Myriam El Gaaloul
MiMBA co-lead, R&D Projects oversight
Maud Majeres Lugand
MiMBA co-lead, Access APM Projects oversight
“MiMBa” means pregnancy in Swahili. It also stands for Malaria in Mothers and Babies, an MMV initiative designed to accelerate discovery, development and delivery of appropriate antimalarial options for women who are of reproductive potential, pregnant or breastfeeding.
Malaria in pregnancy is a significant public health issue, with 23 million women and girls becoming pregnant in developing regions every year. Malaria causes around 10,000 maternal deaths and 200,000 newborn deaths a year, while in 2018 alone an estimated 11 million pregnant women were infected1.
Medicines for Malaria Venture (MMV) is working together with partners to combat the threat of malaria in women that are pregnant, breastfeeding or of child bearing potential. Alongside heightened global awareness and a changing regulatory environment to provide more medicines for a patient population that traditionally has not been part of clinical research before registration of a new drug, MMV has updated its strategy and is planning to intensify efforts to address Malaria in Mothers and Babies (MiMBa) through drug development and deployment strategies.
Dr Myriam El Gaaloul, MiMBa initiative co-leader, says: “There are huge concerns about the few treatment options available for pregnant and breastfeeding women, especially in the first trimester and for women who might become pregnant.
“They are generally systematically excluded from research and clinical trials for fear of causing harm, as a result, when a new drug is registered, we do not know whether it can be given safely or that it is efficacious for them. As additional data is required, most drugs become available to pregnant women 5–10 years later. We want to change that.”
Prevention is not necessarily a well-accepted concept, and many pregnant women wonder why they should take medicine if they are not sick.
Aiming to bridge the data gap
MMV’s MiMBa strategy aims to generate more evidence on existing antimalarials already on the market to speed up access for pregnant and breastfeeding women. For new drugs in development, it prioritises those that are deemed low risk to the mother and the developing foetus; and thus aims to facilitate the inclusion of pregnant and breastfeeding women in clinical trials earlier than currently practiced.
In parallel, MMV and Liverpool School of Tropical Medicine have established a pregnancy registry to capture data on the real-life use of ACTs during all stages of pregnancy, including the first trimester. It is hoped that the data generated will inform evidence reviews that could lead to policy change.
Low uptake of existing preventive treatment
The intervention currently recommended by the WHO to prevent pregnant women from getting malaria is intermittent preventive treatment in pregnancy (IPTp). This takes the form of several courses of sulfadoxine-pyrimethamine (SP) administered during routine antenatal care visits starting as early as possible in the second trimester of pregnancy.
“It is cost-effective, but uptake remains very low,” says Maud Majeres Lugand, MiMBa initiative co-leader. “Almost 30 years ago, SP was a recommended treatment for uncomplicated malaria, but drug resistance undermined its curative efficacy in the 1990s. Hence there are healthcare providers who do not necessarily trust it as a medicine for preventive treatment during pregnancy, despite its established benefits.”
“There is also the issue that prevention is not necessarily a well-accepted concept, and many pregnant women wonder why they should take medicine if they are not sick, so there is a lot of work to do on awareness raising.”
“There is a problem of access, too. If you are eight or nine months pregnant, you will not want to walk a few hours to get preventive medicine.”
Furthermore, since the onset of the COVID-19 pandemic, the issue has become more acute. “The situation is really worrying. We are anticipating the number of women infected will increase as, given the context, there is an issue with non-communication, where people are not seeking the essential care they need,” said Maud Majeres Lugand.
Addressing the access issue
To help address these access issues, MiMBa is supporting projects to explore the impact on uptake of IPTp-SP of including community health workers as part of the delivery mechanism to reach out to pregnant women where they live.
A call to action to prioritise IPTp for pregnant women was launched in 2015, but, as uptake remains low, the Malaria in Pregnancy working group from Roll Back Malaria, of which MiMBa is part, is taking the fifth anniversary this year as an opportunity to renew the call. The first part of this will involve a media briefing on malaria in pregnancy on October 6, which will be open to all.
“We want all organisations and stakeholders to continue to sustain their efforts to prioritise the critical intervention,” said Maud Majeres Lugand. “Though we have some way to go, the only way we’ll get there is by working together across organisations, sectors and with the women at risk.”
1 WHO World Malaria report 2019