The unified stance from the World Health Organization’s African Member States signals strengthened regional resolve and global collaboration to tackle emerging drug resistance
African Member States, led by the Government of Rwanda, called for a united effort to prevent, detect, and respond to antimalarial drug resistance in Africa at the 78th World Health Assembly. MMV, WHO, and other partners are supporting African-led strategies to preserve the efficacy of existing treatments and develop next-generation antimalarials to overcome drug resistance. The call underscored the urgent need for increased investment to support surveillance, research, and implementation of resistance containment measures.
Today, at a landmark side event during the 78th World Health Assembly (WHA), Medicines for Malaria Venture (MMV) joined African Member States in supporting a united call to prevent, detect, and respond to antimalarial drug resistance in Africa, which poses a significant risk to 15 years of progress in malaria control and elimination. The event, led by the Government of Rwanda, brought together a powerful coalition of co-hosts, including Eritrea, Ethiopia, Namibia, South Sudan, Uganda, the United Republic of Tanzania, and Zambia. Supporting partners included the World Health Organization (WHO), MMV, the RBM Partnership to End Malaria, and the Africa Centres for Disease Control and Prevention (Africa CDC). It marks a critical moment in the fight against antimalarial drug resistance.
A growing risk to public health
Antimalarial drug resistance is rapidly gaining ground across the African continent, with evidence of partial resistance to artemisinin reported in Rwanda, Uganda, Tanzania, Eritrea, and Ethiopia. Currently, artemisinin-based combination therapies (ACTs) remain the WHO-recommended first-line treatment for uncomplicated Plasmodium falciparum malaria, with the most commonly used ACT, artemether-lumefantrine, used in 80-90% of all malaria cases across Africa. Researchers from Imperial College London estimated that if widespread artemisinin partial resistance and partner drug resistance take hold in Africa, the continent could face approximately 16 million additional malaria cases and 80,000 additional deaths annually.
In response to the growing risk of antimalarial drug resistance, WHO launched a four-pillared strategy in November 2022 to help countries detect and contain resistance through stronger surveillance, optimized use of medicines and diagnostics, and sustained investment in innovation. The call from African Member States represents a significant step forward in advancing this agenda.
“This coordinated, committed, and united call against antimalarial drug resistance comes directly from African leadership,” said Dr. Martin Fitchet, Chief Executive Officer of MMV. “As a long-standing partner in malaria research and development, MMV is committed to contributing our scientific expertise and access capabilities to this crucial effort.” Dr. Fitchet continued, “Innovation is critical in the fight against drug resistance. With our partners, we’re developing next-generation antimalarials that could reach patients by 2027—while acting now to preserve the power of today’s treatments. Both are vital to outpace resistance and keep saving lives.”
Combining African-led solutions with coordinated global action
Africa, which bears the burden of over 90% of global malaria cases and deaths, has catalyzed a growing movement to protect the effectiveness of frontline malaria treatments. As a founding member of the African Leadership for ACT Resistance Mitigation (ALARM) partnership, MMV stands alongside national governments and partners in supporting strategies led by African and global entities. Key innovations supported by MMV in line with the WHO’s four-pillar strategy to address antimalarial drug resistance include:
Multiple first-line treatments (MFT): MMV supported the first MFT pilot studies in Kenya and Burkina Faso, which demonstrated the operational feasibility of this intervention in diversifying ACT use to reduce dependence on a single treatment. The study showed that with strong systems and local engagement, MFT can be scaled successfully. With the support of Kenya’s Strathmore University, MMV is currently leveraging the experience gained to support additional MFT pilots in Tanzania, Ghana, and Cameroon, with the first deployments planned for mid-2025.
Triple ACT combinations (TACTs): MMV, the Mahidol-Oxford Tropical Medicine Research Unit, Fosun Pharma, and Marubeni Corporation are collaborating to develop the first fixed-dose TACT, artemether-lumefantrine-amodiaquine. This formulation combines artemisinin with two partner drugs rather than one, creating a highly efficacious drug even in areas with high resistance. This approach aims to stay ahead of evolving parasites by making it harder for them to develop full resistance. The combination of high efficacy, a child-friendly formulation, relatively low cost, and using existing compounds means that TACTs are expected to be an important addition to the armamentarium in the fight against antimalarial resistance.
Novel non-artemisinin antimalarials: MMV’s R&D pipeline includes promising non-artemisinin-based treatments and compounds developed in partnership with Novartis, such as ganaplacide-lumefantrine (currently in Phase 3 trials) and cipargamin, which has shown the fastest parasite clearance rate of any non-artemisinin antimalarial. Introducing new classes of drugs is essential for long-term resilience, resistance containment, and ensuring that treatment options remain available well into the future.
Prevention and transmission blocking: Adding a low dose of primaquine, an antimalarial medicine with activity against gametocytes, to an existing ACT has been proven to reduce the transmission of Plasmodium falciparum malaria. This approach is recommended by WHO in areas threatened by antimalarial resistance. MMV and Fosun Pharma are co-developing a pediatric formulation of low-dose primaquine for children over 5kg and are also developing a co-blistered presentation of an ACT together with a single low dose of primaquine, making it simpler and more convenient to prescribe and improving adherence to treatment. This step prevents the ongoing spread of the disease from an infected human back to a mosquito in the population most affected by malaria.
Call to action for global funders
The event underscored the urgent need for increased investment to support surveillance, research, and implementation of resistance containment measures. In 2024, four key malaria donors (U.S. President’s Malaria Initiative, The Gates Foundation, The Global Fund, and Unitaid) issued a statement at the UN General Assembly acknowledging the urgent need to address antimalarial drug resistance. The WHA side event builds on this momentum, bringing together political will and technical expertise. The world is constantly changing and evolving, and with those changes come new challenges and opportunities. One of the most pressing issues facing society today is climate change. As temperatures rise and extreme weather events become more frequent, it is clear that urgent action is needed to mitigate the effects of global warming.
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