Malaria Forum

October 17, 2007
Prepared remarks by Bill Gates, co-chair

Editor's note: To view Melinda Gates' portion of the keynote, which preceded Bill Gates' remarks, please click here.

Bill Gates: It's a privilege for Melinda and me to host this conference and see so many people who are doing brilliant work on so many different aspects of this disease. If the parasite were as ingenious as they say, it would target this hall.  There is no greater threat to the future of malaria than the energy and intelligence of the people here today. Thank you for coming to Seattle.

What is the most repeated failure in all of global health? It could well be the commitment to eradicate malaria. So why would anyone want to follow a long line of failures by becoming the umpteenth person to declare the goal of eradicating malaria?

There's one reason. We should declare the goal of eradicating malaria because we can eradicate malaria. Today, I want to make the case that we have a real chance to build the partnerships, generate the political will, and develop the scientific breakthroughs we need to end this disease.

My optimism starts with the rush of new actors who are bringing fresh ideas and new energy to the fight against malaria. The biggest players today were not in the game five years ago. The Global Fund for AIDS, TB, and Malaria had just been created. President Bush had not yet announced his major initiative against malaria. Neither had the World Bank. In the past five years, companies like Novartis, GlaxoSmithKline, Exxon Mobil, and Sumitomo have become very involved in the fight. All these groups are now doing more than they’ve ever done, all at the same time, with a renewed commitment.

The infusion of new money is allowing countries with high rates of malaria to look for the first time at comprehensive, national programs where they can coordinate a wide variety of tools and efforts for maximum effect. No single approach will work alone, but several partially effective approaches can have a huge impact.

Zambia is an inspiring example of a nationally-coordinated effort. Three million long-lasting insecticide-treated bednets are being distributed there this year, and the country is close to reaching its national target of 80 percent of households with at least one net–up from 20 percent two years ago. Any pregnant woman can now get preventive medicines as well as nets for herself and children under 5. And pregnant women at ante-natal clinics in Zambia have reached 62 percent coverage for intermittent preventive therapy–one of the highest levels of coverage in Africa.

Earlier this week, representatives from Zambia and three other countries–Ethiopia, Tanzania, and Mozambique–met together here in Seattle, along with major funders of malaria, to discuss how countries can follow Zambia's model of national scale-up. It is a breakthrough that these countries are considering national programs today; a few short years ago there was only enough funding for district efforts.

This kind of coordination is a huge advance. Medicines, bednets, and insecticides are capable of breaking transmission at the intervention points Melinda talked about. When you use a series of partially effective interventions in combination, they can have a very synergistic effect. For example, the more successful prevention is, the fewer people you need to treat—and the fewer people who are infected, the less chance they can spread malaria to others. So prevention increases the reach of treatment; and treatment is a form of prevention. And they're both much more effective when you coordinate them, which more and more countries are doing today.

I'm also very optimistic because of the extraordinary breadth of research underway–in medicines, vaccines, and other control tools.

The transformation in malaria treatment began with the Chinese discovery of plant-based artemisinin and the subsequent developments of artemisinin combination treatments in Southeast Asia, which make it much harder for the parasite to develop resistance. As you know, artemisinin-based combination therapies, or ACTs, are the most effective antimalarial available today. But they're also expensive, supplies are limited, and they require multiple doses over three days. We need to discover new drugs that are not only effective, but also cheap to make and easy to take.

Fortunately, the Medicines for Malaria Venture has the largest and most diverse portfolio of new drug candidates in the history of malaria. One of their most promising projects is an approach to improving on artemisinin with a completely new synthetic peroxide. In early animal studies, a single dose of the synthetic peroxide drug cured malaria—something we've never seen before. This opens the possibility for a single-dose cure of malaria for people. That by itself could transform our fight against the disease.

But that's not all the researchers are up to. MMV and other partners are also making great progress with new plant technology and metabolic fermentation to provide artemisinin at the quantities and savings we need to meet global demand. If you could add those advances to the ability to make the drug synthetically, you could make as much medicine as you need, and far more cheaply and predictably than we do today. These developments could change the world.

Developments in vaccine research today are just as exciting. Researchers with the PATH Malaria Vaccine Initiative are using several different scientific approaches in pursuit of a vaccine. Some are working on a classic approach — which is to pick a few promising antigens and test them. Others are focusing on sporozoites–creating a weakened form of the parasite that would generate a short-lived infection that would then generate immunity. Yet another group is looking at molecular targets using the latest tools. Never in the history of malaria have so many scientific approaches been used in the pursuit of new vaccines.

In addition to vaccines and medicines, researchers with the Innovative Vector Control Consortium are studying a variety of ways of making mosquitoes less capable of transmitting the parasite. They’re also working on new pesticides, to make them more effective in preventing mosquito-borne disease in humans.

I'm also optimistic because we're finding ways to stretch the reach of market forces to get the private sector more involved. GlaxoSmithKline is doing fantastic malaria vaccine research in a way that we hope will become a model for big drug companies. Our foundation pays the cost of the clinical trials; GSK bears the opportunity cost. They're pulling top scientists off of work that could lead to more lucrative discoveries. Since they’re not in the business of doing break-even R and D, it’s the most you can ask a big company to do and still have any expectation that the CEO will keep his job. It's a terrific model, and I hope it sets a precedent for what private drug companies are willing to do in global health. The benefit to humanity is immense.

In a clear and recent example, the Manhica Health Research Center in Mozambique recently finished a small clinical trial of the world's most advanced malaria vaccine, RTS,S, developed by GlaxoSmithKline Biologicals. This was the first study to test the vaccine in young infants.

The trial results–according to a paper published in The Lancet today–serve as a proof of concept that the vaccine is safe, is well tolerated, and significantly reduces malaria infection and clinical malaria in infants 10-18 weeks of age.

The study reports that vaccine efficacy for new infections was 65 percent over a three-and-a-half-month follow-up period, and that it reduced episodes of clinical malaria by 35 percent during a six-month follow-up from the initial vaccination.

These are only interim results, but they are encouraging because they represent a significant step toward fighting malaria infections in an age group most vulnerable to severe illness and death from malaria.

There are more Phase 2 studies to be completed, and if all goes well, a large-scale Phase 3 study should begin in 2008 at ten African trial sites.

Melinda and I would like to recognize the many groups that have worked together on this study: the government and people of Mozambique, the hospital clinic at the University of Barcelona, the Spanish Agency for International Cooperation, the PATH Malaria Vaccine Initiative, and GlaxoSmithKline Biologicals.

I want to offer special recognition to Manhica for running the trials. Running a successful trial requires organizing large numbers of trusting people in an infectious area where you know the baseline. When you consider the difficulty, every drug is a miracle drug, just for making it through trials.

More than a decade ago, Pedro Alonso–with a grant from the Spanish government and the help of researchers from Mozambique funded by the government–set up Manhica in one of the most malaria-infested parts of Mozambique. I've visited the Center, and it has the health research facilities of a university in a poor, rural setting–and the value to public health is priceless.

Pedro runs a census so he really knows who the kids are and what the baseline is. And he's got the relationship with the community. So researchers don't just wait until they have the vaccines they want to test and say: "okay, let's find a place where we can go get the trust of the community, and figure out the baseline of malaria." He's already done that. It's an extraordinary asset in the search for a vaccine.

We are now working with other committed investigators to expand this approach. Fred Binka and INDEPTH are crucial to this effort. One of their projects, the Malaria Clinical Trials Alliance, is replicating the Manhica effort by working to strengthen research sites in preparation for what we hope will be Phase 3 trials next year.

These are just some of the reasons why we believe we should declare the goal of eradicating malaria. There is no doubt that if the world dedicates the time and the money, we can develop the tools in the laboratory and coordinate them in the field in a way that will eradicate malaria. The question is—will the citizens and the governments of the world give us that chance?

Right now—in the U.S. government, at the World Bank, we see the approaching end of the funding cycle. Fighting malaria and eradicating malaria is not a short-term job. It's not a four-year or even eight-year event. That can't work in malaria. If you stop halfway, you don't get half the benefit; you could end up with zero percent of the benefit. The progress counts only if we keep it going.

President Bush—by launching the President's Malaria Initiative—has provided a historic level of funding for malaria. If the world is ultimately going to eradicate malaria, then the record funding that began with this president must not end with this presidency.

Melinda and I say to every U.S. presidential candidate: if you win this office, you will inherit a record commitment to fighting malaria. The world needs you to sustain it and enhance it. Malaria will never be eradicated without the full support of the president of the United States.

Likewise—the World Bank, under Paul Wolfowitz, has committed record funding to fighting malaria. We call on the new president, Robert Zoellick, to sustain it and enhance it.

And the leaders of every developed donor country should generously support the work of the Global Fund, to enhance its role in fighting malaria.

We call on heads of state in countries suffering from malaria to implement a well-coordinated, integrated country-wide program, similar to what's being done in Zambia. And we call on donor countries to step in and help fund these efforts.

We call on major donor agencies to work with affected countries to agree on a global plan for malaria—the concrete steps that will make it possible to scale up programs and, ultimately, eradicate the disease. This includes funding, implementation, and monitoring. Then we need those same groups to join together to execute that plan.

In addition, we call on heads of state and heads of foundations and corporations to ensure that as new tools and technologies are developed over the next several years, we can find ways to make them accessible and affordable to those who need them most. Today, we call on world leaders to fund the Affordable Medicines Facility for malaria, a financing mechanism that will provide artemisinin-based combination therapies at reduced prices for those who need them most. ACTs are an incredibly effective treatment for malaria, but their price puts them beyond the reach of most people living in developing countries. If this treatment remains unavailable, people will resort to cheaper, less effective drugs. They may take a form of the drug that will drastically increase the risk of resistance, reducing the effectiveness of this last remaining malaria treatment before the world has time to develop another. We can't let that happen.

We call on the malaria community to press forward with innovation. We have to assess what sets of tools and situations will be necessary to achieve eradication. Then we have to make the investments in innovation necessary to develop the tools and create the situation that makes eradication possible.

Finally–Melinda and I would like to say to the people here in this hall: the hopes of the world rest on you and your colleagues. If you show the world that we can end this disease, you will unleash the energy and the caring and the commitment we need to meet that goal. So keep on fighting, and never lose heart when things go wrong. If one approach fails, take up another.

We're not done, and we will not stop working, until malaria is eradicated. Thank you very much.