses or fungi, has been shipped free of charge to researchers to allow them to identify compounds of relevance to the COVID-19 response.  
  • MMV also launched the COVID Box, containing a standard set of compounds with known or predicted activity against SARS-CoV2. It has been shipped free of charge, to accelerate open research into treatments for COVID-19 and other SARS coronaviruses. 
  • MMV is working with manufacturers, procurement partners and international organizations to evaluate how the COVID-19 epidemic may necessitate different strategies for the deployment of malaria medicines, identify drug supply chain bottlenecks, and help ensure the continuity of malaria drug supplies. 
  • MMV is also working with partners within the framework of the WHO convened workstreams to contribute to the collection of key clinical data to support decision-making for wider malaria and COVID-19 response efforts in resource-poor settings. MMV will work with its established clinical trials network partners for this purpose.

4. What impact will your organization have on the lives of women, children and adolescents, and how are you measuring this?

MMV’s work to discover, develop and facilitate the delivery of new and affordable antimalarials, to support the global effort to tackle COVID-19 and to ensure that national and international players are adequately equipped with sound information to make the right decisions to protect lives is likely to help prevent unnecessary deaths among women, adolescents and children. MMV’s work on malaria within the context of COVID-19 will be measured and results included in various reports available to donors and the public.

5. Who (partner organizations) are you working with to achieve this?

MMV has an extensive partnership network of over 150 active partners within academia, clinical research, the pharmaceutical industry, national and international organisations, NGOs, among others. MMV and its partners work hand in hand to achieve its mission to reduce the burden of malaria in disease-endemic countries.

MMV is also contributing its expertise to various high-level working groups such as the Roll Back Malaria Partnership to End Malaria’s Malaria in Pregnancy Working Group, the Wellcome Trust, the National Institutes of Health NIH, the Bill and Melinda Gates Foundation and the Coalition for Epidemic Preparedness and Innovation (CEPI). This includes advising WHO on how to engage the pharmaceutical industry and coordinating a malaria supply-chain group. 

Along with 70 other organizations, MMV is a member of the COVID-19 Clinical Research Coalition and is sharing expertise for clinical trials of COVID-19 in low-resource settings. 

Photo courtesy of Toby Madden/MMV.