European drugmakers GlaxoSmithKline of the UK and Novartis of Switzerland have agreed to contribute to a nearly $4 billion global research effort to fight drug-resistant strains of malaria. 

The companies will be part of a wide-ranging initiative called Medicines for Malaria Ventures (MMV), kick-started by a pledge of $1 billion from the Bill & Melinda Gates Foundation. Glaxo plans to invest $250 million, while Novartis has pledged more than $100 million.

According to the World Health Organization (WHO), emerging resistance to drugs and insecticides is making eradication of the insect-borne disease more difficult, with some geographies experiencing a resurgence. The organization’s figures show that the number of malaria cases rose 2% to around 216 million globally in 2016, with the number of deaths remaining constant at 445,000.

Certain variants of the lethal parasite known as Plasmodium falciparum have become resistant to artemisinin – said to be the most potent medicine currently available. The resistant strains have been detected in five Asian countries and risk taking hold in Africa, according to Novartis, which makes an artemisinin the drug.

Seeking an alternative to artemisinin and other anti-malarial drugs to which the disease has  become resistant, the Swiss pharmaceutical giant and Medicines for Malaria began testing a new anti-malaria pill known as KAF156 in Africa last year. The company has promised to implement an “equitable pricing strategy” to maximize patient access in malaria-endemic countries.

According to a new study, almost one in four blood bank supplies in certain regions of Africa may be contaminated with malaria parasites. Additional research efforts will investigate the likelihood of contracting the disease through infection with Plasmodium through blood transfusions.

Glaxo and the PATH Malaria Vaccine Initiative meanwhile are due to begin pilot projects shortly for their first jointly developed experimental malaria vaccine, called RTS,S or Mosquirix, in Ghana, Kenya and Malawi later this year. The drugmaker said the projects will take five years to complete.

In November 2017, GSK submitted a new drug application to the US States Food and Drug Administration (FDA), seeking approval for a single-dose use of its drug tafenoquine for the radical cure (prevention of relapse) of Plasmodium vivax (P. vivax) malaria in patients 16 years of age and older.

Bill Gates has stressed that the broader fight against malaria will depend on advances in science and technology, including gene editing. He has highlighted the promise of using Crispr to genetically alter mosquitoes and cause females to become sterile or produce mostly male offspring. Malaria is spread exclusively by the female mosquito.