Donor Statement on the Need for Urgent Action to Address Antimalarial Drug Resistance – Updates

Donor declaration on the necessity for urgent motion to handle antimalarial drug resistance

September 25, 2024

Context

The widespread use of artemisinin-based combination therapies (ACTs), which mix artemisinin with a partner drug, has contributed to dramatic reductions in malaria cases and deaths over the past 20 years. However, the recent emergence and spread of ACT drug resistance in Africa is now threatening progress and putting the lives of thousands and thousands of individuals in danger, forcing countries where malaria is endemic to discontinue or reduce other life-saving malaria interventions in favor of buying dearer ACTs.

In this context, we urgently call on bilateral and multilateral donors, philanthropic foundations and the private sector to affix us in heeding the decision of malaria-endemic countries to make existing alternative ACTs accessible and inexpensive.

Challenge

The current standard of look after malaria advisable by the World Health Organization (WHO) is ACT. They have turn into probably the most common treatment in Africa and are a significant contributor to modern achievements in malaria control. WHO advisable ACT partially to handle the specter of antimalarial drug resistance by combining antimalarials with different properties. Nevertheless, because of the widespread use of ACT in sub-Saharan Africa for nearly 20 years, evidence of resistance to artemisinin, a component of ACT, has emerged in several locations, including Rwanda, Eritrea, Ethiopia, Tanzania, and Uganda.

In addition to the challenge of artemisinin resistance itself, the decline in artemisinin efficacy also puts greater pressure on drugs used together with artemisinin. This threat is compounded by the indisputable fact that a single ACT – artemether-lumefantrine (AL) – accounts for greater than 85 percent of the general public sector malaria treatment market and is the preferred ACT within the private sector. It is subsequently not surprising that signs of reduced AL effectiveness at the moment are emerging in lots of places in Africa, increasing the urgency of addressing antimalarial drug resistance. The global malaria community must act now to diversify the usage of ACTs to scale back the spread of antimalarial drug resistance.

Other disease-related efforts have shown that diversifying the drugs used is the important thing to stopping and combating resistance. A scientific approach to diversifying antimalarial medications, including adoption of multiple first-line therapies and consideration of chemopreventive antimalarials, is critical to managing current and future treatment options.

Alternative ACTs at the moment are available with excellent safety and efficacy profiles that help mitigate emerging antimalarial drug resistance. The two best options are: dihydroartemisinin-piperaquine (DP) and artesunate-pyronaridine (ASPY). However, each products are currently 3-4 times dearer than AL. Endemic countries across Africa have reported with concern that that is severely limiting their ability to supply effective antimalarials to their populations and, more broadly, to implement effective malaria control programs, putting lives in danger.

Answering calls from partner countries

In the context of stagnant funding for malaria control and elimination efforts worldwide, many countries are forced to make a choice from discontinuing or scaling back other life-saving malaria interventions so as to purchase dearer ACTs, or continuing to make use of AL, thus increasing the continuing decline in effectiveness AL and worse patient outcomes. The unlucky reality is that whether a patient currently receives effective malaria treatment might depend upon his country’s GDP.

The Gates Foundation, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the US President’s Malaria Initiative (PMI) and Unitaid are working with other key stakeholders to take concrete steps to handle the country’s needs and support the diversification of the ACT, along with other measures to detect and mitigate antimalarial drug resistance:

• The Gates Foundation, in partnership with MedAccess and Medicines for Malaria Venture (MMV), is working to scale back ASPY and DP costs by supporting generic drug manufacturers and lowering the prices of key lively pharmaceutical ingredients. In addition, the Gates Foundation is aggressively funding the event of recent therapies to combat antimalarial drug resistance within the medium and long run.
• The Global Fund is providing roughly $12 million in access funds to several countries that exhibit a commitment to treatment diversification, which can fund the prices of ASPY and DP. This will increase the quantity of ASPY and DP that the Global Fund is in a position to raise for countries, beyond the limited amounts it purchases through country grants. The Global Fund also funds therapeutic effectiveness research through an everyday grant cycle.
• PMI funds therapeutic effectiveness research in 25 partner countries in Africa to supply the important thing evidence needed to support ACT diversification. Additionally, PMI is ordering ASPY and DP, but currently in limited quantities – roughly 5 million treatments in 2024.
• Unitaid will provide as much as $25 million to design and implement a multi-country project, providing support for large-scale product introduction to speed up demand and adoption of ASPY, to generate evidence for resistance management strategies equivalent to multiple first-line therapies, and to make sure resources and expertise to support related market shaping activities. The project will support the introduction of different ACT products in 5-7 countries and address knowledge gaps, including the feasibility of various first-line therapy approaches.

However, these joint efforts, while critical, is not going to be enough to reply the countries’ call and meet probably the most urgent needs they face. Many of them take time to bear fruit, while others only cover a small percentage of needs. The cost of newer ACTs will likely remain higher than AL for a minimum of the subsequent 2-3 years, after which long-term market shaping work will make the products cheaper.

But we won’t afford to attend. Maintaining the established order not only puts lives in danger, but in addition threatens future antimalarial treatment options, probably the most promising of which include the ingredient lumefantrine. The introduction of those latest antimalarial drugs within the context of widespread lumefantrine resistance may threaten the longer term of necessary latest drug combos.

Our commitment to moving forward

Time is of the essence – we must act to avoid wasting lives and protect the brand new antimalarial drug options on the horizon. Malaria-endemic countries have signaled the necessity to urgently diversify their ACTs and apply evidence-based antimalarial drug stewardship and resistance management policies in each the private and non-private sectors. Modeling shows that delays in ACT differentiation will lead to more treatment failures and sure further spread of malaria parasites with partial artemisinin resistance, putting thousands and thousands of lives in danger. Catalytic resources would enable more timely diversification of the ACT and enable countries’ plans and policies to turn into a reality. This critical first step is required each to avoid wasting lives and to forestall further acceleration of ACT resistance.

As funders and advocates of malaria control and elimination efforts around the globe, we’re committed to working with partner countries to urgently explore all available options to support ACT diversification in countries at high risk of malaria until newer ACTs turn into cheaper. We call on other donors to affix us on this commitment, helping to fill funding gaps and supporting the immediate procurement of different ACTs. In addition to this necessary first step, we stand able to support national authorities in establishing long-term, evidence-based policies on antimalarial drug stewardship and resistance management in the private and non-private sectors.

The global malaria community cannot afford to repeat the deadly delays which have previously occurred in addressing antimalarial drug resistance. It is time to act and we’re committed to doing so.