What We Do

Malaria

Strategy Overview

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A textile mill in Tanzania that produces long-lasting, insecticide-treated mosquito nets.

our goal:

to control, eliminate, and ultimately eradicate malaria.

The Challenge

At A Glance

Malaria occurs in nearly 100 countries worldwide and affects more than 200 million people.

About 655,000 people died from malaria in 2010, more than 90 percent of them in Africa.

Through a combination of interventions, malaria incidence in the past decade has fallen by at least 50 percent in one-third of the countries where the disease is endemic.

We invest in efforts to develop more effective treatments, diagnostic tools, mosquito-control measures, and a safe and effective malaria vaccine.

Our Malaria strategy, updated in 2012, is led by Alan Magill, director, and is part of the foundation’s Global Health Division.

Malaria occurs in nearly 100 countries worldwide, exacting a huge toll on human health and imposing a heavy social and economic burden in developing countries, particularly in Sub-Saharan Africa and South Asia. More than 200 million people suffered from the disease in 2010, and about 655,000 died , the vast majority of them children under age 5.

Malaria is caused by parasites that are spread by mosquitoes, and even in relatively mild cases it can cause high fever, chills, flu-like symptoms, and anemia, which can be especially dangerous for pregnant women. Children who survive severe malaria can suffer lifelong mental disabilities. Malaria’s economic impact is estimated to cost billions of dollars in lost productivity every year.

The Opportunity

Malaria is preventable and treatable, and history shows that it can be eliminated. Less than a century ago, it was prevalent across the world, including Europe and North America. In high-income countries, aggressive prevention measures and more effective monitoring and treatment gradually brought the disease under control and then led to elimination—which the World Health Organization defines as the complete interruption of mosquito transmission of the disease for three or more years. In the United States, this milestone was achieved in 1951.

Major gains have been made in controlling malaria in developing nations. In the past decade, malaria incidence has fallen by at least 50 percent in one-third of the countries where the disease is endemic. These gains have been made through a combination of interventions, including timely diagnosis and treatment using reliable tests and anti-malarial drugs; indoor spraying with safe insecticides; and the use of long-lasting, insecticide-treated bed nets to protect people from mosquito bites at night.

However, current tools and treatments are insufficient to achieve elimination in many countries, let alone global eradication. In the meantime, malaria could rebound quickly as the parasites develop resistance to currently available insecticides and treatments. Both forms of resistance have already emerged as serious potential threats to effective and affordable malaria control.

Innovation is essential to meeting these challenges and maintaining progress against malaria. Sustained research and development (R&D) is needed to create a diverse array of treatment and prevention tools and thus avoid overreliance on a small set of anti-malaria tools, which has proven risky for effective malaria control.

Fortunately, global commitment to fighting malaria has solidified; malaria funding has increased almost six-fold since 2003. Through the Global Malaria Action Plan, the World Health Organization (WHO) and the Roll Back Malaria Partnership are coordinating international efforts. But we still need more effective policies and increased funding to secure lasting gains against one of humanity’s greatest health threats.

Our Strategy

Malaria is a top priority of the Bill & Melinda Gates Foundation. Our resources, while significant, are only a small part of worldwide funding to combat malaria, and we work closely with donor governments and developing countries. To ensure that our investments complement other efforts, we concentrate our resources in areas where existing funds are limited, our support can have catalytic effect, and we can assume risks that are more challenging for others to take on. Our strategy addresses the areas in which we believe the foundation is best positioned, among a broad spectrum of partners, to help reduce the burden of malaria.

An entomologist examines dead mosquitoes extracted from a window trap in a village.

We support R&D for more effective treatments, diagnostics, mosquito-control measures, and a safe and effective malaria vaccine. We also support the development of strategies to make progress toward malaria elimination.

To date, we have committed nearly US$2 billion in malaria grants. We have also committed more than US$1.4 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which supports the expanded use of proven prevention and treatment tools for malaria, HIV/AIDS, and tuberculosis. Beyond our own direct investments in the fight against malaria, we also advocate for sustained and increased funding of malaria control and elimination efforts by donor governments and endemic countries.

Areas of Focus

We work with a broad array of partners—including government agencies, multilateral organizations, nongovernmental organizations (NGOs), academic institutions, community organizations, and private industry—in several areas to advance the goal of controlling, eliminating, and ultimate eradicating malaria.

Drugs and Diagnostics

The current treatment for malaria is artemisinin-based combination therapies (ACTs).  ACTs are effective and are well-tolerated by patients, but because of their high cost, patients often purchase cheaper, less-effective drugs, poor-quality drugs, or counterfeits, all of which can increase the risk that drug-resistant strains of malaria will emerge. Resistance has already been observed in Southeast Asia.

A nurse dispenses a malaria drug to treat an infected child in Tanzania

To improve the availability of treatments and eventually develop a single-dose cure for malaria, it is important to diversify the drug pipeline and invest in the discovery and development of effective non-artemisinin-based treatments.

Our strategy supports the effective delivery of ACTs, the elimination of artemisinin resistance, and the discovery of novel malaria drugs. The Medicines for Malaria Venture (MMV) is our major grantee in this effort. MMV has developed the largest malaria-drug pipeline in history. We also support efforts to improve the use of effective diagnostic tools to ensure that people are diagnosed and then treated appropriately.

Our investments include:

  • Developing new non-artemisinin-based drugs for purposes such as prevention (including long-lasting prophylaxis), treatment of liver-stage infection, and blocking of transmission
  • Ensuring a stable supply of quality-assured artemisinin, through the introduction of high-yield plants and biosynthetic artemisinin
  • Ensuring greater access to affordable ACTs, particularly through the private sector
  • Preventing the spread of resistance by eliminating poor-quality or counterfeit drugs and monotherapies and improving surveillance systems and malaria-control programs
  • Increasing the use of diagnostic tools for treatment, monitoring, and elimination of malaria

We will monitor success in this area based on the effectiveness of drugs and diagnostics that are developed and delivered and the ability of these tools to reduce malaria transmission. We will also assess their impact on artemisinin-tolerant parasites in Southeast Asia.

Vector-Control Tools

Indoor residual spraying and long-lasting insecticide-treated bed nets are currently the two most effective interventions for reducing and interrupting malaria transmission. Unfortunately, their effectiveness is threatened by increasing mosquito resistance to the pesticides used. Moreover, indoor sprays and bed nets are not effective against mosquito species that are active outside homes or that bite during the daylight hours.

We support efforts to improve existing vector-control tools and develop new ones that can interrupt transmission in all settings. Our investments include:

  • Improving current vector-control approaches by developing longer-lasting indoor residual spraying, insecticides that can be used in combination to overcome resistance, and active ingredients that avoid known resistance mechanisms
  • Exploiting novel aspects of the ecology or behavior of vector mosquitoes through the use of new tools and strategies such as spatial repellants, sugar-baited traps, and animal treatments
  • Identifying which tools, alone or in combination, are most effective for eliminating malaria in particular settings

Together with our partners, particularly the Innovative Vector Control Consortium, we will monitor success in this area based on the effectiveness of new or improved tools. We also will monitor progress toward identifying optimal packages of vector-control tools to interrupt malaria transmission.

Vaccines

An effective vaccine could provide a powerful tool against malaria, but developing one will take sustained scientific effort over many years. In recent Phase III clinical trials, the RTS,S malaria vaccine had lower-than-desired efficacy, but the data demonstrated that it is possible to vaccinate against a parasite—an important advance.

Beyond the current vaccine candidates that could play an important role in reducing malaria in various target groups, successful efforts to eradicate malaria will ultimately require more efficacious second-generation vaccines that can block transmission across entire populations at risk. The process of vaccine development is currently slowed by lack of knowledge of the mechanisms of immunity.

We invest in efforts to develop vaccines that can interrupt malaria transmission, including a second-generation vaccine or new vaccines based on transmission-blocking antigens. We also support research that can guide more efficient vaccine development.

Integrated Interventions

A number of interventions are highly effective against malaria, but questions remain about where and how best to deploy them: What is the impact of intensifying these interventions? In which countries is elimination currently feasible? What combination of tools will be optimal for eliminating malaria in specific transmission settings?

We support efforts to answer these questions and to capture and share lessons learned about the impact of scaling up and sustaining interventions. We also invest in efforts to learn how best to sustain financing of and commitment to anti-malaria efforts.

Advocacy, Policy, and Financing

The fight against malaria has gained momentum from a remarkable growth in partners, political will, and funding, but this momentum needs to be sustained over the long term. More resources are needed to enable further progress in R&D and to support countries in their prevention and treatment efforts.

Rural residents of Pailin Province, Cambodia, attend a course on malaria prevention.

In the past decade, funding for malaria control risen from US$300 million in 2003 to an estimated US$2 billion in 2011. This massive increase was made possible by the Global Fund to Fight AIDS, Tuberculosis and Malaria and commitments from the U.S. President’s Malaria Initiative, the UK Department for International Development, UNITAID, the World Bank, and other bilateral and multilateral agencies.

Still, the Global Malaria Action Plan estimates that an additional US$5 billion in annual funding is needed to achieve and sustain universal coverage and pursue research and development. Our strategy includes investments to encourage continued funding commitments by current major donors, mobilize new donors for malaria R&D, and support efforts to track country-level progress against malaria.

Progress on malaria policy and advocacy will be evaluated based on the level of global funding for malaria control and R&D through bilateral, multilateral, and private sources. Progress also will be evaluated based on countries’ adoption of effective policies to improve malaria control.

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