Malaria affects millions worldwide, and progress against the disease is stalling. Emerging drug resistance threatens to reverse hard-won gains, putting many more lives at risk. Public–private partnerships are racing to close the treatment gap before the current drugs begin to fail.

“We believe that the eradication of malaria is in sight, but it’s an ongoing challenge,” said Martin Fitchet, chief executive officer of Medicines for Malaria Venture (MMV), at a one-day scientific event on 7 October. MMV, a Geneva-based not-for-profit public-private partnership, focuses on developing and delivering affordable antimalarial drugs.

MMV’s first-ever “Science of Malaria Medicine” symposium brought together experts and practitioners from around the world to discuss the challenges and advancements in preventing and curing malaria.

According to Cristina Donini, Executive Vice President, Head of Research, Early Development and Modelling at MMV, the progress seen towards  achieving the goals set out in the World Health Organization’s (WHO) Global Technical Strategy for malaria elimination is stalling.

To stay on the path of reducing malaria cases by at least 90% by 2030, this year’s number of infections would have needed to decrease to 14.5 per 1,000 people at risk. However, current projections estimate the actual figure at more than four times higher, standing at 60.4/1000.

The African region continues to suffer the highest burden, accounting for 94% of reported cases and 95% of the 597,000 malaria-related deaths worldwide in 2023. Among the most affected are pregnant women, for whom new treatments have just entered Phase 3 trials.

Increased signs of drug resistance

A major challenge is the parasite’s ability to develop antimalarial drug resistance. With partial drug resistance to artemisinin, the backbone of standard of care, now present and expanding across multiple countries  in the African region, experts are alarmed.

This development poses an existential threat to populations at risk, warned Dorothy Achu, team leader for tropical and vectorborne diseases at the WHO Regional Office for Africa. 

The WHO forecasts an additional 78 million cases of malaria over five years in the absence of pre-emptive action. ‘This could result in over 80,000 excess deaths per year,’ she said.

Extreme weather events caused by climate change, as well as crises or conflicts that displace populations or damage public health infrastructure, exacerbate the risks.

The increased transmissibility of drug-resistant parasites, particularly in non-immune populations, as well as so-far limited deployment of new malaria vaccines, which have only recently been rolled out in Africa, also help drive resistance, she said. Companies like GSK are currently developing second-generation vaccines.

Urgency for single dose cure

Another main driver of drug resistance is patients failing to comply with the doses of multiple medications, which are  common Artemisinin Combination Therapy (ACT) treatments. The resulting subtherapeutic dosage is unable to fully eliminate the parasites from the body. In some regions, the adherence rate to a full course of treatment is as low as 40%.

To counter this, and to make treatment easier to administer for health workers and patients, efforts are underway to combine up to three different antimalarial drugs into a single dose. ‘Single-dose combinations are the way forward,’ said Joseph Okebe from the pharmaceutical giant Merck. Phase 1 trials on single-dose treatment by the pharmaceutical company Novartis in partnership with MMV are ongoing.

Additionally, researchers have yet to solve other crucial problems. Vomiting after oral administration and drug-drug interactions are common issues in antimalarial treatment, and that also may result in subtherapeutic dosage. With the single-dose approach, only one treatment is foreseen. Still, patients must be monitored for adverse effects, and countermeasures taken, if necessary. This is particularly difficult in low-resource areas.

‘A single-dose cure is a good approach, but we have to weigh the risks carefully,’ warned Omary Hassan from the Ifakara Health Institute, a leading biomedical and public health research centre in Tanzania.

Funding cuts also jeopardize malaria goals

The impact of recent, massive cuts in global health funding by major donor countries, including the United States, was another recurring thread of discussion throughout the day at the event, which drew some 100 researchers and experts from more than 16 countries.

Can the necessary funds be mobilised to finance more progress?  For instance, MMV’s new anti-malarial drug specifically designed for newborns and infants under 5 kg was launched this month in Ghana. But support will be required to ensure this live-saving formulation, and other new innovations, reach the patients that need them. See related story here:

Ghanaian Newborns First to Get New Malaria Medication

In 2023, the WHO projected that an estimated $8.3 billion would be required for that year alone, to maintain progress in the WHO’s global technical strategy for malaria (GTS) goals as the world emerged from the COVID-19 pandemic. 

However, actual funding amounted to just $4 billion in 2023. And this year, the drastic cuts to global health funding triggered by new United States President Donald Trump, are further exacerbating the shortfalls. If the current trajectory continues, analysts expect that only 60% of the necessary funding will be achieved by 2030.

Huge gains were made in the past year, with 173 million cases of malaria treated in 2024 and medical advances picking up momentum. Said Fitchet, while “‘institutions are under strain and public health sectors are struggling, scientific momentum is unfolding against a backdrop of global challenges.” See related story: 

https://healthpolicy-watch.news/global-fund-declines-in-malaria-hiv-and-tb-deaths-threatened-by-donor-aid-cutbacks-climate-and-conflict/

Image Credits: Novartis, Violaine Martin/MMV, MMV, Violaine Martin/MMV , WHO .