11 MALARIA STRATEGY Presentation at Roll Back Malaria information session David Brandling-Bennett and Gabrielle Fitzgerald November 10, 2008

22 The Foundation in brief  The Bill & Melinda Gates Foundation was founded in 2000 to help reduce inequities around the world.  Our work begins with Bill and Melinda Gates’s belief that all lives have equal value.  3 program areas: »Global Health »Global Development »U.S. Programs  Global Health = 50% of foundation payout, appx $2b/annually  The Global Health Program’s objective is to ensure that lifesaving advances in health are developed and shared with those who need them most. We focus our funding on: »Access to existing vaccines, drugs, and other tools to fight diseases common in developing countries. »Research to develop health solutions that are effective, affordable, and practical.

33 How We Prioritize  Greatest burden  Widest imbalance  Gaps in attention  Benefit the most people  Balance risk vs. innovation

44 Global Health: Strategic Program Teams Infectious Diseases  HIV/AIDS  TB  Malaria  Pneumonia  Enteric Diseases  Neglected and Other Infectious Diseases Integrated Health Systems  Vaccine Preventable Diseases  Maternal, Newborn and Child Health  Reproductive Health  Nutrition  Tobacco

55 Malaria: Our theory of change Implement current tools R&D for new tools 1 2 Burden Advocacy 3 Implement new tools Sustainable control And potentially eradication Significant burden reduction At present there is a funding shortfall. To effectively tackle malaria there needs to be:  Increased funding Increase advocacy efforts to increase global, domestic, and private sector spending  Reduced costs Design more efficient delivery systems and develop more cost-effective tools to reduce funding needed in future At present there is a funding shortfall. To effectively tackle malaria there needs to be:  Increased funding Increase advocacy efforts to increase global, domestic, and private sector spending  Reduced costs Design more efficient delivery systems and develop more cost-effective tools to reduce funding needed in future More investment now means less funding needs in the future

66 Towards eradication – breaking the cycle  Malaria more visible as a global health problem after long period of neglect;  Strong progress in different areas but significant challenges remain;  NOW is the time to seize a historic opportunity and increase momentum;  Need for comprehensive, long-term strategy;  Eradication is an audacious but necessary end goal. Prevent infection severe disease and death Prevent illness / treat infected persons Prevent transmission/ reduce parasite population Reduce vector population / prevent parasite asexual maturation 1 Prevent human contact Drugs Vaccine IPT Vector control Drugs 5

77 The foundation supports a comprehensive approach to fighting malaria Vaccines Drugs & diagnostics Vector control Effectiveness, control and scale-up Advocacy

88 Aims  Develop safe and affordable vaccine with 80% efficacy, lasting >4 years by 2025;  Significant progress on lead candidate but need further effort to expand diversity of pipeline and develop second generation vaccine. Select grants  $287 million to the Malaria Vaccine Initiative (MVI). MVI has tested a number of candidates, including RTS,S which offers partial protection from severe malaria in children aged one to four;  $16 million to the Seattle Biomedical Research Institute to develop a malaria vaccine that would be safe for use during pregnancy. Vaccines A preventive vaccine would provide the best long-term hope to defeat malaria, and would be especially beneficial for those at greatest risk – infants, children, and pregnant women.

99 Aims  Develop new tools to address unmet needs;  Distribute ACTs and develop second generation drugs to combat resistance; develop novel drugs for prevention;  Develop an affordable malaria diagnostic. Grants  $165 million to the Medicines for Malaria Venture to develop more affordable and effective malaria treatments;  $43 million to the Institute for OneWorld Health to develop ways to produce large quantities of affordable ACTs;  $14 million to the University of York to develop a high-yield Artemisia plant. Drugs & diagnostics The development of more affordable and effective treatments is a major priority. Current artemisinin-based combination therapies (ACTs) are highly effective, but also expensive.

10 Aims  Develop new tools to combat resistance and increase user uptake;  Roll out an effective, sustainable package of vector control interventions, e.g., long-lasting insecticidal nets (LLIN), indoor residual spraying (IRS);  Increase R&D to support new active ingredients/products that are easier to use for consumers. Grants  $51 million grant to the Innovative Vector Control Consortium at Liverpool University, to develop safer, more effective, and longer- lasting insecticides. The consortium will also develop improved nets and other insecticide- treated materials, and help health authorities determine how to deploy insecticides for maximum impact. Vector control Current public health insecticides are more than 25 years old and are losing their effectiveness. Insecticides should be safe for humans and the environment, and more affordable and longer-lasting.

11 Aims  Increase access to and targeting of ACTs;  Support field studies of new tools when available;  Ensure results of effectiveness studies are used appropriately by policy makers. Grants  $650 million to the Global Fund to Fight AIDS, TB and Malaria, contributing to malaria prevention and treatment programs worldwide;  $64 million to the Malaria Control and Evaluation Partnership in Africa in Zambia to strengthen national capacity and document lessons learned, and work in several other African countries;  $5 million to the Roll Back Malaria Partnership to establish the Southern Africa Regional Network and $6 million for core support Effectiveness, control and scale-up Countries such as Zambia, Ethiopia and Rwanda are examples of significant success stories of scale-up of malaria control.

12 Aims  Increase resources and political support for malaria globally;  Improve global coordination in the malaria community;  Increase efforts to develop innovative financing and delivery models. Grants  $10 million to the United Nations Foundation to work with the Methodist and Lutheran churches on a malaria fundraising campaign;  $9 million grant to Voices for a Malaria-Free Future at Johns Hopkins to support advocacy in Ghana, Kenya, Mali, and Mozambique, track global malaria funding trends, and educate policymakers about successful anti-malaria efforts and evidence-based results;  $800,000 grant to Malaria No More to support their Washington DC Policy Center Advocacy In the past five years, malaria has become a more visible global health issue and new, highly effective advocates have emerged. The foundation seeks to build on current efforts to increase the momentum for further progress on malaria.

13 The first reason to work to eradicate malaria is an ethical reason—the simple human cost. Every life has equal worth. Sickness and death in Africa are just as awful as sickness and death in America…Any goal short of eradicating malaria is accepting malaria; it's making peace with malaria; it's rich countries saying: "We don't need to eradicate malaria around the world as long as we've eliminated malaria in our own countries." That's just unacceptable. Melinda Gates October 17, 2007