What it takes to reach ZERO MALARIA

By Keziah Njoki

Malaria immunologist, Francis Ndungu, grew up in central Kenya where malaria is not prevalent but is now interested in understanding of how semi-immune individuals control malaria parasite growth and the associated inflammation (symptoms). He is also interested in the potential translation of that knowledge in the development of effective malaria vaccines.

His current work is in understanding how we develop immunity to Malaria . These studies are based on; long term studies of selected groups of children living with P falciparum malaria, and; in adults who have developed some immunity to Malaria being infected with the same species of malaria parasites to help researchers understand how they are protected from Malaria in Kilifi, Kenya.

What does World Malaria Day mean to you?
A day of reflection – remembering all the devastation on human life and world economies and especially in Africa, where malaria continues to cause an unacceptable level of severe disease and death.
It is also a day to reflect on our progress in malaria control so far – and there is no doubt that both cases of severe Malaria leading to hospitalisation and death have reduced significantly over the years owing to deployments of effective treatments, bed nets and vector control.

How has your experience in malaria research been?
So far good, but I must highlight that the main challenge on malaria research in our corner of the world is limited funding. This in addition to the fact that the malaria parasite is very complex means that there is still a lot we don’t know about malaria – and especially the interactions between the Malaria causing parasite and the human immune system.

What is a key highlight of your time in this field?
Although, it’s effectiveness is limited, the development of the RTS,S/AS01 vaccine (Mosquirix) has to be the main highlight. Developing a malaria vaccine, it turns out, is a difficult, expensive, and complicated venture. In fact, we have been developing malaria vaccines over many decades now, and there have been many failures. Thus, to see Mosquirix being tested in the ongoing implementation trials in Kenya, Malawi, and Ghana, is a triumph of sorts. Most importantly, this limited success shows that vaccinating humans against malaria is achievable and should be an inspiration for developing a better generation of malaria vaccines.
Having said that – I would like to congratulate the Multi-stage Malaria Vaccine Consortium group, which has just reported exquisite efficacy results for the R21/Matrix candidate vaccine, which becomes the first malaria vaccine to exceed the WHO vaccine efficacy goal of 75%. In a phase Ib/IIb trial in Burkina Faso, they found that this vaccine has a 77% efficacy among 5 – 17-month-old babies. Whilst we wait for the replication of these results in phase III trials – this is a very promising finding given that the trial was conducted in the target population.

What is the future of malaria research?
Looking back, we have succeeded in developing very powerful tools for malaria control: highly effective curative drugs and insecticide treated nets, which became very effective in bringing down malaria associated death to around 500,000 per year by the beginning of the Covid-19 pandemic, when used in combination with vector control. The historical annual death levels used to be in millions before.
Looking forward, we need to quantify the impact of Covid-19 pandemic on malaria control.
The pandemic itself has resulted in the successful use of a new technology in vaccine development: the mRNA vaccines from Mordena and Pfizer. Whether mRNA vaccines could work for malaria vaccine development or not, this development should be an inspiration to the malaria immunology/vaccinology workers to be brave in trying out new innovative ways that might bring the development of highly effective malaria vaccines closer. I am therefore looking forward to seeing more discovery research in malaria immunology/vaccine development, using both current and new technologies.
I am also looking forward to the results on the ongoing implementation trials for Mosquirix and results from several vaccine candidates that are still in clinical trials.

What would be your advice to those looking to join malaria research, where can they begin?

Oh! Why would anyone want to join such a challenging field? Of course, we need more researchers to join us, and they are welcome. They need to seek career advice from their mentors to be aware of the challenges ahead – so that they can make informed and enduring decisions for their future careers.

The WHO Global Malaria Programme coordinates WHO’s global efforts to control and eliminate malaria by: setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies, and guidelines; keeping independent score of global progress; developing approaches for capacity building, systems strengthening, and surveillance; and identifying threats to malaria control and elimination as well as new areas for action.

World Malaria Day is an occasion to highlight the need for continued investment and sustained political commitment for malaria prevention and control.

Country leaders, frontline health workers and global partners came together in a virtual forum held on 25 April to share experiences and reflections on efforts to reach the target of zero malaria.

The 2020 edition of the World malaria report takes a historical look at key milestones that helped shape the global response to the disease over the last 2 decades – a period of unprecedented success in malaria control. The report features a detailed analysis on progress towards the 2020 milestones of WHO’s global malaria strategy and a special section on malaria and the COVID-19 pandemic.

This latest report draws on data from 87 countries and territories with ongoing malaria transmission. As in past years, the report provides an up-to-date assessment of the burden of malaria at global, regional and country levels. It tracks investments in malaria programmes and research as well as progress across all intervention areas.