Malaria progress has levelled but new drugs are due

With progress stalling in the treatment of malaria, the development of new medicines to prevent and treat it are a top priority if we are to prevent a backward slide to the dark days of the ’90s.

Less than 20 years ago, the situation for those living in countries worst affected by malaria was dire, says George Jagoe of the Swiss not-for-profit foundation, Medicine for Malaria Venture. “Existing medications had become wooden bullets in the clinical armoury because of drug resistance,” he says. At that time, clinicians expressed frustration and despair at their inability to offer effective treatments to sick patients. The vast majority of the time, those clinicians were coping with very ill young children whose immature immune systems leave them most vulnerable to malaria.

Beginning in the mid-2000s, thanks to widespread adoption of new artemisnin-based medicines and a significant increase in R&D investments, improvements in antimalarial treatments have contributed to large reductions in malaria-related mortality rates.

Over the last decade, progress in drug treatments for children between 0–5 years (along with other interventions) have resulted in millions of lives saved, says Jagoe.

Resistance is a threat to drug efficacy

When it comes to malaria, however, drug resistance is an ever-present reality. In the latest World Malaria report, the World Health Organization noted that the trajectory of the disease had changed. Between 2014-2016 the number of deaths from malaria has increased, returning to 2010 levels. Multiple factors have contributed to this backsliding.

“As Alan Magill, a leading malarialogist, once said, worst case, we may end up running as fast as possible just to stay in place in the race to eliminate malaria – and fatigue will set in,” Jagoe says. “We need smarter deployment of our existing tools, and continued investment in better tools if we are to outrun the disease. Keeping pace with malaria by making incremental improvements will not work.”

Ensuring the continued efficacy of existing drug treatments before resistance strikes is something that keeps Jagoe and others like him ‘awake at night’, he says.

As someone whose work focuses on ensuring access to the most effective and appropriate medicines, Jagoe believes that part of the solution will require continued development of improved treatment options. A mosaic of new therapeutic options to prevent and treat malaria are being developed – as well as specific interventions such as targeted population-based treatment strategies to uproot malaria for good in specific settings.

Single dose drug by end of 2018

Fortunately, a number of new drugs in development are providing scientists with grounds for cautious optimism. This progress includes antimalarials that can prevent the disease, as well as ones to treat severe malaria, which may result from delayed diagnosis and/or access to oral treatment for uncomplicated malaria.

Another drug treatment for a relapsing form of malaria (vivax malaria) may come to market before the end of 2018, according to Jagoe, where a single dose cure could be used to replace the current 14-day treatment to stop the relapse.

The existing, 14-day therapy frequently results in poor compliance, due to the duration  of treatment. As such, Jagoe notes that the new single dose cure could prove ‘revolutionary.’

“Without new drugs we risk a return to the same situation with malaria that we saw in the 1990s,” he says. “Thankfully, more effective tools are in the pipeline so there are reasons to be hopeful.”

By Victoria Briggs

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