Prospects for new interventions
Boosting investments in the development and deployment of a new generation of malaria tools is key to achieving the 2030 global malaria targets. Future progress in the fight against malaria will likely be shaped by technological advances and innovations in new tools, such as new vector control approaches, improved diagnostics and more effective antimalarial medicines.
At the September 2019 Forum on Rising to the Challenge of Malaria Eradication, Dr Tedros Adhanom Ghebreyesus, WHO Director-General, called on the global health community to ramp up investment in the research and development (R&D) of innovative and transformative tools and approaches.
This message was further reinforced in the April 2020 report of the WHO Strategic advisory group on malaria eradication. The group noted that one of highest priorities for achieving a world free of malaria is a renewed research and development agenda that improves the knowledge base and products necessary for achieving eradication.
Funding for malaria-related R&D reached just over US $619 million in 2020. According to the latest World malaria report, an average annual R&D investment of US$ 851 million will be needed in the period 2021-2030.
- Malaria vaccines. The world’s first malaria vaccine, known as RTS,S,
has now reached hundreds of thousands of African children in Ghana, Kenya and Malawi through a WHO‑coordinated pilot programme. Beginning in 2019, ministries of health in each of the pilot countries led the vaccine introduction in selected areas,
in collaboration with in‑country and international partners, including WHO, PATH, UNICEF and GSK, the vaccine manufacturer. Financing for the programme has been provided by three global health funding bodies: Gavi, the Global Fund and UNITAID.
In October 2021, WHO recommended the broad use of the RTS,S vaccine for children living in sub-Saharan Africa and in other settings with moderate to high P. falciparum malaria transmission. The vaccine reduces
child illness and death from malaria and, if widely deployed, could save tens of thousands of lives every year.
RTS,S is a first-generation vaccine that could be complemented in the future by other vaccines with similar or higher efficacy. WHO welcomes recent progress in the development of R21/Matrix-M and other malaria vaccine candidates in early clinical development. The successful completion of clinical trials for these vaccines will be important to assess their safety and efficacy profiles. WHO also welcomes the news from BioNTech, manufacturer of the Pfizer-BioNTech COVID-19 vaccine, that it aims to develop a malaria vaccine using mRNA technology.
- Vector control
A number of new tools and technologies for malaria vector control have been submitted to WHO for evaluation. Should these tools demonstrate efficacy in controlling the disease, WHO will formulate new policy recommendations or amend existing ones to support their deployment in malaria-affected countries. Tools currently under evaluation include, for example, new types of insecticide-treated nets, spatial mosquito repellants, gene-drive approaches and sugar baits designed to attract and kill Anopheles mosquitoes.
- Medicines
In the field of antimalarial medicines, WHO welcomes the recent approval by the Australian Therapeutic Goods Administration of single-dose tafenoquine for the prevention of P. vivax malaria among children aged 2-15. As a single dose, tafenoquine is expected to support patient adherence to treatment. The current standard of care requires a 7- or 14-day course of medication.
A number other antimalarial medicines with new modes of action are being developed for the treatment of uncomplicated and severe malaria. Ganaplacide-Lumefantrine, currently in a Phase II clinical trial, is the first non-artemisinin combination therapy and could be an asset in fight against emerging drug-resistant malaria in Africa.
- Tackling biological threats
In addition to antimalarial drug resistance, WHO has reported on other pressing threats in the fight against malaria, such as mosquito resistance to insecticides, an invasive malaria vector that thrives in urban and rural areas, and the emergence and spread of mutated P. falciparum parasites that are undermining the effectiveness of rapid diagnostic tests. Innovation in tools and strategies will be critical to contain these threats, together with a more strategic use of the tools that are available today.