Greer van Zyl
Scientists at the largest malaria conference ever held in Africa, which took place in Durban last week, were upbeat about forming alliances to fight malaria on the continent.
>From humble beginnings in Dakar two years ago, the Multinational Initiative against Malaria (MIM) has burgeoned into a global movement aimed at controlling the disease that kills at least one million Africans – many of them younger than five – and infects up to 500-million people every year.
The MIM conference showed that malaria cannot be treated as a country-specific problem and scientists and control staff committed themselves to working together to find solutions to the public-health problem the disease posed.
KwaZulu-Natal MEC for Health Zweli Mkhize announced a tripartite programme involving the governments of South Africa, Mozambique and Swaziland to fight malaria in the region.
Many new approaches and breakthroughs came out of the conference. One particularly effective method of preventing malaria is the use of old- fashioned bed nets. Researchers showed that bed nets cost less than residual spraying of houses with insecticides and may be as effective.
Scientists were optimistic that a vaccine against malaria will be a reality in the next 10 years. However, they stressed there had to be an understanding of the parasite at its most fundamental level.
“The life cycle of Plasmodium falciparum is one of the great mysteries of biology, and understanding its genetic blueprint will help solve one of the most fascinating problems,” said Professor Harold Varmus, director of the United States National Institutes of Health. A vaccine which covers all the stages of the parasite’s life is already being tested.
An African-centred project aimed at pinpointing where malaria occurs on the continent is being steered by the Medical Research Council’s Durban office. The final product of this data collection will be an atlas that will help policymakers and malaria control managers to plan effectively and direct resources appropriately.
The cost of drugs and the lack of commitment from pharmaceutical companies to develop new anti-malarials was highlighted. It was pointed out that because malaria affects the poor, there is little incentive to invest in drug development. While there are more than 100 antibiotics on the market, there are only 10 anti-malarial drugs, and the threat of multi- drug resistance looms ever closer.
“Drug resistance has complicated an already dangerous disease, and we need to educate rural people about drug compliance. We also need to empower African scientists to develop new drugs, so we need to keep capacity in Africa. Collaborative work will bring down the cost of clinical trials, and it’s easier to get help from South Africa than Europe,” said Professor Ayo Oduola of the University of Ibadan in Nigeria.
A major breakthrough has been the discovery of a herb that has excellent cure rates. The herb is known as quinhaosu – common wormwood – but the active ingredient, artemisinin, appears only in certain species of the weed found in China and parts of Africa. When taken in conjunction with other anti-malarial treatment, artemisinin derivatives produce better cure rates and are the faster acting than other anti-malarial agents. The drug is effective against multi-drug resistance.
WHO is working on an artemisinin derivative, artesunate, in suppository form, which is useful for seriously ill patients in rural areas who have no access to injectable anti-malarials, and who can use it as emergency medication while they get to hospital.
Artemisinin derivatives are not freely available in South Africa, but can be released on a named patient basis through the Medicines Control Council. However, this may prove to be extremely expensive for the individual.
Greer van Zyl is head of media liaison at the Medical Research Council
ENDS