Jun 24, 2019

Trying to eradicate malaria around the world

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Data: The Malaria Atlas Project; Map: Harry Stevens/Axios

The fight against malaria in the past couple decades has largely had a positive trajectory — since 2000, there have been 7 million lives saved and about 1 billion cases prevented — but recently there's been pockets of plateauing or increased infections in the world.

Why it matters: Malaria parasites are starting to show more resistance against insecticides and drug treatments. Combined with political instability and lack of necessary funding, the goal of eliminating malaria now requires urgent action with new tools no longer using the "one size fits all" method, a group of malaria experts tell Axios.

"We need to get the right combination of interventions to the right people at the right place to save lives."
— Jennifer Gardy of the Gates Foundation

Background: The female Anopheles mosquito is the vector of malaria parasites (there are now more than 100 species). When diagnosed early, malaria is considered treatable for most patients, depending on the particular parasite.

  • Plasmodium falciparum, found mostly in Africa, is the most deadly parasite as it can cause cerebral malaria. Plasmodium vivax tends to be less deadly but is more prominent throughout the world, including in South America.

What's new: "For the first time [in recent history] we're seeing cases rise in high burden areas," says Michal Fishman of the nonprofit Malaria No More.

  • The reasons for the uptick are mainly due to 3 issues: higher population movement from refugees, a lack of necessary funding, and the parasites are becoming more resistance to insecticides and drug treatments, according to Simon Hay of the University of Washington's Institute for Health Metrics and Evaluation (IHME) who tracks malaria via maps.
  • Malaria was eliminated in the U.S. in 1951, but the country still has the Anopheles mosquitos that can bite an infected person and transmit to others.

The group of experts from nonprofit and for-profit groups tell Axios the following steps are needed...

1. Decisive actions from governments are key, mainly through policy and funding.

  • "Political will is such a critical factor in driving results in Africa," says Abbott's Damian Halloran. Fishman agrees, and points to Zambia's president as one who tracks their malaria effort every day.
  • The World Health Organization, which has called for 10 countries to be malaria-free by 2020, pointed out last week that China is a good example after eliminating malaria "became the joint goal of 13 ministries, including health, finance, industry, and education. The results were impressive and the country has gone from 30 million cases in the 1940s to zero indigenous cases in 2017."
  • Yes, but: Hay warns there's a $2 billion funding shortfall in WHO's malaria plan.

2. New tracking technologies can assist.

  • Real-time mapping is a tool researchers and advocates can use to pinpoint where to focus resources and expertise.
  • The Malaria Atlas Project at the University of Oxford and IHME published 2 studies in The Lancet on Wednesday mapping P. falciparum and P. vivax. "We've seen spectacular successes in many places, but a plateauing in some places and a resurgence in others," Hay says. Venezuela and Yemen are 2 places in particular that have seen more malaria due to political instability, Hay adds.
  • IR Mapper tracks reports of insecticide resistance in mosquitos.

3. New diagnostics and preventative measures.

  • Bed nets need to be improved to combat growing drug resistance, according to Patrick Sieyes, regional director for Vestergaard, a company that produces nets. While long-lasting treated nets are considered to be a key reason malaria cases have dropped, "we're seeing a plateau and even a reversal [in some cases] ... we're very concerned," Sieyes says. In response, the company recently developed a new version of the Permanet plus the IR Mapper app noted above.
  • Fast, reliable testing is needed to help people immediately determine if the person has malaria or not, Halloran says. Abbott has created rapid diagnostic tests for malaria that can detect it even in people who show no visible symptoms of the disease, he says. This is important because many other illnesses show similar symptoms, he adds.
  • CRISPR technology can be used to help quickly detect viral biomarkers of malaria via a saliva or urine sample, says Trevor Martin, co-founder and CEO of Mammoth Biosciences, which is developing such a test.
  • Gardy says that genomic epidemiology is the way to move forward because "by reading the DNA sequence of either the parasite or the mosquito vector," a plan of action can be created for that region.

An effective vaccine would be another important tool in the arsenal, Gardy says. A pilot program has started in Malawi and Ghana testing a new malaria vaccine called RTS,S against the deadly P. falciparum, but it faces some issues like efficacy and accessibility (it requires 4 shots). It will be brought into Kenya in July.

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