World Malaria Day 2024: Accelerating the development of innovative approaches to end malaria
On this World Malaria Day, under the theme ‘Accelerating the fight against malaria for a more equitable world’ we are reminded that more than 90% of malaria cases and deaths occur in Africa, where vulnerable populations such as pregnant women, infants and children are most affected. EDCTP reiterates its commitment to support the development of new and improved medical interventions for the diagnosis, prevention and treatment of malaria, as well as product-focused implementation research, to ensure that these products reach the populations that need them most. Moreover, recent results from EDCTP-supported studies offer new hope towards achieving the malaria eradication agenda.
EDCTP investment in malaria research
Research and development (R&D) for new and improved transformative tools is essential to achieve a world free of malaria. EDCTP is already supporting this R&D agenda with investments of almost €155 million under the second EDCTP programme (EDCTP2).
EDCTP2 has supported 65 projects on malaria research from large-scale international collaborative clinical research projects implemented by African-European research consortia, to projects conducted by EDCTP Fellows who are leading the malaria research agenda in Africa.
The Global Health EDCTP3 programme, which was launched in 2021, builds on the work of previous EDCTP programmes, and has invested €25 million to date to support malaria-related collaborative research. In 2024, the programme has committed an additional €30 million in a dedicated call for proposals to support research on the existing malaria vaccines and the development of new promising malaria vaccine candidates.
Vulnerable populations
Malaria disproportionately affects the most marginalised populations in society. According to the World malaria report 2023, the African region carries the heaviest burden of the disease – accounting in 2022 for about 93.6% of cases and 95.4% of deaths globally. Nearly 80% of all deaths in this region were among children aged under 5 years.
EDCTP’s malaria funding strategy has produced new interventions and tools to protect populations most at-risk, including infants and children, pregnant women and people with co-infections and co-morbidities. We invite you to read below examples of EDCTP-funded research of which some is addressing the needs of these vulnerable populations.
New malaria treatment for infants under 5kg
Positive data from the phase II/III CALINA study, part of the PAMAfrica project, demonstrated that a novel formulation of Coartem® (artemether-lumefantrine) developed for babies weighing less than 5kg has the required pharmacokinetic profile and good efficacy and safety to treat malaria in this vulnerable group. The data have been submitted for regulatory review.
Malaria prevention in pregnant women
Malaria during pregnancy can cause serious maternal and newborn health issues, especially in women living with HIV. The World Health Organization recommends daily doses of the antibiotic co-trimoxazole to prevent malaria in pregnant women living with HIV residing in areas with high malaria transmission. However, its efficacy in sub–Saharan Africa is threatened because malaria parasites are becoming increasingly resistant to the drug.
Two EDCTP-funded studies, IMPROVE-2 and MAMAH, showed that the addition of the antimalarial drug dihydroartemisinin–piperaquine (DP) to daily co-trimoxazole substantially reduces the risk of malaria infection in pregnancy.
Starting on 1 June 2024, the SAFIRE project is an ambitious adaptive platform trial project that focuses on the safety and efficacy of current malaria treatments during early pregnancy. As there is limited data on the safety and efficacy of existing treatment strategies, the project aims to generate scientific evidence that will inform treatment guidelines and clinical practice, and ultimately ensure that pregnant women have access to safe and efficient treatment options.
Extending primaquine use to children with malaria
The DPP project and its continuation IMPRIMA aim to improve children’s access to quality-assured primaquine. Several countries have already added primaquine to national guidelines as part of their malaria elimination strategy. Single low-dose primaquine has shown to be effective in blocking malaria transmission and can be used in individuals with G6PD deficiency. The DPP project is developing a child-friendly, flavoured formulation of primaquine that will be tested under the IMPRIMA project in Burkina Faso, Burundi and Madagascar. By engaging with local communities and policymakers, the project aims to support the adoption of single low-dose primaquine.
Fighting drug resistant malaria
Artemisinin-based combination treatments (ACTs) are the backbone of all currently recommended malaria treatments. The potential impact of widespread ACT resistance in Africa has been estimated at 16 million more malaria cases and nearly 80,000 additional malaria deaths annually. The MARC SE-Africa project is determining the extent of antimalarial resistance regionally and sharing the data with National Malaria Programmes and their implementation partners to protect the efficacy of current first-line malaria treatments.
A second vaccine against malaria
The RTS,S/AS01 vaccine, the first malaria vaccine approved by WHO, is in high demand but supplies are currently limited. For this reasion, additional malaria vaccines are urgently needed. An EDCTP-funded phase II trial through the MMVC project demonstrated that the malaria vaccine, R21/Matrix-M, was highly efficacious, meeting WHO’s preferred 75% efficacy target. The results of a phase III multicentre trial were equally encouraging. In October 2023, WHO recommended the vaccine for the prevention of malaria in children, and in December 2023, R21/Matrix-M malaria vaccine was added to WHO’s list of prequalified vaccines.
Enhancing seasonal malaria control programmes
Seasonal malaria chemoprevention (SMC), where all children are given antimalarial drugs at times of the year when malaria transmission is most intense, is an effective strategy for reducing the burden of malaria. SMC has been adopted by multiple countries in sub-Saharan Africa, but coverage is suboptimal – only around half of eligible children receive SMC. The OPT-SMC project is working with national malaria control programmes in 13 countries in West and Central Africa that have introduced SMC to improve the efficiency and coverage of national SMC programmes.
OPT-SMC is also working with the WHO Global Malaria Programme on the development of an SMC module within the health information system that all countries use for malaria surveillance. This will enable countries to better track and analyse their SMC activities.