While annual funding for malaria research and development has increased five-fold over the last two decades, contributing to a 26% reduction in malaria deaths during the last 10 years, up to US$8.3 billion in additional funding is needed between 2013 and 2022 if efforts to combat the disease are to be sustained, a new report warns.

According to the report by Policy Cures, a non-profit research group based in Sydney, Australia, funding for malaria R&D rose from US$131 million in 1993 to US$610 million in 2011, despite the global recession. Much of that growth occurred after 2004, when support for malaria R&D stood at US$320 million.

As a result, the malaria pipeline “has never been healthier”, with nearly 90 products in development, Policy Cures notes. It includes nearly 40 drugs, ten of which are in late-stage clinical trials; and the first vaccine candidate to reach late-stage testing, with “dozens” of other vaccines bubbling under.

Less drug funding

Drug development for malaria will actually require less funding over the next decade than when the last needs projection was made in 2009, due to the shift towards an eradication strategy for the disease, the report points out.

It estimates that around two thirds of the projected funding requirement for the next decade – the mid-range forecast calls for annual investment of some US$700 million –will be for new tools to support eradication.

Among these tools are drugs that can completely eliminate parasites from infected patients; vaccines that interrupt malaria transmission between humans and mosquitoes; vector-control products that kill mosquitoes before they reach humans; and better diagnostic tools for health workers in the field.

Funding for both vector-control and diagnostics R&D needs to double in 2013-2022, since these two areas currently attractvery, very modest” funding compared with investment in drugs and vaccines, observes the PATH Malaria Vaccine Initiative.

MVI provided input and financial support for the Policy Cures report, From Pipeline to Product: Malaria R&D Funding Needs Into the Next Decade, along with other malaria-focused product-development partnerships such as Medicines for Malaria Venture, the Foundation for Innovative New Diagnostics and the Innovative Vector Control Consortium. 

Plasmodium vivax challenge

The report also warns of the challenge posed by the Plasmodium vivax species of malaria parasite. While less life-threatening than the P. falciparum parasite, P. vivax can cause severe and relapsing malaria, it notes.

This species accounts for half of all malaria cases in South and Southeast Asia, and for up to 81% of malaria in Latin America. The report found it hard to document the flow of R&D resources into P. vivax malaria: only 5%of investments could be identified as exclusively for vivax R&D.

Sustaining is critical

Although malaria is in retreat, it still kills around 660,000 people a year, most of them young children in Africa, the report points out. Sustaining R&D investments is therefore critical, given the emergence of drug resistance in the malaria parasite and insecticide resistance in mosquitoes.

“The fruits of past investments in science and innovation have helped to turn the tide on an epidemic that has stolen the lives of millions,” commented Ashley Birkett, director of the PATH Malaria Vaccine Initiative.

“But the only way to see its eventual eradication is to continue making strategic investments in research and development over the long term.”

Allocating resources

The Policy Cures report uses economic modelling to determine how R&D resources should be allocated over the next decade to maximise impact.

It foresees 32% of the requisite funding going to vaccine R&D; 27% to medicines; 11%, to mosquito control; and 3% to diagnostics.

The remainder of the investment would fund basic research to understand better the biology of malaria infection and transmission, the report suggests.

These goals depend on a very small group of donors, it adds.

Currently the top five donors – the Bill & Melinda Gates Foundation; the US National Institutes of Health (NIH); industry; the European Commission; and the US Department of Defense (DOD) – account for nearly three quarters of all funding for malaria R&D.

Moreover, only the Gates Foundation and NIH have stepped up their commitment, while the European Commission and the DOD saw funding cuts through to 2011.