Malaria is still one of the gravest public health problems in the world, with dozens of millions of cases of the disease reported each year, mostly in sub-Saharan Africa. Even though the world has made promising advances in controlling malaria in recent years, the disease remains a massive burden on populations in the tropical belt, affecting in particular the most vulnerable (children under five, and pregnant women). Recent discoveries in malaria research are paving the way for innovative prevention methods that could transform malaria control and potentially lead to the disease’s elimination. Here’s what some of those exciting new developments in malaria research are and how they could change the face of malaria prevention as we know it.
1. The Evolution of Malaria Vaccines
RTS,S/AS01 Vaccine
The most recently approved malaria vaccine, RTS, S/AS01 commonly known as the mosquito vaccine was developed by GlaxoSmithKline (GSK) and the PATH Malaria Vaccine Initiative. RTS, S/AS01 targets the Plasmodium falciparum parasite, the deadliest malaria parasite. It is the first malaria vaccine approved for use in endemic areas.
This has already been found in phase 3 trials to reduce malaria incidence in children under five by about 30 percent in high-transmission areas. In the new experimental doubly-boosted vaccine, that protection went up to 50 percent. If an accompanying vaccine against meningitis proves added protection against deadlier forms of malaria, that might be enough to make this more accessible and far-reaching version of the RTS, S/AS01 a viable option. Eispit might be the best malaria vaccine around but it’s not a cure for malaria. Perera believes that further trials are vital to figure out how best to integrate the protection it offers into a broader strategy for combating malaria.
Novel Vaccine Candidates
Research is ongoing on next-generation vaccine candidates that could provide more efficacy and/or broader protection. For example, the R21/Matrix-M vaccine, developed by the University of Oxford, recently reported an efficacy of 77 percent in clinical trials, which would make it considerably more effective than RTS, S. It could be the basis of future malaria prevention efforts.
2. Advances in Vector Control
Genetically Modified Mosquitoes
Probably the most imaginative approach for vector control is the use of genetically modified (GM) mosquitoes. Various approaches, including those described below, have been developed.
- Gene Drive Systems: these spread genetic alterations rapidly through mosquito populations, whether by drastically reducing the mosquito population of Anopheles or by making them resistant to malaria parasites.
- Sterile Insect Techniques: Release sterile male mosquitoes into the wild. When females fertilize relevant sex-determination genes, the offspring are impotent or infertile. As this pattern repeats over the next few generations, this family does not multiply.
These genetic approaches offer the possibility of reducing malaria transmission by a factor of 100, in a very short timeframe. They also create a raft of ecological and ethical issues.
Long-Lasting Insecticidal Nets (LLINs)
thoroughly laced insecticide nets that weigh long-lasting insecticidal nets (LLINs) on the scales of time and quality Recent years have seen the development of longer-lasting insecticide-treated nets – especially those with new formulations or materials (for example, those treated with polymers that increase durability, or laced thoroughly with fast-acting, long-lasting insecticide).
3. Enhanced Diagnostic Tools
Rapid Diagnostic Tests (RDTs)
One of the most impactful molecular technologies in diagnostic medicine today is the rapid diagnostic test (RDT). This simple and reliable point-of-care method quickly diagnoses malaria, delivering results in minutes rather than hours and functioning effectively in nearly any setting, regardless of human resource limitations. Recent advances in RDT technology include:
- Emerging RDTs are better able to detect low concentrations of antigen, hence reducing the risk of false negatives, and recognize lower concentrations of antigen with near-perfect specificity, hence reducing the risk of false positives.
- Multiplex Tests: Researchers are developing RDTs that simultaneously test for more than one pathogen (eg, HIV and syphilis, or different strains of malaria). In some cases, patients might appear positive for various biomarkers when only one is involved. Importantly, even the earliest serial tests will have to differentiate among patient populations to monitor the transition from acute to chronic illness. This could help formulate new ideas about who should get tested and how to protect those with a higher burden of disease. For more information, you can visit The Conversation.
Molecular Diagnostics
In terms of molecular diagnostics, polymerase chain reaction (PCR) tests are highly sensitive and can detect parasites at levels of malaria transmission below the current level to cause illness. PCR still lags behind RDTs in terms of ease of use and expense, but increasing investment in this field is now making these molecular diagnostics more accessible and affordable aiding both early case finding and sentinel surveillance programs.
4. Innovative Drug Treatments
New Antimalarial Drugs
The increasing number of new antimalarial drugs also provides a ray of hope to control resistance and improve treatment:
- Artemisinin-based Combination Therapies (ACTs) have proven highly effective in treating malaria, especially after the disappointing results of artemisinin monotherapy. However, reports of drug resistance have emerged after 10-15 years of use. As a result, researchers are investigating new combination therapies and considering other promising compounds.
- Targeted drug development: New drug targets that work against targets of interest in the parasite proliferate. For example, new compounds are in the pipeline to treat malaria by inhibiting enzymes or pathways known to sustain the parasite during its life cycle, to circumvent resistance and the limited treatment options available.
Drug Resistance Monitoring
As antimalarial drug resistance continues to grow, robust monitoring systems have become essential for global tracking of resistance patterns and for adjusting treatment policies. Novel tools and techniques, such as molecular assays and genomic studies, are being developed for effective surveillance of drug resistance.
5. Integrated Approaches to Malaria Prevention
Combination Strategies
They increasingly recognize that using multiple layers of prevention together is a high-impact tool for malaria control. Until a malaria vaccine can prevent all cases, the most effective strategies are a combination of those that target the different steps in the parasite lifecycle. Programs designed to both vaccinate and provide prompt treatment alongside improved vector control can offer the greatest protection against the disease while also lowering transmission rates. Researchers and policymakers are working toward integrating such strategies at the local level, tailoring them to both the tools and the transmission patterns in each setting.
Community Engagement and Education
Effective malaria prevention also calls for strong community engagement and education Attitudes and behaviours related to malaria management exist at the community level. For example, communities can weigh the costs and benefits of compliance with malaria prevention and treatment tools. Research is developing an emerging body of work exploring community behavior and attitudes toward participation in malaria prevention and treatment programs at a community level. Programs that involve robust community participation in decision-making processes and educate communities about how to ameliorate malaria – in short, programs that engage communities – are more likely to succeed.
6. Future Directions and Challenges
While recent research breakthroughs offer hope for more effective malaria prevention, several challenges remain:
- Equity and Access: Every new intervention will need to reach the populations that most need it, overcoming substantial barriers to access, such as cost, infrastructure, and existing health system capacity.
- Sustainability: Long-term sustainability of malaria elimination or prevention programs will require continued funding, political resolve, and local capacity-building. This will require a research agenda not just to develop new tools, but to ensure for the duration of their use that they will be implemented and supported.
- Resistance Management: Monitoring and management of resistance to drugs and insecticides are critical to the effectiveness of malaria control efforts.
Courtesy Flickr/HumanitarianphotoSome truly exciting new developments in the field of malaria research have the potential to change the game in malaria prevention; new methods of vaccination, vector control, diagnosis, and drugs could help to dramatically curb malaria incidences and deaths. A recap of the latest developments follows.
Researchers must continue their work to translate findings into useful and affordable tools that communities affected by malaria can benefit from. Achieving the goal of eliminating malaria requires ongoing scientific innovation, sustained community engagement, and strong international partnerships.
