‘Let’s do more to end malaria...

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Joint statement: Scientists update on residual malaria situation

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Dar es Salaam, November 29, 2017. Ifakara Health Institute (IHI) Chief Executive Director (CED), Dr. Honorati Masanja, has challenged scientists and other partners in the global fight against malaria to evaluate and step up measures taken to eliminate the disease.

Addressing scientists from Africa, Asia, Europe and America attending the Residual Malaria Transmission workshop in Dar es Salaam, Dr. Masanja (pictured) said, “This forum has come at an opportune time. The World Malaria Report 2017 has just been released and results show that we are not doing very well.”

He added, “This is not good. Why we experience a revise trend? Why are we going back? We need to ask ourselves, what and where the problem is. Is it because we’re not investing enough?”

The WHO has released the World Malaria Report 2017 report today. The report draws on data from 91 countries and areas with ongoing malaria transmission.

The information is supplemented by data from national household surveys and databases held by other organizations, says the WHO in a statement posted on its website.
The WHO says, this year’s report shows that after an unprecedented period of success in global malaria control, progress has stalled. In 2016, there were an estimated 216 million cases of malaria, an increase of about 5 million cases over 2015. Deaths reached 445 000, a similar number to the previous year.

IHI in the global fight against malaria

IHI is proud to be part of this success and growing movements to end malaria for good.

Bed net trials and uptake into national malaria control policy: IHI contributed significantly in the early evaluations of bed nets for malaria prevention. In recent years, IHI scientists also comprehensively assessed the potential of combining long-lasting insecticidal bed nets and indoor house spraying with residual insecticides. IHI is now an active participant in the evaluation of new generation bed nets and IRS through collaborations with industry and IVCC.

Improved understanding of malaria transmission and control: IHI scientists have been tracking malaria transmission, its epidemiology and control in various parts of Tanzania for many years. This has contributed significantly to the current understanding of the disease dynamics and effective control measures.

Examples include the early characterization of clinical malaria in Tanzania, and observations of non-seasonality of malaria transmission in areas of intense malaria burden. Now, there is some interesting work on Test Treat Track for elimination in Zanzibar.

Malaria drug resistance monitoring: IHI scientists were instrumental in the analysis of the drug-resistance patterns associated with chloroquine, formerly the first line malaria treatment in Tanzania, and then sulfadoxine-pyrimethamine (SP), which was introduced after chloroquine resistance spread widely. Findings by IHI scientists were used to inform policy change in 2001 from chloroquine to SP and again in 2006 from SP to Artemisin Combination Therapy (ACT).

Malaria drug formulations for children: After the introduction of ACTs for treatment of uncomplicated malaria, Coartem®, which was a fixed dose combination of artemether and lumefantrine was widely used and consistently achieved very high cure rates exceeding 95% in clinical trials.

Unfortunately, while these doses were great for adults, they were not effective for children, for whom the tablets had to be crushed and mixed with water. Our scientists, together with partners, evaluated a formulation of AL specifically designed for children.

The tests included randomized single-blind multicenter trials hosted in Benin, Mali, Kenya, Mozambique and Tanzania, where this new dispersible formulation was compared with crushed commercial tablets. This new formulation, Coartem Dispersible achieved >96% cure rates in trials conducted in Africa.

Malaria diagnosis policy change: Tanzania has implemented a policy requiring the use of malaria Rapid Diagnostic Tests (mRDTs) in health facilities since 2008. The mRDTs were required for confirming malaria cases at all levels and throughout the year, complementing light microscopy where this is present.

IHI scientists were not directly involved in the large-scale cluster randomized trials of mRDTs against microscopy, but they contributed in multiple ways to the influential complementary studies, which strengthened the case for sustaining the mRDT policy in Tanzania.

Global policy on net distribution and coverage: Until 2006, malaria control programs prioritized pregnant women and children below the age of 5 years when distributing mosquito nets. Unfortunately, community level impacts achievable by targeting all people of all age-groups were largely ignored, and therefore it was difficult to ascertain equity.

Using demographic, epidemiologic and entomological data generated from several studies before they were incorporated into mathematical models simulating mosquito life cycle processes, IHI scientists and partners estimated coverage thresholds for entire populations at which individual protection obtained from bed nets matched community level protection, which was then considered as the reasonable target coverage.

The WHO considered the contribution and revised the policy of net use and began, promoting wider coverage including mass distribution covering all bed spaces, while retaining a critical focus on pregnant women and children.

Vaccine Trials (RTS,S/ASO1 and Second Generation Vaccines): Perhaps IHI’s most commonly known contribution is our work on the malaria vaccine, RTS,S/ASO1 (Rts 2015). Our scientists have been part of these trials through both Phase II and Phase III studies.

In mid 2000s, we evaluated the safety and immunogenicity of an earlier version, RTS,S/AS02D, in infants in Tanzania, including feasibility of incorporating this vaccine into the standard WHO Expanded Program of Immunization in a Phase 2B trial conducted by Dr. Salim Abdulla and team.

The conclusions of these early studies were unequivocal; that the use of RTS,S/AS02D vaccine in infants had a good safety profile, did not interfere with the other EPI vaccines and also reduced malaria infection in the infants.

In later studies, in which IHI also partnered as a member of a network of 11 other African sites, the vaccine candidate prevented a substantial number of clinical malaria cases in young infants and children, when administered with and without a booster. It’s now considered as having great potential for malaria control when used in combination with other effective control measures, especially in areas of high malaria transmission.

The RTS, S/AOS1 is now widely accepted to provide significant protection against both clinical and sever malaria in African children and has been very favorably evaluated by the European Medicines Agency and also by the WHO Global Malaria Advisory Policy team, which recently proposed the first pilot studies to monitor the vaccine through Phase IV studies. It’s now expected that this will be the first ever malaria vaccine to be used in African children, and will initially be manufactured by the GSK.

IHI scientists have also recently began working on second generation malaria vaccines, relying on live sporozoites injected in humans to prevent new infections. The institute recently completed the first ever controlled human malaria infections, where healthy adult Tanzanian were injected intradermally with aseptic, purified cryopreserved Plasmodium falciparum sporozoites (PfSPZ).

These studies are on-going and we believe they will set forth a new wave of malaria vaccine studies, leading to even greater protection and possibly providing more realistic options for eventual malaria elimination.

These trials open new ways to assess innovative vaccine candidates and also demonstrate improving capacity of institute in the fight against infectious diseases. IHI is now firmly established as a dependable site where such studies could be conducted in the future.

Dar es Salaam Urban Malaria Control Program: It is important to highlight at least one specific large program that Ifakara Health Institute undertook from scratch to the end. In 2004, IHI, together with partners (Swiss TPH, Havard School of Public Health, Valent Biosciences) established the Dar es Salaam Urban Malaria Control program, which consisted of a large scale larviciding campaign in the city.

Vector Biology and Control: Currently, the institute has one of the largest group studying field biology, ecology and control of malaria vectors anywhere in the world. Studies by this group, both historical and the more recent ones starting in 2004 have been particularly instrumental in filling the gaps for vector control, particularly in the fight against malaria.

This group focuses on development and evaluation of new interventions against malaria vectors and has channeled multiple innovations in the past decade. It’s within the Environmental Health and Ecological Sciences (EHES) department that most of the IHI’s malaria vector research is hosted. There are numerous opportunities for enthusiastic African researchers to establish a viable career with medium to long-term agenda.

This vibrant group has postdoctoral scientists and collaborators, mostly in their 30s and early 40s, plus post-graduate students, collectively working on the ecology and prevention of mosquito-borne illnesses, water and sanitation related illnesses and malnutrition. #

 

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