Highlights: "Innovate, invest and implement innovation" is the theme of World Malaria Day this year 2023. The disease still killed nearly 600,000 people in Africa in 2021. The range of new solutions is expanding to circumvent the resistance of the parasite or its vector, the mosquito, to drugs and insecticides. Two new nets have been developed, BPO Nets and G2, which combine a pyrethroid with another product. A new, simpler method of administration is advocated for children under 5 years of age (86% of malaria victims) in Sahelian regions.

"Innovate, invest and implement innovation" is the theme of World Malaria Day this year 2023. The disease still killed nearly 600,000 people in Africa in 2021, but...

Malaria: innovations in the face of parasite resistance

Photo taken in Ndhiwa, Homabay County, western Kenya, on September 13, 2019, during the launch of the malaria vaccine in Kenya. AFP - BRIAN ONGORO

Text by: Claire Fages Follow

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Innovate, invest and implement innovations is the theme of World Malaria Day this year 2023. The disease still killed nearly 600,000 people in Africa in 2021, but the range of new solutions is expanding to circumvent the resistance of the parasite or its vector, the mosquito, to drugs and insecticides.

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In Africa, 29 countries found that the insect had become resistant to pyrethroids (or pyrethroids).

In response, two new nets have been developed, BPO Nets and G2, which combine a pyrethroid with another product, pyriproxyfen or chlorfenapyr. Where the first was deployed, "malaria mortality has fallen by 40%," says Dr. Corine Karema, Acting Executive Director of the Roll Back Malaria Partnership.

Researchers at Imperial College London also measured a decline in malaria in the five countries where the second malaria was tested (Cameroon, Côte d'Ivoire, DRC, Tanzania and Togo).

New mosquito nets, new child prophylaxis

The disadvantage of these new nets is that they are expensive. WHO and Unitaid are working with pharmaceutical companies to lower their production costs as the market grows. Still imported into Africa, they could eventually be produced locally.

On the treatment side, a new, simpler method of administration is advocated for children under 5 years of age (86% of malaria victims) in Sahelian regions where the parasite is very seasonal.

Seasonal chemoprevention (SPC) consists of a three-day treatment, for four months, just before the rainy season.

It has worked very well in Senegal and Burkina Faso, with a decrease in the prevalence of malaria in communities " says Dr. Karema.

Widely distributed since 2020, this prophylaxis was adopted in 2021 by 13 African countries including Benin, Niger and Togo.

RTS,S and R21: rush for new vaccines

The result of thirty years of research, two vaccines have been developed for children under 5 years of age. The RTS,S developed by GSK, the first malaria vaccine in history, licensed by the World Health Organization (WHO), is to be administered in four doses, the first year, with one booster per year.

"Already implemented in three African countries (Ghana, Kenya and Malawi), it has been requested to the Gavi Vaccine Alliance by 21 countries on the continent for implementation next year. ", the time to prepare the logistics and raise awareness among their population. Gavi was able to mobilise USD 160 million from 2022 to 2025.

Another promising serum is R21 Matrix-M, designed by Novavax to induce a greater antibody response to the parasite.

It has been tested in Burkina Faso and is 75% effective after 12 months in children ».

Still in the study phase (second test phase out of four in total), it has not yet been approved by the WHO, but two countries, Ghana and Nigeria, did not wait for this green light to approve it on their own. These states have well-established regulatory structures and were likely motivated by the pharmaceutical group's promises to set up a manufacturing plant in Ghana and donate doses to Nigeria.

Waiting for the genetically modified mosquito

Another promising avenue of research is that of genetic modification of mosquitoes, which is in its second phase of testing.

After working on the production of sterile males, the researchers favor the track of the "biased male", where we end up with a male offspring at 95%, to limit the reproduction of this insect vector of malaria, but also to limit the transmission of the parasite, knowing that it is the female anopheles that bites humans.

This genetic trail will not be operational for a few years, according to Dr. Lea Pare Toe of the Burkinabe Institute for Research in Health Sciences and responsible for the impact of stakeholders in Target Malaria's research.

The technique could, according to her, also be very useful in the future to fight against a new vector that has appeared in African cities, the Asian mosquito (Anopheles stephensi).

Already present in eight African countries, from east to west of the continent (Djibouti, Eritrea, Ethiopia, Kenya, Somalia, Sudan, then Ghana and Nigeria), it is a new and great challenge for the fight against malaria in Africa, in a context of galloping urbanization.

► Read also Fight against malaria: "The RTS, S vaccine is a good solution"

► To listen also Malaria: mosquitoes of the insectarium of the Centre for Immunology of Infectious Diseases studied

Malaria: innovations in the face of parasite resistance

Malaria: innovations in the face of parasite resistance

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