Let’s exploit innovations to reduce malaria disease burden

About 3.5 million new clinical cases of malaria and 10,700 deaths are recorded in Kenya yearly, according to the Centers for Disease Control and Prevention. Now more than ever, concerted efforts by stakeholders are needed to counter the growing threat.

As the world recently marked World Malaria Day, WHO called for a more diverse toolbox; investments and innovation that bring new vector control approaches, diagnostics, antimalarial medicines and other tools to speed up progress. However, it’s important to note that adoption of new technological innovations alone may have little impact on disease transmission in the long term, if not properly implemented.

For vector control, a large number of tools targets indoor-biting populations. These interventions are losing effectiveness by the day and are no longer adequate in many settings where transmission is now significantly sustained by outdoor-biting populations.

Novel models such as the use of larvicides, odour-baited mosquito trapping systems and attractive toxic sugar baits could provide cost-effective and scalable angles of attack for the control of outdoor-biting vectors and offer versatility in the way they can be dispensed in various settings.

Endectocides, where humans act as vector control, include the use of a drug that’s lethal to mosquitoes if they bite humans. Genetic modification of mosquitoes, though far-fetched in the minds of many, can be the real game changer as it has the potential to get to even remote areas and doesn’t discriminate against any class, rich or poor. Sustained success will require these and other vector control approaches that combine cost-effectiveness, scalability and sustainability.

In diagnostics, access to malaria diagnosis outside health facilities to more peripheral communities beyond the reach of microscopy is needed. A highly sensitive point-of-care field test is needed to rapidly detect low-density parasitemia and identify all infected individuals, enabling immediate treatment.

A hand-held devise model distributed to community health workers for door-to-door screening and diagnosis would be welcome, especially in endemic areas. If possible, non-invasive diagnostic testing for mass screening, such as saliva-based diagnostics and urine-based tests, would be most ideal. Such innovations need government funding or private partnerships to spur uptake, especially in resource-limited areas.

As part of the malaria elimination agenda, simpler courses of treatment that are active against emerging resistant strains of the parasite may be more promising. Current treatments are taken over three days, and compliance with the full course of treatment is poor.

A medication allowing a single-dose cure, and, therefore, directly observed therapy, would be ideal. Additionally, scaling up innovative approaches like the use of text message reminders to increase adherence to medication may also reduce the risk of drug resistance.

There is also need for cost-effective seasonal malaria chemoprophylaxis for vulnerable groups and better drug formulations, especially for the paediatric population.

There is a growing appreciation that vaccines combining multiple targets and stages will be required for achieving and sustaining elimination.

The Malaria Vaccine Technology Roadmap, updated in 2012, outlines that by 2030, vaccines should be developed that provide at least 75 per cent efficacy against clinical malaria, reduce transmission, and can be deployed in mass campaigns. The ideal vaccine would be one that protects individuals against disease and/or Plasmodium infection and stops transmission of multiple species (and strains).

No single tool that is available today will solve the malaria problem. However, if innovative approaches are properly implemented in an integrated and complementary manner, we will sustain and build upon the impressive reductions achieved to date, significantly enhancing the prospects for elimination.

Dr Catherine Gathu is a consultant physician and programme director at the Department of Family Medicine, Aga Khan University Medical College, East Africa.