No 'plan C' drugs available, malaria progress threatened

Although a scale up of effective interventions has led to a reduction in global malaria mortality rates by nearly half since 2000, a number of challenges pose a serious threat to gains made.

One of the most concerning is growing resistance in Southeast Asia to artemisinin by the malaria parasite, according to the head of international nongovernmental organization Malaria Consortium. Eliminating malaria is the only way to get rid of drug-resistant malaria, but “our most effective drugs are under threat,” Charles Nelson, chief executive of the Malaria Consortium, told Devex.

“The big challenge with drug-resistant malaria is that when the resistance recurrence was happening in the past there was a plan B, a combination therapy that we could use,” Nelson explained. “The problem now is that plan B is becoming less viable and there is no current drug-based plan C available, so we have to stop transmission.”

Nelson took time to talk to Devex following a panel discussion in Brussels, held the day before World Malaria Day 2015 on April 25. Here’s more from our conversation:

What are the key steps to eliminating malaria on the ground?

In order to reduce parasite burden to zero, it is crucial to significantly increase the quality of surveillance, to identify the people that are hosting these parasites so that those cases are found and treated.

We also need to strengthen the response mechanism to tackle any emerging case quickly and ensure that the right drug regimen is given to eliminate the parasite from that individual. An equivalent parallel step to take is giving some prophylaxis to the population affected, to stop further transmission.

And what is the role of the global development community here? How can implementers and practitioners expedite progress?

I think what we need is getting to a level of being able to identify and diagnose the parasite. To do so we need to work together with the private sector to develop more sensitive tools and new techniques.

There are already partnerships with private sector, of course, for example with the manufacturing sector. One is the Roll Back Malaria partnership. As part of this, the private sector supports the drug industry and the medical devices industry in finding better tools and drugs to help deal with the disease.

And what new partnerships are under discussion in the sector?

There are always discussions underway on the private sector development side. In order to develop new tools, there are constantly new ideas being generated, whether it is a new insecticide to kill the mosquitoes, or a new drug, or a new diagnostic tool: As ideas are coming to light, partnerships are being created all the time, or new partners join partnerships that exist already.

There are many partnerships working on malaria already and some new ones are emerging now on the delivery side, in terms of health care delivery. There are new ideas too on the role of the private sector in reaching out to all communities, including the hardest to reach, such as ethnic minority groups, migrant and mobile populations. Here, for example, the private sector could provide the necessary prophylaxis and protection to migrant workforces, to the migrants along the borders in Southeast Asia who are moving from low-risk to high-risk areas.

And what expertise and professional profiles are lacking in the sector in order to tackle these types of emergencies?

We need to continue to track mosquitoes and parasite development, as well as people and the way they respond to the available cures. The area where more could be done is in behavioral change: We need professionals who can communicate with culturally diverse groups of people to explain to them how to use the tools available, in a way that allows these tools to be effective.

For instance, there are people in the malaria-affected regions who have bed nets but don’t use them because they don’t like the color, they don’t like the texture, because it’s too hot.

There is also a lot of concern in some areas about vaccinations. There have been places where health workers have been targeted and killed because they were injecting “Western philosophy.” We need people able to communicate to the population the sensitive things to do.

It is about the local population doing what is needed to support the elimination of malaria, because without their collaboration we can’t defeat the disease.

We also need to continue to bring through good epidemiologists and good entomologists — people that can do the surveillance and then know how to provide a rapid response to each case, as it emerges.

And your concrete call to action to the global development community on the fight against malaria?

Without concerted action, there will be a resurgence of malaria. If it spreads to sub-Saharan Africa, where 90 percent of all malaria deaths occur, the impact would be devastating.

The European Union will continue to promote a health systems approach, rather than a disease-specific approach. My call is to keep focusing on diseases until the burden is lower. At the same time, we need to be encouraging governments to take decisions about what they want their future health systems to look like and help them move toward it.

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