New tools and a “zambitious” goal to end malaria

April 25, 2017 by Dr. Laurence Slutsker

As Zambia and other countries attempt to become malaria-free, new innovations are on the horizon.

A new, highly sensitive rapid diagnostic test is one of a number of new tools that will contribute to efforts to eliminate malaria. Photo: PATH/Georgina Goodwin.

A new, highly sensitive rapid diagnostic test is one of a number of new tools that will contribute to efforts to eliminate malaria. Photo: PATH/Georgina Goodwin.

We’re celebrating good news in the effort to end malaria:

The world’s first malaria vaccine, called RTS,S, took a big step forward: the World Health Organization has selected Ghana, Kenya, and Malawi for the vaccine’s first pilot implementation. Results from a pivotal clinical trial conducted by PATH, vaccine developer GSK, and clinical centers across Africa suggest that this partially effective vaccine, in combination with other malaria prevention and control tools, could result in a substantial reduction in the number of malaria cases experienced by young children.

A newly launched, highly sensitive rapid-diagnostic test offers a greater than tenfold improvement in detection. The test, which was developed by Alere with support from the Bill & Melinda Gates Foundation, PATH, and FIND, will help health care workers screen for individuals who are asymptomatic but may be carrying the malaria parasite—greatly aiding efforts to accelerate malaria elimination.

And Zambia launched a bold national strategy to make the country malaria-free by 2021. Ridding the country of malaria is so important that Zambia’s president, Edgar Chagwa Lungu, announced the ambitious plan at a World Malaria Day event.

A man points to a map titled "Malaria Risk Map 2017."

Zambia is working to create malaria-free zones on the way to eliminating the disease altogether. Photo: PATH/Stacey Naggiar.

An unimaginable goal

After a massive effort to reduce the disease, Zambia saw a remarkable 93 percent reduction in malaria in children in Southern Province. Now they’re taking the effort nationwide.

An ambitious goal like theirs (or “zambitious,” as they say in Zambia) was unimaginable when I began my career at the US Centers for Disease Control 30 years ago. At that time, countries didn’t have easy access to prevention or diagnostic tools.

Most malaria in Africa was diagnosed based on symptoms like fever instead of by diagnostic tests. That meant a lot of people were misdiagnosed and mistreated. The most commonly used treatment, chloroquine, was failing, and there was very little funding for research.

Well over a million people died from malaria in 1987—a number that rose to a peak of 1.8 million in 2004.

Woman wearing a floral print shirt looking at a young boy standing next to her.

More than 19,000 children were enrolled in trials to prove the world’s first malaria vaccine, including Mary Okeyo’s son. The vaccine, called RTS,S, will be piloted in Ghana, Kenya, and Malawi starting in 2018. Photo: PATH/Eric Becker.

No red in the blood

As a young doctor, I assumed I would join the unfolding effort against human immunodeficiency virus (HIV), but a small group of passionate malaria scientists and a trip to Western Kenya changed my life’s direction.

I was sent to investigate an epidemic of severe anemia in children that some thought was due to a virus. So many children were ill that they were packed three to a bed in some pediatric wards.

One day I watched as a doctor drew blood. I thought he must have missed the child’s vein. The boy had so few red blood cells that his blood was pale pink. That memory remains vivid even today.

We discovered that these children were infected with malaria parasites that had developed resistance to chloroquine. Drug resistance had spread like wildfire through Western Kenya. Thousands of children were living with—and dying from—undiagnosed chronic malaria.

A changed world

Thankfully, the world is a much different place today. Wealthy nations and large foundations have made substantial investments in malaria prevention, diagnosis, and treatment. This in turn allowed for the creation of desperately needed new tools, from long-lasting insecticide-treated bednets to a new, highly effective treatment called artemisinin combination therapy (ACT).

The results showed that malaria is one of the best investments in global health: nearly 7 million lives have been saved since 2000.

While assistance for global health comprises less than one percent of the US federal budget, historic investments have made the United States a leader in the global fight against malaria.

And it’s a bipartisan success story. Elected officials from both parties recognize that malaria funding is a cost-effective investment that is saving lives and helping to unlock the economic potential of countries struggling with the disease. They understand that for many countries like Zambia, malaria stands in the way of it becoming a middle-income country.

A man carries antimalaria indoor-residual spraying gear.

Mosquitoes that carry the malaria parasite are building resistance to insecticides used to spray the walls of homes. As part of the NgenIRS partnership, PATH is leading an effort to evaluate next-generation indoor residual spraying products in combination

Staying ahead of resistance

But in order for all countries to eliminate malaria, we’ll need more innovation. For instance, to thwart the threat of insecticide resistance, PATH is helping to introduce next-generation active ingredients for indoor residual spraying.

Other organizations are working on newer bednets and attractive toxic sugar baits. The latter showed impressive results in reducing mosquito populations in early trials.

Investments in drug development by various companies have recently yielded a new ACT (pyronaridine-artesunate), but artemisinin resistance is building in the Mekong subregion. A new generation of antimalarials will be needed. Fortunately, several non-ACT candidates are in advanced stages of clinical evaluation.

A man and a woman sit side by side at a desk and look at a laptop.

Reliable data becomes even more important as malaria cases become fewer and harder to find. With near real-time data visualizations, health officials from the local to the national level can better see the malaria situation and decide where and when to de

Rapid response for the end game

PATH helped to develop a framework of “steps” for malaria elimination, which are used by national and regional malaria programs to implement a package of interventions to drive transmission to zero. Strong surveillance and response systems are a critical cornerstone of this work.

Historically, malaria surveillance has been weak, but new investments and partnerships are beginning to turn that around.

As an example, PATH’s Malaria Control and Elimination Partnership in Africa (MACEPA) program is working with the government of Zambia to improve malaria surveillance and data use. Contributions from technology partners are a central focus of this effort, particularly from Tableau Software and the Visualize No Malaria partnership.

So let’s embrace the good news that global investments have paid off in remarkable progress. But let’s also remember that continued investments, and commitment from malaria fighters, political leaders, and communities worldwide will be needed to end malaria for good.