New tools are needed for the fight against malaria, experts tell Congress

On November 18, malaria experts from around the world gathered in Washington, DC, to discuss the critical role of new drugs, vaccines, and other tools in the fight against malaria. Speakers at the Capitol Hill briefing, which was attended by a large audience of congressional and US agency officials, called for continued and increased US investment in the scale-up of current interventions, and in research and development for more effective tools to combat malaria.

The briefing was co-sponsored by the American Society for Tropical Medicine and Hygiene (ASTMH), PATH, and Malaria No More, in cooperation with US Representative Adam Smith (D-WA) and Senators Sam Brownback (R-KS), Richard Durbin (D-IL), and Patty Murray (D-WA).

Dr. Kent Campbell, director of PATH’s Malaria Control Program and chair of the ASTMH Advocacy and Policy Committee, opened the briefing by thanking the US government for its critical support and investment for malaria. US-led research and development in malaria over the last several decades has resulted in many front-line interventions that are used today, such as bed nets and drugs. However, the road to malaria elimination is long, Campbell noted, and many barriers still exist. Elimination of malaria will not be possible without continued investment in the development of new tools to control the disease.

“We know that the tools we have to control malaria today are fragile,” Campbell said. “We know that we will always need better drugs. We know that we will always need better insecticides. We know that we will need tools and approaches that we have not yet even envisioned.”  

Dr. Elizabeth Chizema, director of technical support services for the Zambia Ministry of Health, told of the country’s great strides in malaria prevention and control through the scale up of existing interventions like bed nets, indoor residual spraying to kill mosquitoes, and preventive medicines. As the former coordinator of the National Malaria Control Centre in Zambia, Chizema has seen firsthand the progress that can be made against malaria in just a few years when countries have the resources and necessary tools.

Since 2002, Zambia has distributed more than 6 million bed nets, increasing coverage from 14 percent of the population to 63 percent today. The country has also made significant progress in increasing indoor residual spraying, now reaching half of Zambia’s 72 districts. Through these efforts, more two-thirds of Zambians are being protected from malaria.

Dr. Alan Magill, director of experimental therapeutics at the Walter Reed Army Institute of Research and chair of ASTMH’s Clinical Group, provided detailed insight into the need for continued and increased investment in the development of new drugs to control and treat malaria while continuing current efforts to combat the disease.

Likening the quest for effective antimalarial drugs to an arms race, Magill stressed the importance of staying one step ahead of this evolving disease. He noted that the emergence of drug resistance has historically required the development of new drugs to continue to fight malaria as it adapts and becomes resistant to current treatment. Recent reports from the Thailand-Cambodia border suggest that malaria is becoming resistant to artemisinin, a common antimalarial drug.

“We’re trying to kill parasites faster than they can mutate to get around our ‘arms,’ our drugs,” Magill said.

Dr. Tom Monath, a partner at the venture capital firm Kleiner Perkins Caufield & Byers who spent 25 years in public service, shared the significant and exciting progress in malaria vaccine development and applauded the many US government agencies that support these efforts. Monath noted how vaccines have been successful in preventing diseases such as smallpox, whooping cough, and measles. “The impact of vaccines on human health is really hard to exaggerate,” he said.

GlaxoSmithKline Biologicals and the PATH Malaria Vaccine Initiative have made significant progress toward creating a vaccine against malaria by developing RTS,S, the world’s most clinically advanced malaria vaccine candidate. Phase 3 testing of RTS,S is currently underway at sites in seven African countries. If approved for use, this vaccine will likely be 50 percent effective against clinical malaria in infants and young children.

“Ultimately, we’ll need a better tool, better vaccines,” Monath said. “We must invest in innovation.”

Dr. Patricia W. Njuguna, of the KEMRI-Wellcome Trust Research Programme, is the principal investigator at the RTS,S clinical trial site in Kilifi, Kenya. She highlighted the excitement generated by the start of the RTS,S phase 3 trial and shared her unique perspective on the need for new malaria tools.

As an African, a pediatrician, a research scientist, and a parent, Njuguna said she is concerned about tackling malaria. RTS,S has the potential to save hundreds of thousands of lives in Africa.

Great progress has been made in preventing and controlling malaria in recent years—progress that has emboldened the malaria community to speak of malaria elimination and eradication. The message from public health experts and malaria scientists was clear: to continue on the path toward a world without malaria, we must invest in innovation for the next generation of tools to combat this disease.

• PATH’s work in malaria control
• The PATH Malaria Vaccine Initiative

Photo: PATH/Jenny Lyons.

Posted December 2, 2009.