• Medicines for Malaria Venture (MMV) is a leading product development partnership (PDP) in antimalarial drug development dedicated to the discovery, development and delivery of new, effective and affordable antimalarial drugs for under-served and very poor populations.
• Over 20 years, MMV has achieved commendable success in its mission to reduce the burden of malaria in disease-endemic countries and thus improve the health of people suffering from malaria.
• MMV has built the largest antimalarial drug pipeline in history, brought forward 13 new medicines estimated to have saved over 3 million lives and, in 2020 alone, protected over 33 million children from malaria. 
• MMV works to ensure the affordability, acceptance and accessibility of malaria medicines, supports equity in access to these treatments and thus contributes, with an end-to-end approach, to the drive to eradicate malaria and thereby improve health equity and reduce poverty.
• MMV’s success would not have been possible without the sustained support of long-term donors, such as the UK, and collaborations with academic and industry partners – over the last 5 years MMV has collaborated with over 40 scientific and industry partners across the UK.

• MMV welcomes the IDC’s inquiry into tackling extreme poverty and the UK’s quest to draw closer to Target 1.1 of SDG1 – so that people in developing countries can lead healthier, safer, more prosperous lives.
• MMV submits this response, sharing our experiences as a long-time partner with the UK in global health and malaria, because success in the fight against malaria contributes to success in the fight against extreme poverty (SDG1) and to the achievement of health and wellbeing for all (SDG3).

How well is UK Official Development Assistance (ODA) targeted towards tackling extreme poverty and how effectively do the FCDO policies and programmes contribute to the achievement of Target 1.1 of SDG 1? (By 2030, eradicate extreme poverty for all people everywhere, currently measured as people living on less than $1.25 a day)  

The growing burden of extreme poverty and its multiple causes is well documented

• The steady decline in global poverty over 20 years has suffered a setback[1]. The UN Agenda 2030 for sustainable development, which includes the targets to reduce the burden of disease by 90% and eradicate extreme poverty by 2030 is off track.
• In 2018, the rate of decline in poverty began to slow and now, with the onset of COVID-19, the World Bank estimates1 that the pandemic has already pushed 100 million more people into extreme poverty.
• The world is confronted with major challenges, such as persistent health inequities, drug resistance, global vulnerability to epidemics and pandemics, climate change-related disasters and migration, which push more and more people into poverty and put a heavy burden on them. Significantly, several of these challenges are also major obstacles to malaria eradication.

The FCDO has prioritized the fight against malaria as it is a major health risk to over 3 billion people in the world’s poorest regions

• Over half of the world’s population[2] is at risk of malaria.
• The UK recognizes that the disease is both a cause and consequence of poverty and is committed to its eradication.
• Access to innovative tools is key to control and eradicate malaria.
• Malaria can be averted with prevention medicines, with bed nets and indoor spraying, and with partially effective vaccines.
• Sustained investment in programmes to prevent and mitigate the effects of malaria serve to boost the growth and prosperity of communities and nations and is an assured path to poverty alleviation: based on 2017 estimates, for every US$1 per capita investment in the fight against malaria in Africa, per capita GDP[3] increases by US$6.75.

A recent assessment by the WHO reveals that the world bears a heavier malaria burden than previously thought – putting more people at risk of sliding into poverty

• Efforts of the malaria community over the last 20 years saved an estimated 10.6 million lives and prevented ~1.7 billion cases. Over the past few years, this progress has stalled.
• Using a new methodology, the 2021 World Malaria Report2, estimates that 627,000 people lost their lives to malaria in 2020, 80% of whom were children under the age of 5, which means that a child dies from malaria every minute of every day.
• Where malaria doesn’t kill, it debilitates, and is an obstacle to children’s development and education. Studies have shown that malaria deteriorates the general and neurological health of children and causes 50% of preventable school absenteeism.[4] This contributes to increasing their risk of falling into poverty.
• The UK’s continued long-term investment and leadership in the drive to end malaria for good is more important than ever and is a prerequisite to tackling poverty.

The UK’s commitment to ending malaria via innovative medicines and equitable access to medicines is bearing fruit – and thereby contributing to lifting millions out of poverty (SDG1)

• The UK’s pioneering leadership in global health with a strong commitment to the malaria community, including the work of MMV, has been instrumental in saving millions of lives, including those of pregnant women and children2 who are often the most at risk, from this deadly poverty-related disease.
• As people become healthier and no longer suffer the effects of malaria, the numbers in extreme poverty will fall.

• The UK’s funding of MMV, dedicated to the research and development (R&D) of new antimalarial treatments and tools for under-resourced communities, is a direct contribution to the target to end malaria epidemics (SDG3.3) and indirectly eases the burden of poverty in the poorer regions of the world (SDG1).[5], [6]
• The fight against malaria also directly contributes to other SDGs inextricably linked to the fight against malaria and broader societal goals.6 Thus, the UK’s support to the fight against malaria and to PDPs such as MMV has a far wider impact on society beyond immediate malaria-related outcomes, all serving to lift people out of poverty.
• The recently published FCDO position paper on Health System Strengthening for Global Health Security and Universal Health Coverage has placed a clear emphasis on investing in health systems to improve health security. The paper features the importance of the work of PDPs, such as the critical malaria R&D undertaken by MMV, as an enabling factor towards strengthening health systems of countries most at risk of disease outbreaks and pandemics.

The UK’s model of working in partnership ensures success

• FCDO policies and programmes focus on working in partnership at local and international levels in the public and private sectors. This model is highly effective and ensures success – its support of MMV is a prime example.  
• MMV’s links with the UK stretch back to its creation in 1999. The UK’s long-standing, flexible and sustained partnership has enabled MMV to provide impressive and tangible benefits to the lives of millions.
• MMV’s success is largely due to UK Aid’s support of strong networks and collaborations, including with British industry and academia, allowing a two-way flow of malaria expertise and experience.
• In turn, the UK receives value for money on its investment in MMV: each £1 MMV receives is transformed into £3.50 through direct and in-kind contributions from pharmaceutical partners.
• This effective partnership with the FCDO enormously benefits the global health agenda directly and addresses extreme poverty indirectly.

How might the FCDO’s strategy, policies and programmes need to change as the number of people in extreme poverty grows due to the global pandemic or the effects of climate change? 

• All signs point to the fact that global poverty is on the rise (see response to Q1) and a global response is urgently needed.
• The UK must safeguard its position as a world leader in global development and lead the way with targeted policies and programmes that increase support to current health and development initiatives demonstrating success.
• The world’s continuing experience with the COVID pandemic has underlined the importance of R&D in infectious diseases which is critical for pandemic preparedness and requires sustained investment and technical support from donor countries like the UK.
• The reduction in UK’s ODA has put its global health policies and bilateral R&D programmes at risk. To eradicate extreme poverty pre-COVID-19 levels of ODA support to all programmes targeting poverty alleviation should be reinstated or increased.
• As stated earlier, success in the fight against malaria is a prerequisite for success in the fight against extreme poverty.

How effectively do the FCDO’s strategy, policies and programmes address the needs of women and girls in extreme poverty? 

• We write this from the perspective of MMV and our work in malaria, a disease which places a heavy burden on the impoverished women[7], girls[8] and children in disease-endemic countries.
• Of the 627,000 lives taken by malaria in 2020, 80% were children under five and 93% lived in Africa’s most impoverished regions. Their care is paramount.
• A recent FCDO strategy paper[9]: Ending preventable deaths of mothers, babies and children by 2030 reiterates the unacceptably high number of maternal, newborn and child deaths worldwide.
• The health of women and children is central to MMV’s work and mission. The UK’s early investment in MMV encouraged the prioritization of the discovery, development and delivery of medicines appropriate for children as well as pregnant and lactating women.
• UK’s investment helped MMV and partners bring forward six drugs for children that have saved almost one and a half million young lives and in 2021 alone protected over 33 million children from malaria. It is conducting targeted research on compounds that are well tolerated in pregnant women. This will have a huge impact on poverty alleviation in the longer term.[10]
• UK’s investment in MMV’s work is effectively contributing towards SDG3.3 and indirectly to SDG1 as well as SDG5 (gender equality), SDG 8 (decent work and economic growth) and SDG 10 (reduced inequality).6
• Equitable access to adapted treatments for women, girls and children frees them from the burden of caring for family members when they fall sick with malaria, and increases their likelihood of completing education, entering and remaining in the workforce, and participating in public decision making. Empowering women and girls in this way helps lift them out of poverty and ensures they do not slide into extreme poverty.
• A reduction, withdrawal or change in the conditions of UK’s investment in malaria would dramatically affect the malaria community’s ability to effectively tackle the unmet malaria needs of women and girls, and could keep this vulnerable population mired in poverty, without effective treatment. It would also negate the gains made so far.

How effectively does the FCDO review the outcomes of the projects and programmes it funds that tackle extreme poverty? What evidence is there that UK aid is being used to build pathways from extreme poverty to sustainable livelihoods? 

• Historically, the UK has made sustained investments in building pathways out of extreme poverty indirectly via catalytic support to PDPs in research and product development.
• Over two decades, MMV has worked with UK’s system of programme and outcome review before each renewal of funding. MMV’s leadership and technical experts meets regularly with FDCO’s health team for deep dives into MMV’s R&D portfolio and its work to ensure access to quality approved antimalarials. FCDO’s input during these meetings is of immense value and is used to drive MMV’s strategy and priorities.
• The impact of UK investment goes far beyond the number of lives saved from malaria, or the number of new drugs launched on the market. Investment of UK aid in malaria has profound indirect effects on the economic security and prosperity of developing countries, as well as both domestic and international research capacity.
• A glance at the many benefits mentioned earlier achieved by the UK’s funding of malaria and the work of PDPs like MMV makes it eminently clear that the UK is making a strong contribution to building novel pathways from extreme poverty to sustainable livelihoods in many malaria-endemic countries.

How the FCDO can play a more effective part in the eradication of poverty as a convener, thought leader and investor. 

• For FCDO to play a more effective role and ‘remain a world-leading international development donor, committed to the global fight against poverty and to achieving the UN SDGs by 2030’ it is important that its approach addresses the multiple causes of poverty, including the health inequities inherent in poverty-related diseases and supports access to medicines and innovation in this field.
• In the area of malaria and public health, the FCDO can do more in terms of convening forums focused on poverty-related diseases – continuing to invest in the excellent All Party Parliamentary Group on Malaria and Neglected Tropical Diseases[11]. It can also:
• Mobilize change by using its diplomatic network, bilateral relationships and prominent voice in national and international fora. The complex nature of poverty can only be addressed by a global, multisectoral collaboration including representation from UK’s health, policy, academic and private sectors.
• Build closer collaboration with the Commonwealth of Nations as they strive to achieve the SDGs – 56 countries in this group of countries bear the highest burden of malaria and a large proportion of their populations are trapped in poverty[12]. Closer partnership between FCDO and the Commonwealth to improve data tracking, supply chain protection, health system strengthening and access to medicines has the potential to enormously improve the wellbeing of the poorest in these countries.
• Adhere to current funding models – flexible UK funding of MMV has allowed resilience and flexibility of its malaria drug development and access projects, leading to the impressive results we have achieved over the past 20 years.
• Revoke the 2021 decision to cut spending on ODA to 0.5% of GNI, not only because it will harm the development of the world's poorest but will also be detrimental to the UK’s position and reputation as a leader in global development.

• The UK has a proven track record in thought leadership in global health, which is being carried forward by the new FCDO structure. This can be further enhanced if the FCDO can:
• Bring together experts across sectors and geographies to explore a wide variety of topics and identify solutions to address the multiple causes of poverty.
• Lead the global donor community in trend analysis and adaptation, including a shift to:
• Shared leadership and a focus on collective impact.
• Integrated approaches across sectors and end-to-end solutions.
• Equitable access to health commodities
• A focus on under-served and poor populations.
• Catalyze opportunities for innovation and managed risk taking, for example through demonstration projects in high burden areas that can strengthen the evidence base and lead to more effective decision making.
• Keep the FCDO sufficiently staffed with appropriate scientific and policy expertise.

• The prevalence of malaria is an established indicator of weak, impoverished, under-resourced health systems. We believe that as the UK defines a sustainable investment strategy to address extreme poverty, it must continue to invest in:
• Science and research – one of the UK Government’s seven key priorities to deliver on poverty reduction to achieve SDG1 and thus SDG3.
• The malaria ecosystem – as an active partner, the UK can enable the work of all stakeholders collaborating to eradicate malaria.
• Better tools (via the malaria R&D community) and better impact (via investments in access to medicines) to reduce the burden of malaria, improve health equity and lift people out of poverty.
• Stronger health systems in LMICs to enable them to prevent, diagnose, track, and treat infectious diseases like malaria, with an emphasis on building the capacity of the health workforce and primary health care facilities to build more resilient overall health systems.

6