Dfhghfjhjghjfshnghdfhbfdb fbfvbMalaria occurs in nearly 100 countries worldwide, exacting a huge toll on human health and imposing a heavy

social and economic burden in developing countries, particularly in Sub-Saharan Africa and South Asia. More than 200 million people suffered from the disease in 2010, and about 655,000 died , the vast majority of them children under age 5. Malaria is caused by parasites that are spread by mosquitoes, and even in relatively mild cases it can cause high fever, chills, flu-like symptoms, and anemia, which can be especially dangerous for pregnant women. Children who survive severe malaria can suffer lifelong mental disabilities. Malarias economic impact is estimated to cost billions of dollars in lost productivity every year.

The Opportunity
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Malaria is preventable and treatable, and history shows that it can be eliminated. Less than a century ago, it was prevalent across the world, including Europe and North America. In high-income countries, aggressive prevention measures and more effective monitoring and treatment gradually brought the disease under control and then led to eliminationwhich the World Health Organization defines as the complete interruption of mosquito transmission of the disease for three or more years. In the United States, this milestone was achieved in 1951. Major gains have been made in controlling malaria in developing nations. In the past decade, malaria incidence has fallen by at least 50 percent in one-third of the countries where the disease is endemic. These gains have been made through a combination of interventions, including timely diagnosis and treatment using reliable tests and antimalarial drugs; indoor spraying with safe insecticides; and the use of long-lasting, insecticide-treated bed nets to protect people from mosquito bites at night. However, current tools and treatments are insufficient to achieve elimination in many countries, let alone global eradication. In the meantime, malaria could rebound quickly as

the parasites develop resistance to currently available insecticides and treatments. Both forms of resistance have already emerged as serious potential threats to effective and affordable malaria control. Innovation is essential to meeting these challenges and maintaining progress against malaria. Sustained research and development (R&D) is needed to create a diverse array of treatment and prevention tools and thus avoid overreliance on a small set of anti-malaria tools, which has proven risky for effective malaria control. Fortunately, global commitment to fighting malaria has solidified; malaria funding has increased almost six-fold since 2003. Through the Global Malaria Action Plan, the World Health Organization (WHO) and the Roll Back Malaria Partnership are coordinating international efforts. But we still need more effective policies and increased funding to secure lasting gains against one of humanitys greatest health threats.

Our Strategy
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Malaria is a top priority of the Bill & Melinda Gates Foundation. Our resources, while significant, are only a small part of worldwide funding to combat malaria, and we work closely with donor governments and developing countries. To ensure that our investments complement other efforts, we concentrate our resources in areas where existing funds are limited, our support can have catalytic effect, and we can assume risks that are more challenging for others to take on. Our strategy addresses the areas in which we believe the foundation is best positioned, among a broad spectrum of partners, to help reduce the burden of malaria.

An entomologist examines dead mosquitoes extracted from a window trap in a village.

We support R&D for more effective treatments, diagnostics, mosquito-control measures, and a safe and effective malaria vaccine. We also support the development of strategies to make progress toward malaria elimination. To date, we have committed nearly US$2 billion in malaria grants. We have also committed more than US$1.4 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which supports the expanded use of proven prevention and treatment tools for malaria, HIV/AIDS, and tuberculosis. Beyond our own direct investments in the fight against malaria, we also advocate for sustained and increased funding of malaria control and elimination efforts by donor governments and endemic countries.

Areas of Focus
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We work with a broad array of partnersincluding government agencies, multilateral organizations, nongovernmental organizations (NGOs), academic institutions, community organizations, and private industryin several areas to advance the goal of controlling, eliminating, and ultimate eradicating malaria.

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Drugs and Diagnostics Vector-Control Tools Vaccines Integrated Interventions Advocacy, Policy, and Financing

Drugs and Diagnostics

The current treatment for malaria is artemisinin-based combination therapies (ACTs). ACTs are effective and are well-tolerated by patients, but because of their high cost, patients often purchase cheaper, less-effective drugs, poor-quality drugs, or counterfeits, all of which can increase the risk that drug-resistant strains of malaria will emerge. Resistance has already been observed in Southeast Asia.

A nurse dispenses a malaria drug to treat an infected child in Tanzania

To improve the availability of treatments and eventually develop a single-dose cure for malaria, it is important to diversify the drug pipeline and invest in the discovery and development of effective non-artemisinin-based treatments. Our strategy supports the effective delivery of ACTs, the elimination of artemisinin resistance, and the discovery of novel malaria drugs. The Medicines for Malaria Venture (MMV) is our major grantee in this effort. MMV has developed the largest malaria-drug pipeline in history. We also support efforts to improve the use of effective diagnostic tools to ensure that people are diagnosed and then treated appropriately.

Our investments include:

Developing new non-artemisinin-based drugs for purposes such as prevention (including long-lasting prophylaxis), treatment of liver-stage infection, and blocking of transmission Ensuring a stable supply of quality-assured artemisinin, through the introduction of high-yield plants and biosynthetic artemisinin Ensuring greater access to affordable ACTs, particularly through the private sector Preventing the spread of resistance by eliminating poor-quality or counterfeit drugs and monotherapies and improving surveillance systems and malaria-control programs Increasing the use of diagnostic tools for treatment, monitoring, and elimination of malaria We will monitor success in this area based on the effectiveness of drugs and diagnostics that are developed and delivered and the ability of these tools to reduce malaria transmission. We will also assess their impact on artemisinin-tolerant parasites in Southeast Asia.

Vector-Control Tools
Indoor residual spraying and long-lasting insecticide-treated bed nets are currently the two most effective interventions for reducing and interrupting malaria transmission. Unfortunately, their effectiveness is threatened by increasing mosquito resistance to the pesticides used. Moreover, indoor sprays and bed nets are not effective against mosquito species that are active outside homes or that bite during the daylight hours. We support efforts to improve existing vector-control tools and develop new ones that can interrupt transmission in all settings. Our investments include:

Improving current vector-control approaches by developing longer-lasting indoor residual spraying, insecticides that can be used in combination to overcome resistance, and active ingredients that avoid known resistance mechanisms

Exploiting novel aspects of the ecology or behavior of vector mosquitoes through the use of new tools and strategies such as spatial repellants, sugar-baited traps, and animal treatments Identifying which tools, alone or in combination, are most effective for eliminating malaria in particular settings

Together with our partners, particularly the Innovative Vector Control Consortium, we will monitor success in this area based on the effectiveness of new or improved tools. We also will monitor progress toward identifying optimal packages of vector-control tools to interrupt malaria transmission.

Vaccines
An effective vaccine could provide a powerful tool against malaria, but developing one will take sustained scientific effort over many years. In recent Phase III clinical trials, the RTS,S malaria vaccine had lower-than-desired efficacy, but the data demonstrated that it is possible to vaccinate against a parasitean important advance. Beyond the current vaccine candidates that could play an important role in reducing malaria in various target groups, successful efforts to eradicate malaria will ultimately require more efficacious second-generation vaccines that can block transmission across entire populations at risk. The process of vaccine development is currently slowed by lack of knowledge of the mechanisms of immunity. We invest in efforts to develop vaccines that can interrupt malaria transmission, including a second-generation vaccine or new vaccines based on transmission-blocking antigens. We also support research that can guide more efficient vaccine development.

Integrated Interventions
A number of interventions are highly effective against malaria, but questions remain about where and how best to deploy them: What is the impact of intensifying these interventions? In which countries is elimination currently feasible? What combination of tools will be optimal for eliminating malaria in specific transmission settings? We support efforts to answer these questions and to capture and share lessons learned about the impact of scaling up and sustaining interventions. We also invest in efforts to learn how best to sustain financing of and commitment to anti-malaria efforts.