Scientists and experts from different backgrounds came together to discuss latest findings in malaria research, control and eliminationAt the approach of World Malaria Day on April 25, the Multilateral Initiative on Malaria (MIM) celebrated its 7th Pan African Malaria Conference in Dakar, Senegal, from April 15-20. During five intensive days, scientists and experts from different backgrounds came together to discuss latest findings in malaria research, control and elimination. The Malaria Elimination Scientific Alliance (MESA) asked four correspondents (including Helena Marti Soler from ISGlobal) to deliver live daily reports direct from Dakar. Here are some highlights selected from those daily posts.
Pedro Alonso during his lecture at the 7th MIM Pan African Malaria Conference, in Dakar, Senegal
Opening the congress
Pedro Alonso (Director of WHO's Global Malaria Programme) expressed his concern that funding has plateaued over the past years and a significant number of countries are going backwards.
Pedro Alonso expressed his concern that funding has plateaued over the past years and a significant number of countries are going backwardsIn fact, the malaria world seems to be divided in two groups: those countries approaching elimination and those where cases have increased. Fred Binka (University of Health and Allied Sciences, Ghana) underscored the need to develop a malaria elimination data base and the importance of strong but flexible health systems as a vehicle to reach zero transmission.
More sensitive diagnostic tools to detect subclinical infections are neededPopulation-wide interventions to approach elimination were presented. In Southern Mozambique, intra-residual spraying plus two massive drug administration (MDA) rounds significantly decreased disease prevalence but did not stop transmission. Similar results were obtained in Zambia.
When aiming at elimination, a critical question is whether zero cases means zero transmission. More sensitive diagnostic tools to detect subclinical infections are needed, although ultrasensitive RDTs may only have marginal benefits. Easy access surveys in children and serological surveys were proposed as complement to clinical surveillance data.
Intermittent preventive treatment has been used successfully to protect pregnant women (IPTp)The P. falciparum sporozoite vaccine, with more than 30 clinical trials (one planned in Indonesia in 2018) has given promising results in terms of protection. New versions are currently being developed with genetically attenuated or in vitro produced sporozoites. A multistage subunit vaccine (targeting antigens expressed at different life stages of the parasite) is also under development and has shown to have a good safety profile. Transmission blocking vaccines, which target the development of Plasmodium parasites within the mosquito, are also promising but will require mass administration to achieve herd immunity and reduce the incidence of infections.
Intermittent preventive treatment has been used successfully to protect pregnant women (IPTp) and some attempts have been made in infants (IPTi) and children (IPTc). However, chemoprevention must be combined with other health interventions and long-acting drugs need to be developed.
Correspondent Helena Martí Soler, from ISGlobal, in the openning event of the conference
Controlling the mosquito
The global community cannot afford to be complacent about the increase in insecticide resistance Hillary Ranson, technical advisor to the Innovative Vector Control Consortium (IVCC), underlined that the global community cannot afford to be complacent about the increase in insecticide resistance despite the lack of evidence of wide-scale impact on the personal protection provided by nets.
One of the most promising strategies in malaria control and elimination is the genetic modification of malaria mosquitoes, particularly through gene drive technology whereby new traits deliberately introduced in Anopheles can rapidly spread through the wild population (making them for example refractory to malaria parasites or more likely to die). Uganda and other African countries are working not only on the science but on the regulatory affairs and stakeholder engagement issues this type of approach requires. If successful, gene drive approaches would have a high impact for the large-scale and rapid control of malaria transmission. An increasing number of African scientists have been trained in gene drive technologies by the Pan African Mosquito Control Association (PAMCA) and Target Malaria. Mobile Insectary Laboratory modules will enhance tests and evaluations of genetically modified mosquitoes in diseases endemic countries.
Keeping an eye on the parasite
One major challenge to malaria elimination is the emergence of artemisinin-resistant parasites in South East Asia. Evidence presented in the congress indicates that artemisinin resistance in Africa may involve additional mutations than the K13 mutations observed in Asia. Given the threat posed by artemisinin resistance, the Medicines for Malaria Venture (MMV) hopes to find new non-artemisinin therapies for severe malaria by 2024.
The Plasmodium Diversity Network Africa [...] is aiming to build capacities in the handling of big data generated by genomic and bioinformatics approachesIn this regard, the Plasmodium Diversity Network Africa (PDNA) is a valuable initiative. It is a pan African network of researchers from 15 institutions aiming to build capacities in the handling of big data generated by genomic and bioinformatics approaches. The potential use of these data for detecting parasite origin and flow, identifying markers of adaptation to interventions, and tracking the spread of drug resistance was presented.
Along this line, a symposium organized by the European & Developing Countries Clinical Trials Partnership (EDCTP) addressed the opportunities and challenges of capacity development and networking in key areas of clinical research in Africa.
One session of the congress focused on different aspects of the other most relevant malaria parasite: Plasmodium vivax. Although less deadly, vivax malaria is a problem in many parts of Africa and the speakers highlighted the need to include it in the malaria elimination agenda.
Youssou N’Dour closed the gala dinner with a concert
Singing with Youssou N’Dour
The gala dinner gathered old and new friends around the table and represented the perfect occasion to honour key members of the malaria community. The cherry on the top: Youssou N’Dour closed the night with what the correspondents called a memorable performance.