New strains, low funds derail fight against key killer diseases in Africa

A mosquito on human skin. [Getty Images] The fight against the three killer diseases in Africa is uncertain with emerging strains and low funding. The continent mainly depends on funding from the Global Fund to fight HIV/Aids, Tuberculosis (TB) and malaria. But, according to experts, the funding is not sustainable, and are now calling on African states to allocate budgets, to revamp the fight and reduce the spread of the disease. Prof Oyewale Tomori, a virologist from Nigeria, said much emphasis has not been put by the continent to eliminate these diseases. "Africa must find a balance in eliminating deaths caused by malaria, TB and HIV. We cannot have thousands of people dying, yet we have solutions at hand," said Tomori, in an interview at the sidelines of a health summit in Kigali. Healthcare systems in the continent, according to the expert, are likely to be overstretched in case of a pandemic like Covid-19, as patients suffering from the diseases will be exposed to more infections. People with the diseases are exposed to more infections because of their low immune system. "African governments are waiting for donations, but when they do not come, they complain. We cannot continue to beg," adds Tomori. Tomori's sentiments were echoed by Dr Richard Mukabana, a researcher at African Institute for Development Policy. "Donor aid is not structured in a way that would control the disease for you. If you have malaria, and start writing a proposal to a donor to fund treatment, then you are going to die," said Mukabana, a medical entomologist and parasitologist. "Malaria is a preventable disease, but it's a big shame, that we are still losing lives to the disease. We know what to do to prevent malaria. Global Fund continues putting resources into a pot that has a hole at the bottom," observed Dr Mukabana. Kenya is not exceptional. For example, the country has a total funding gap of Sh11 billion required to procure essential HIV commodities for FY 2021-2023. The total commodity allocation for Kenya on HIV services is Sh28.7 billion, out of which Sh5.3 billion is from Global Fund, and Sh3.3 billion by the Kenyan Government. Out of the Sh28.7 billion, Global Fund allocates Sh4.6 billion on ARVs, while Kenyan Government allocates Sh2.2 billion. The country has a total shortage of Sh2.4 billion in ARVs. Bonaventure Ahaisibwe, Managing Director at Seed Global Health, on his part acknowledged gains made in the fight against TB, HIV and malaria. A reduction in cases is attributed to increased coverage of mosquito nets, indoor residual spraying with insecticides and treatment. "Despite a reduction in malaria cases and deaths, and cases, malaria still accounts for a larger population proportion, and affects pregnant women, and children. Globally, according to WHO, malaria causes over 400,000 deaths each year worldwide. Also, according to World Malaria report of 2022, about 96 per cent of malaria deaths globally, and 95 per cent of cases are reported in Africa. In 2021, about 563,000 people died from the disease in the continent. It is however worrying that scientists are reporting the emergence of new strains of malaria, which are not easy to detect with the current rapid diagnostic testing kits. "Re-emergence of malaria is a major worry in the fight against the killer disease. Quick interventions are required to prevent deaths and a surge in cases," said Dr Githinji Gitahi, Group CEO, Amref Health Africa. There are also resistance patterns to anti-malarial medicines. For instance, East African is reporting resistance of chloroquine drugs. "Currently, artemether drugs are being used to treat malaria, but we are seeing increased patterns of resistance. It is very worrying," said Ahaisibwe. Another researcher, Collins Mweresa who is also a senior lecturer at Jaramogi Oginga Odinga University in Kisumu said it is worrying that despite gains made in the fight against malaria, Kenya and continent is witnessing residual transmission. Residual is transmission of malaria, despite application of all tools used to fight the disease. Among technologies in place, include monoclonal antibodies, which Dr Said Jongo, a physician and epidemiologist in Tanzania, explains is introducing malaria antibodies in the human body. The antibodies destroy the malarial parasite before it enters the body. "Most children do not contract malaria because during breastfeeding, their mothers pass malaria antibodies to them, making them immune. This is how the technology works," explained Dr Jongo. Research on this innovation was successfully conducted in Tanzania, Kenya and Mali. Solar micro-grids are also an effective technology in fighting malaria. The technology successfully tried in Rusinga Island to trap malaria mosquitoes. The solar micro-grids are fixed with traps which have a smell similar to that of a human being. The traps suck in and kill mosquitoes. "With solar micro grid, there is continuous trapping of mosquitoes from the environment. The more mosquitoes are trapped, the more their population density is reduced, and the number of people likely to be bitten by infected female mosquitoes is low," said Mweresa. The technology was a success as it reduced malaria transmission from 40.8 per cent to 29.6 per cent. Gene drive is another new technology which should be adapted in the fight against malaria in Africa, according to Dr Mukabana. With the technology, male mosquitoes are engineered in labs and released into the environment to mate with their females. This modifies the wild population, making them unable to transmit malaria. Though not yet adopted in Kenya, the technology is being worked on by researchers in Africa and other research groups. Trials of the technology have been done in Bukina Faso, Uganda, Ghana and Sao Tome in Central Africa. Mukabana however regrets that it might take more years before it adapted due to laxity in its approval by policymakers. "We do not need to look for mosquitoes, let them look for one another. Genetic engineering, and gene editing, is coming with a big revolution," said Mukabana. Scientists also advise use of drone in the fight against malaria. The technology kills mosquitoes before they learn to fly, by spraying larvae in water. In Africa, the technology is applied in Zanzibar, Tanzania. Mukabana said there is also need for joined regional efforts to fight the disease. "If you control malaria in your country, it doesn't prevent that in another country, and mosquitoes will keep on migrating. This is why collaboration is key," said Mukabana. Apart from the fight against malaria, Ahaisibwe said the continent is on track towards achieving the 90:90:90 global strategy. The strategy is meant to ensure 90 per cent of the population living with HIV know their status, 90 per cent of people living with HIV are put on treatment, and 90 per cent of those on treatment suppress their viral load. However, during the pandemic, there was interruption of services offered to HIV, and TB patients, effects of which will be reported in future. Mother-child transmission might also be on the rise, as majority of mothers did not seek services in hospitals during the pandemic. "Covid-19 brought interruptions in treatment of chronic diseases like TB and HIV. Viral load in HIV patients increased, which risks transmission of the virus, more so in discordant couples," said Ahaisibwe. However, he said though more emphasis have been put in the fight against HIV and TB, there is a gap in reaching key populations like truck drivers, sex workers, gays, homosexuals and the LGBTQ community. The special population drive HIV and TB transmission. Data by WHO notes that in 2021, key populations accounted for 70 per cent of HIV infections globally. The continent is also struggling with multi-drug resistant TB. It takes longer to treat multi-drug resistance TB, as compared to the ordinary TB, which also poses high risks. Causes of multi-drug TB resistance include late detection, defaulting on treatment and delayed access to care. As per WHO, there were 451,551 new cases of multi-drug TB resistance in 2016. Unlike in the past, more cases of TB are also reported in people who are not HIV positive. About 82 per cent of TB deaths among HIV-negative people occurred in the African Region and South-East Asia Region in 2016. "An affirmative action should be done on people are not HIV positive. Most funding of TB is supplied under HIV care, which compromises access to care, by people who are not HIV positive," Ahaisibiwe said.

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