The first thing a patient feels is a sigh of relief Monoclonal antibodies (mAbs) are a new therapeutic approach to malaria that could eliminate targeted therapy from the toolkit but vastly transform malaria treatment and prevention. The science behind monoclonal antibodies is complex but the details can be difficult to digest. This article highlights the lived experience of malaria patients who have tested these new monoclonal antibody treatments for malaria. No statistics or oblique insights into research can compare with the experiences of those who sit on either end of the needle and have inhaled the antibodies’ fragrance, like that of new-found freedom.
Story 1: A Mother’s Hope for Her Child
Patient: Amina, a 4-year-old girl from a rural village in Nigeria.
his child Amina suffered from malaria frequently, just like a few million other children in sub-Saharan Africa. Despite her best efforts to use insecticide-treated nets and seek prompt medical care, Amina’s mother Fatima was often at her wit’s end trying to manage recurrent malaria episodes.
- Treatment Experience: Amina was part of a trial of monoclonal antibodies to avoid getting malaria. This trial was part of an effort to test the efficacy of new treatments in reducing malaria incidence.
- Impact: After the intravenous monoclonal antibody treatment, Fatima observed that Amina’s health had dramatically improved. Not only did Amina have a malaria-free season for the first time in recent memory, but she returned to her grandfather’s house riding her bicycle with a big smile on her face. ‘I was relieved to see my daughter healthy and full of energy, and the protection from the mosquitoes was a blessing. My heart will forever be grateful for the wide net of protection given by the monoclonal antibody,’ de Melo-Martins remembers her saying.
- Challenges: Despite the positive outcome of her treatment, Fatima struggled with the logistics of the treatment and the clinical trial. The remote location of their village was a legitimate barrier to the therapy (unless planes can fly just about everywhere).
Story 2: Overcoming Severe Malaria
Patient: James, a 30-year-old truck driver from Kenya.
He’s been suffering a long time from severe malaria and is often hospitalized; his job makes him travel long distances, over many weeks, through areas with very high malaria transmission, who are therefore at high risk of severe episodes.
- Experience of Treatment: James was pumped with a monoclonal antibody specific for the Plasmodium falciparum malaria parasite in a clinical trial aimed at improving patients’ outcomes and reducing malaria severity.
- Impact: Shortly after receiving his latest monoclonal antibody infusion, James said: ‘The monoclonal antibody treatment saved my life.’ I asked James how the treatments had made a difference. He said: ‘Before I received the monoclonal antibodies, I had repeated malaria infections that would incapacitate me for days. But after the antibodies, the frequency and intensity of my malaria infections vastly reduced. I was always apprehensive about contracting the disease every time I stepped outside my house. But now I can work without fear of getting malaria. For the first time in my adult life, I don’t live in fear.’
- Challenges: James’s biggest obstacle was the expense and access to the treatment. While the trial provides the medication free of charge, he had to overcome the challenges of dealing with the scheduling of travel to the trial sites and finding the time to fit his treatment regime around his full-time, demanding job.
Story 3: A Community Leader’s Perspective
Patient: Maria, a 45-year-old community health worker from Mozambique.
Maria had worked always to make sure that people knew about preventing and treating malaria. But every high transmission season invariably came.
- Treatment Experience: I’m a participant in a program that offers monoclonal antibody treatment to people at high risk of malaria in endemic areas. Thanks to my participation in this program, not only did I receive the treatment, but I gained experience serving as a ‘facilitator’ to help implement and monitor the program in my community.
- Outcome: Maria was healthier, and there were fewer cases of malaria among those she served. Maria said: It’s been a long time since I was sick. I think being part of the monoclonal antibody program has improved my health. Now I feel like people marrying me are fortunate to have me. These days, hopefully, malaria will not enter the community. That’s what I’m hoping. It’s been such a relief for us.
- Challenges: Coordinating with other health workers was difficult as well, and persuading the community to adhere to the new regimen was another challenge. However through Maria’s participation, the real-world benefits of monoclonal antibodies were demonstrated.
Story 4: A Patient’s Journey with Experimental Therapy
Patient: Ahmed, a 22-year-old student from Tanzania.
- Case: Ahmed came to study at a major university in a high transmission area but, due to the severity of his malaria, standard treatment was proving ineffective.
- Treatment Experience: Ahmed was selected to receive a treatment with a monoclonal antibody designed to provide rapid relief from severe malaria and reduce the risk of complications.
- As a result, Ahmed’s health drastically improved. ‘The treatment worked miracles for me,’ he says. ‘I was dying – I had been feeling very unwell for months leading up to getting this monoclonal antibody – and immediately, when I received this, it changed completely. I was saved. I was able to continue studying without any problems.’
- Problems: There were problems with the experimental nature of the treatment, Ahmed reported. He benefited from the therapy but did not like having to live within the narrow boundaries necessitated by scientific monitoring. There was also uncertainty about the future availability and affordability of such treatments.
The Broader Impact of Monoclonal Antibodies
The stories of these patients emphasize the game-changer role monoclonal antibodies could have in the malaria battle.
- Efficacy: We like monoclonal antibodies because they could reduce the rate of malaria and reduce its severity, thus greatly improving patient outcomes.
- Access and equity: Access to monoclonal antibodies in remote and under-resourced areas can be a challenge. Ensuring equity in all settings is essential to success with these medicines.
- Integration to Existing Strategies: Mabs works best as a preventive when combined with a broader malaria control strategy with vector control, diagnostics, and traditional treatment options.
Patient stories highlight both the potential and the problems associated with the use of monoclonal antibody drugs for malaria. As the development of these treatments continues, bringing new hope for future patients, these stories emphasize the need to ensure that innovative treatments are provided where they are most needed.
It is the potential of monoclonal antibodies to change malaria lives that will drive us to work more collaboratively across the globe, to keep researching, and to keep trying to make access better for those millions we wish to help.
