The human cost of malaria affects countless families worldwide – including my own. As a young man, my grandfather suffered with the disease whilst serving with British troops in India. He described it as having ‘stolen a year of his life’, but that his long illness paled in comparison to the suffering of the local population.
Today, almost half of the world’s population is at risk from malaria infection, which is the case of 600,000 deaths each year. Whilst successful treatments are available, the spectre of parasite resistance is emerging.
As an early-career scientist, I am fascinated by the biological challenges in tackling resistance – however, I feel that scientific development can only take us so far, and that many of the key challenges we face are in the sharing of data, resources and the logistical burdens of delivering treatment. When faced with the emerging public health threats that arise from globalization, such as the quick way resistance to a disease spreads across international borders, it is clear to many of us new researchers that global coordination and collaboration across sectors is key to moving forward.
On World Malaria Day, I want to highlight the vital work of some global health partnerships are already doing to prevent the spread of antimalarial resistance.
The Emergence of Resistant Malaria Parasites
The most lethal form of malaria is caused by infection with the parasite species Plasmodium Falciparum. The current frontline treatment for this infection is artemisinin combination therapy (ACT). Worryingly, resistance to ACT has emerged in the Mekong region of Southeast Asia and its continued spread is monitored rising cause of concern for scientists and the global health community. Resistance affecting other lethal parasite species such as Plasmodium Vivax has also been documented.
Defined as the ability of the parasite strain to survive or multiply despite the successful administration of a drug, resistance may occur due to a variety of causes. These range from specific quirks of parasite genetics, to the practical realities of incorrect drug use and administration and the proliferation of counterfeit and substandard medicines.
In order to effectively tackle the range of causes of resistance, the World Health Organization (WHO) used its 2011 Global Plan for Artemisinin Resistance to call for a five-pillar strategy to reduce resistance spread. I think there are two main themes that are of particular importance: research and development to allow the release of new, effective antimalarial medicines; and simultaneously monitoring drug use effectively, to ensure proper use of anti-malaria treatments and to increase early detection of drug resistance spread.
Prevention through Partnership
I do not believe that isolated research groups, NGOs, public sector initiatives or companies can tackle the pervasive issue of resistance. Much of the recent groundbreaking progress to defeat malaria and counter resistance has been made through the efforts of several important partnerships working in afflicted countries. I found two of these partnerships particularly striking: the Novartis Malaria Initiative and the Medicines for Malaria Venture.
One of the key problems with drug administration is the provision in countries with inadequate health systems of artemisinin drugs at either an incorrect dosage or without the accompanying combination therapies. The Novartis Malaria Initiative, comprised of partners that span advocacy NGOs, research institutes from Switzerland to Kenya, national governments and multilateral donors, focuses on improving access to treatment, working to provide access to quality-assured ACTs in malaria endemic regions, alongside education and training to allow local communities to deliver the drugs effectively.
This partnership has also historically delivered anti-resistance products, with the first of its kind release of Coartem® in 1999. This is a fixed-dose artemisinin-based therapy, which is provided free-of-charge for public sector use in Africa. The treatment combines an artemisinin derivative with another compound, which in combination acts to reduce the risk of resistance compared with other treatments. It is also available as Coartem ® Dispersible, a sweet-tasting, easily dissolvable form to improve delivery of the bitter-tasting therapy to children. Since 2001, over 800 million treatments have been distributed across Africa, Southeast Asia and the Pacific.
Another partnership driving product development is the Medicines for Malaria Venture (MMV). This is a product development partnership (PDP)that involves both public and private partners in research, developing and facilitating delivery of new malaria treatments. MMV is working with hundreds of dedicated experts to build the largest pipeline of antimalarials in history.
One key aim of this partnership is to provide a drug portfolio broad-enough to outflank emerging resistance. MMV supports in the early discovery phases of drug research which has led to screening of over 5 million compounds for their potential to act against malaria parasites. MMV-supported projects have also taken a clear stance on accessibility and have released data on active molecules into the public domain.
The Novartis Malaria Initiative and MMV show that by acting across several different strategies to combat malarial resistance, cross-sectorial partnerships can break down barriers between organizations. They can provide a forum to safely share data and research materials for the benefit of the entire research community and, ultimately, people the world over in need of innovative treatments.
Ultimately, I believe that the success of releasing of new treatments currently in the R&D pipeline and ensuring their effective delivery will largely depend on such partnerships. Working together, we may prevent the further spread of resistant malaria, and in doing so, prevent the countless deaths and suffering from continuing down the generations.
World Health Organization, Global plan for artemisinin resistance containment (GPARC), January 2011