Accessing malaria drugs still a big problem

By Peter Orengo

The world’s largest malaria conference closed in Nairobi on Friday amid calls for substantial and sustained support for research to save countless lives.

While the conference showcased new technologies to be used in research to combat malaria, experts also discussed the growing drug and insecticide resistance, and the shocking inaccessibility to life-saving drugs for the disease that continues to kill 2,400 people daily.

The World Health Organisation estimates that 40 per cent of the world’s population is still at risk of malaria, mainly in poor countries.

Since the last multilateral initiative on malaria conference in 2005, the global community has made tremendous strides against the disease. However, many African countries still struggle to meet the sixth Millennium Development Goal aimed at halting the incidence of malaria.

Dr Adrian Lutry, a senior researcher at Radboud University Nijmegen Medical Centre in the Netherlands and chair of the Multilateral Initiative on Malaria (MIM), says for the global community to eradicate malaria, it must invest in science that guides these efforts.

The announcement of advances towards the invention of a malaria vaccine, Mosquirix, was received with much relief.

The new vaccine, a result of partnership between Kenya Medical Research Institute (Kemri), Centre for Disease Control (CDC), the PATH Malaria Vaccine Initiative and GlaxoSmithKline (GSK), with the support of the Bill and Melinda Gates Foundation, is in the third face of trials.

Two separate trials done in Kenya and Tanzania showed the vaccine had a promising safety and tolerability profile, which reduced the risk of episodes of malaria by 53 per cent in children aged five to 17 months over an eight-month follow-up period.

But excitement of the breakthrough was marred by the realisation that African countries might not access the vaccine when it is finally developed due to policy and economic constraints and lack of political goodwill.

While the development is seen as good news, especially for Africa, which bares the brunt of malaria infection, it is a setback to vaccine research, as test trials require a malaria prone environment to sustain investigation.

During the conference, whose theme was ‘Building Knowledge for Action’, it also emerged that use of insecticide treated bed nets, indoor residential spraying campaigns and the nationwide implementation of artemisinin-based combination therapies, had led to a 44 per cent reduction in childhood deaths and 55 per cent reduction in malaria admissions.

Scientists at the conference presented evidence on what must be done to improve access to proven methods by the world’s poor.

According to the latest operational research, home management of malaria is preferred as it offers community health workers training and tools to diagnose and treat malaria within the community.

In practice, the use of rapid diagnostic testing as part of an integrated approach to malaria and pneumonia is a challenge. Currently, most anti-malarials are administered when children present with a fever, without confirmatory diagnostic test.

Drug access

However, fever is also a diagnostic sign of pneumonia, causing a liberal administration of malaria drugs that may lead to resistance and drug wastage.

Drug access is also a big problem, especially in the rural areas. Artemistisisn-based Combination therapies (ACTs) are currently the most effective form of treatment against malaria.

Although 80 countries worldwide have adopted ACTs as a first-line treatment in line with WHO recommendations, surveys indicate that ACTs continue to have a worryingly low presence in the overall market.

At the same time, over-use or arteminism monotherapies and irrational use of ACTs are leading to increased drug resistance.

Innovation

Expanded access to insecticides and agricultural use of insecticides are also causing mosquitoes to develop resistance to malaria control methods.

Dr Solomon Mpoke, Acting- director of the Kenya Medical Research Institute (Kemri), said information from the conference would be crucial in drug improvement, diagnosis and vector control methods.

In terms of gains made in diagnosis, it will soon be possible to detect malaria by chewing a stick of gum and swiping it over a magnet or scanning a finger with ultra- infrared light. This technology is different from the usual test that requires a blood sample.

These are some of the winning proposals for the Bill and Melinda Gates Foundation Grand Challenges awards, which invited researchers to find non-invasive diagnostic alternatives for conditions such as malaria, tuberculosis and HIV.

"It is entirely possible for non-specialists to tackle a problem from angles that specialists in the health field may not have thought of," Gates Foundation spokesperson Melissa Covelli told the delegates. Extracting blood or tissue can require advanced skills on the part of health workers or pose high costs for patients, as well as complex logistics, many of which do not exist in developing countries, Covelli said.