On 23 April 2009, on the occasion of the second World Malaria Day, the European Parliamentary Forum on Population and Development (EPF) organised a working lunch buffet in the European Parliament in Strasbourg, hosted by EPF’s Malaria Taskforce member Hon. Thierry Cornillet, MEP (ALDE, FR). Gathering around 20 participants, MEP Thierry Cornillet recalled that "every year, Malaria causes more than one million deaths worldwide, affecting particularly young children and pregnant women. Every 30 seconds an African child dies from Malaria”. He emphasised that it is Parliamentarians’ responsibility to urgently address this issue.

The guests included M. Jason Peat, Senior Health Officer, Malaria, International Federation of Red-Cross and Red-Crescent Societies (IFRC-RC) whose presentation focused on Malaria prevention and the Roll Back Malaria (RBM) 2010 targets. He recalled that by 2010, particularly in the two lowest economic quintiles, 80% of people at risk from malaria should be protected, 80% of malaria patients should be diagnosed and treated within one day, and Malaria burden should be reduced by 50% compared with 2000. Recalling that the IFRC-RC is coordinating the Alliance for Malaria Prevention, which is a subgroup of the RBM Partnership representing more than 20 partners, including government, business, faith-based and humanitarian organisations, M. Jason Peat mentioned that IFRC-RC supported several mass Long-Lasting Insecticides treated mosquito Net (LLIN) distributions in African countries, which contributed to a substantial scale-up of LLIN’s coverage and use. He emphasised that there is a real challenge in terms of LLINs’ hanging-up and that volunteers’ mobilisation to help and empower communities is crucial. Among the key challenges to meet the 2010 targets, M. Jason Peat emphasised that there is a need to increase funding, make sure it is available, accessible, and set with a precise timeframe. “Even if now there is an operational and effective model to expand net’s ownership, it is still necessary to improve and ensure net’s usage via post distribution hang up activities” he said. Finally, M. Jason Peat highlighted that other challenges include the lack of technical support, the need for standardisation of data collection and a proper follow-up in tracking commodities as well as a clear definition and ownership of targets to be reached by the recipient country.

Dr Jan Van Erps, Senior Adviser to the Executive Director Roll Back Malaria Partnership (RBM) presented an innovative financing mechanism to scale-up access to effective anti-malarials: The Affordable Medicines Facility-malaria (AMFm). Reaffirming the targets articulated in the Global Malaria Action Plan, he emphasised that by 2010, 80% of malaria patients are diagnosed and treated with effective anti-malarial within 24 hours after the first fever. “One of the greatest challenges in the fight against malaria is drug resistance”, he said. Dr Jan Van Erps informed participants that a new drug, the artemisinin-based combination therapies (ACTs) combining artemisinin with another antimalarial drug, now provides a highly effective alternative medicine to treat malaria and slow resistance. He explained that the drawback in a widely use of ACTs in malaria endemic countries is cost. An adult dose of ACT costs around USD 6-10. In comparison the cheapest previously used antimalarial, chloroquine, only amounts to USD 0.2-0.4. Another obstacle to wide spread use of ACTs is the patient’s inability to promptly access health facilities where free drugs are distributed. Thus, 60% of patients rely on the private sector for treatment against malaria. “Purchase of ACTs through the private sector is too expensive and this is the reason why patients turn to cheaper and less effective medicine putting their lives at risk” he added. Dr Jan Van Erps highlighted that the AMFm, previously known as the “Global Subsidy for ACTs”, was developed as an innovative financing mechanism to solve this dilemma. The Global Fund Board agreed to host and to manage the AMFm as a business line within the Global Fund. Its objective is to make affordable ACTs available to first line buyers in malaria endemic countries who purchase their drugs either in the public, the private or the non-profit sector. “The AMFm has the potential to reduce the cost of effective antimalarials to USD 0.2-0.5 for most patients” he said. Moreover, it is expected that the AMFm has the ability to more than triple the use of ACTs to a projected 360 million treatment courses per year and at the same time reduce the number of purchases of less effective treatments. Finally, Dr Van Erps mentioned that the AMFm will promote the use of ACTs and thereby drive out ineffective monotherapies from the market of malaria endemic countries. This will be achieved by reducing the price of ACTs for malaria patients to an affordable level through price negotiations with manufacturers and through co-payments. The AMFm will negotiate with manufacturers a reduced price of USD 1 for all first-line buyers of ACTs. Then, the AMFm will lower the price for buyers of ACTs by providing a co-payment of around USD 0.95 per treatment. The objective is to subsidise ACTs to the extent that the price of USD 0.2-0.5 per treatment is comparable to the price of chloroquine.

M. Pierre Delval, Anticounterfeiting Advisor, Expert in the Parliamentary Assembly of the Council of Europe gave a presentation on the enormous scourge of counterfeit malaria drugs, particularly in Africa. He recalled that counterfeiting can apply to both brand name and generic products, where the identity of the source is mislabeled in a way that suggests that it is the authentic approved product. M. Pierre Delval highlighted that according to WHO estimates, the scale of counterfeit medicine represents 10% in Russia, 25% in India, 35% in Lebanon, 40% in Peru, 48% in Nigeria, and 70% in Angola. He added that 200 000 patients’ lives could have been saved each year. “In Africa, one third of the antimalarials have been estimated to be inefficient” he said. In 2008, 225 samples of antimalarial drug taken from 6 random cities in Nigeria were analysed. It appeared that 37% of these drugs had no active ingredient or were under dosed. Out of 12 antimalarials used worldwide, 8 are being counterfeited. Malaria drugs are among the highest counterfeited medicines. Emphasising that it is not only an intellectual property rights’ issue, he called decision-makers to fill the penal legal gap. M. Pierre Delval highlighted that even if the European Union and the Council of Europe are strengthening criminal sanctions with regards to counterfeiting and infringements of intellectual property, it appeared that intellectual property rights are inefficient in 60 countries around the world. M. Pierre Delval stressed that it is still necessary to enhance preventive and repressive control at national level in order to protect efficiently patients. “Counterfeit drugs do not only refer to the intellectual property rights, we are facing a criminal situation” he said. Concrete recommendations included the creation of a Technical Operational Governmental Center in charge of controlling medicines delivery, the packaging, the labeling, and in charge of marking each product according to a very specific adapted and harmonised security process. Then unmarked or suspicious products could be immediately seized. Finally, he emphasised the real need to elaborate particularly dissuasive criminal sanctions for these “criminals”.

Ms Sally Ethelston, Director for Communication and Advocacy, PATH Malaria Vaccine Initiative (MVI) gave a presentation on the “Next steps in malaria vaccine development”. Created in 1999 through initial grant from the Bill & Melinda Gates Foundation, Ms Ethelston recalled that the mission of PATH MVI is to accelerate the development of malaria vaccines and ensure their availability and accessibility in the developing world emphasing that malaria is responsible for almost a million deaths and costing Africa USD 12 billion every year. Ms Sally Ethelston explained that MVI works with the private sector, scientists, academic institutions, endemic country partners and donors in order to develop malaria vaccine candidates, develop sites and conduct clinical trials, develop and refine vaccine evaluation tools, but also in assisting countries to prepare for the introduction of a new vaccine. She added that key priorities include advocacy for increased global spending, policy and financial support for malaria vaccine and Research & Development. She mentioned that PATH MVI develops and manages collaborations, elaborates commercialisation strategies, serves as neutral broker and catalyses broader field of malaria vaccines. Ms Sally Ethelston highlighted that the world’s most clinically advanced vaccine candidate today is the RTS,S. She mentioned that PATH MVI is working in collaboration with several partners, including GSK Bio (Belgium), 11 study centres in 7 African countries, and Northern institutions. She specified that key progress were made emphasising that the phase 3 trial of the RTS,S vaccine candidate is expected to begin soon, and that 3 research study centres are specifically working on this in Africa. She added that there is a second vaccine candidate developed by Sanaria Inc. based on an attenuated whole-parasite approach and which was approved for first-in-human trial in the United States. She mentioned that the vaccine goals in sight for 2015 include 50% efficacy against severe disease, lasting more than one year, and complementing the other existing malaria control tools. “The next-generation vaccine could be in the pipeline now, lasting longer than 4 years, blocking the transmission, and combined with all the other existing malaria control tools, it will contribute to malaria elimination and eradication” she said. Finally, Ms Sally Ethelston emphasised that a vaccine can cost up to half a billion dollars, therefore it is necessary to mobilise additional partners, supporters, and resources for research & development and for preparing the vaccine’s introduction.