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Leadership interview: Public-private partnerships make a difference in areas where markets fail

Interview with Dr Chris Hentschel, former CEO of Medicines for Malaria Venture

[RBM leadership interview conducted by Boriana Savova, Communications Officer, Roll Back Malaria Partnership Secretariat, May 2010]

Dr Chris Hentschel
Dr Chris Hentschel

From 1999 to early 2010, Dr Chris Hentschel served as the first CEO of Medicines for Malaria Venture (MMV), a successful public-private partnership for drug development. Today he has transitioned away from this leadership role and talks about his experience at MMV of turning a promising idea into a resounding success.

Q: What motivated you to take up the role of a CEO of a malaria research partnership at a time when malaria was a neglected disease with an uncertain future?

By year 2000, I had reached a stage in my life when I could afford to think about what I really wanted to do with my career. I felt that my experience could be used for public good rather than simply making wealthy people even wealthier. While I did not have a specific interest in malaria at that time, I had a very-specific interest in public-private partnerships. I wanted to show that public-private partnership could be successful in areas where markets fail to develop a product. I had been thinking about this for a long time and when the right set of circumstances appeared, I started scanning the globe for an opportunity to act on my motivation.

To be perfectly honest, I was not driven by malaria per se but the realization that malaria could be a very good model to demonstrate the power of public-private partnership. Of course, I quickly got very interested in malaria too but initially I was more interested in the model as I believed that it could be applied to various diseases.

Q: What is unique about this model? What is unique in the role that MMV plays in the malaria community?

Back in 2000, the model was more of an idea than a reality. Over the past 10 years, it has shown that it can work. In fact, it has worked better than expected and certainly much better than critics feared. Today MMV is probably one of the best examples of a public-private partnership for product development. It has a big pipeline of strong products, two of which are at an advance stage of development. The organization has helped to transform the innovation landscape for malaria drugs from dismal in 2000 to rather bright in 2010, with strong products in the pipeline and more than a 100 committed partners all around the world. This is really an achievement that I am proud of.

Q: What important products have been developed through the model that you are describing? How will the new products in your pipeline change malaria control as we know it?

The first new products will be in the class of ACTs (artemisinin-based combination therapies), which has been recommended by WHO treatment guidelines and is generally purchased by malaria endemic countries through the Global Fund. Currently, however, the choice is very limited. In fact, there is only one product today that meets all the stringent criteria, including approval according to the WHO guidelines, and review by an international regulatory authority as well as the WHO prequalification programme. The only product that has historically met all these criteria is Novartis's Coartem.

As MMV aims to reach out to the poorest of the poor and in particular infants and children who are the main victims of malaria, it developed a pediatric formula of Coartem with Novartis as partner. The drug is dispersible in liquid and sweet-flavored, so that children like its taste. The product was launched last year and already many millions of treatments of this product have been delivered. The roll-out is continuing as we speak.

MMV is involved in developing two other ACTs, which have slightly different properties and different partner drugs. They will be useful in different settings around the world. For example, one of them has been tested not only on Plasmodium falciparum but also on Plasmodium vivax, the second most important parasite strain, and can be used for mixed infections. This is the front end of the portfolio - products that can be launched in one or two years.

In the 5-year time horizon, MMV is aiming to develop new drugs that don't depend on artemisinin. Artemisinin is a very effective antimalarial but has some potential disadvantages. First, it is an agricultural product, which means its supply is prone to the vagaries of the weather. And second, there are increasing worries about emerging parasite resistance to artemisinin. So we need drugs that are easier and cheaper to make and will not be affected by resistance to artemisinin if that does occur on a large scale.

Q: One of the issues with ACTs is their affordability. MMV is involved in the development of new ACT-based medicines. Does that mean that it can influence their market price?

MMV does have some influence in the sense that even at the research stage, it focuses only on products that can be made cheaply and sold at a price of a dollar or below per treatment. But this is still not nearly as cheap as the old drugs such as chloroquine, comprising just one chemical entity and manufactured in thousands of tons, which made it very cheap at the end of the supply chain. In the case of ACTs, we are talking about two drugs, of which one is agricultural. These aren’t as easy to produce cheaply as the old drugs.

The other level at which MMV tries to influence the sales price of ACTs is by working closely with the global subsidy (AMFm), for a radical subsidy applicable to ACT drugs. MMV is not part of the management of this mechanism but supplies technical information and is involved with RBM in advocacy.

Q: What are the greatest challenges for research in 2010 and beyond?

The greatest challenge is access to funding for research, made rather difficult in the current financial environment. The advocacy that MMV does together with RBM has truly boosted its fund-raising effort.

Drug R&D is not simple. It is very difficult to produce genuinely new drugs. Most drugs fail at some stage in the R&D process and you have to pay for the ones that fail as well as the ones that succeed. MMV needs a large enough portfolio to be able to secure a number of successes, despite the inevitable failures. This is not specific to malaria research - it is common to all drug research.

As far as malaria research is concerned, we are quite lucky to have good animal models, which allow us to get an indication of whether a drug is likely to work in humans, even in the early stages of development. Malaria drug R&D is not the most difficult compared to drug R&D that is going on in the world, but having to produce cheap products adds a layer of complication.

…Successful research depends on attracting and retaining top talent and that is related to funding…

It is related to funding but also to the credibility of the organization. MMV has been able to attract the best partners globally, who would probably not have engaged unless they believed in MMV's mission and its core partners. One of these core partners is RBM. So it is the overall credibility of the organization and the partners that support MMV that has brought talent from companies and the talent for the organization itself. The organization has been able to hire good scientists from the industry, as well as the public health sector who worked here in Geneva.

Q: What are the common sources of funding for malaria research?

Most of the money for research comes from the US, with Europe being second largest contributor. Quite a lot of this funding is governmental funding but there are huge contributions from foundations such as the Bill and Melinda Gates foundation in the US the Welcome Trust in the UK and a number of other philanthropic players. Funding has trended upwards from about 2000 to 2008. At 2008 that upward trend stopped, peaked and flat-lined and maybe even went down a bit, although it is difficult to get the most recent data. And now, because of the current economic environment, resources are less readily available and attracting funding is likely to be much more difficult. Government departments have less money and the asset value of philanthropic organizations is much lower than it used to be.

Q: What has been the value of participating in the RBM process?

It is absolutely essential for an organization like MMV to understand the big picture in malaria control and to understand the global strategies that are being developed and contribute to implementing the Global Malaria Action Plan. The organisation can be efficient only if it understands the complex and evolving picture of global strategies and integrate in it.

It has been both a pleasure and a privilege for me to be involved with RBM. It is hard for me to overemphasize how useful this has been to MMV. I have recently left MMV. MMV's participation in RBM has been very beneficial. And I am talking not only about MMV’s involvement in the RBM Board. The RBM Executive Director, Dr. Coll-Seck, has been one of MMV’s main advisers. MMV enjoys a synergistic relationship with RBM.

Q: What does it take to be a successful leader in your field?

I believe in MMV's mission and I greatly enjoyed my job. Besides, over the past decade I have consistently benefited from the strong support of MMV’s many stakeholders.

I feel gratified that in 2010 the situation of MMV is so positive - more money was raised in 2009 than in any other year, it has a stronger R&D portfolio, a stronger management team and a stronger scientific group. I think that the situation is set fair for the organization.

When I announced that I was leaving MMV, I had incredible correspondence with so many members of the malaria community. I have not yet been able to answer all messages and letters I have received. But they indicate two things - that MMV has done a great job and that I have made a lot of friends in the malaria community asking me to stay in touch, even if I leave the malaria area. Getting so many positive responses is a nice way to move on.