Each year, as World Malaria Day comes back around, it presents an opportunity to take stock, evaluate progress and look to the future. It has felt for a number of years’ as though we take one step forward to take one step back again, but this year has seen major developments in the face of the ongoing global pandemic. There is much to celebrate – and much more to do.
1) China declared malaria-free
Following a 70-year effort, China was awarded malaria-free certification from the World Health Organization (WHO) in June 2021. This is despite reporting 30 million cases of the disease annually in the 1940s. China is the first country in the WHO Western Pacific Region to be awarded a malaria-free certification in more than three decades. Other countries in the region that have achieved this status include Australia (1981), Singapore (1982) and Brunei Darussalam (1987).
2) New approach reduces hospitalisation and deaths among children by 70%
A new study found giving young children the world’s first malaria vaccine RTS,S/AS01E and antimalarial drugs before the rainy season substantially reduces cases of life-threatening malaria in the African Sahel.
The randomised trial followed nearly 6,000 children aged 5-17 months in Burkina Faso and Mali, two countries with a very high burden of malaria. After three years, the combination of seasonal administration of antimalarials (known as Seasonal Malaria Chemoprevention/SMC) and vaccination lowered clinical episodes of malaria, hospital admissions with WHO-defined severe malaria, and deaths from malaria by about 70% compared to Seasonal Malaria Chemoprevention alone. SMC is the approach currently used in both countries
3) WHO vaccine recommendation
This year’s major story! It represents the first time a parasitical vaccine has been recommended for routine use in humans. The World Health Organization (WHO) has announced that the RTS,S/AS01 (RTS,S) malaria vaccine should be given to children in sub-Saharan Africa and other regions with moderate to high P. falciparum malaria transmission.
4) WHO World Malaria Report 2021
The first World Malaria Report to partially account for the impact of COVID on malaria control and prevention saw an uptick in mortality for the first time since the millennium.
Thanks to the incredible amount of work and effort put in by governments and organisations to mitigate the worst-case scenario of the pandemic, which could have seen a doubling of malaria deaths between 2019-2020, the increase was kept to 12 percent. This figure is still far too high, but the timing of the pandemic was such that it exacerbated the global malaria burden that had already been plateauing in recent years. Still, this remains sobering news and new methodology shows we have been underestimating the disease burden globally, most significantly in the WHO Africa region and in children aged under five years.
5) New drug approved
Tafenoquine (Krintafel) is the first new drug to be approved for the treatment of relapsing Plasmodium vivax malaria in 70 years. The approval includes a novel, 50 mg dispersible tablet that can be dispersed in water and which was developed by GSK in partnership with MMV to facilitate use in children, who are disproportionately affected by the disease.
6) New bed nets trial
First new insecticide for 40 years that’s shown to be safe and effective for use on nets could save many young lives. Unlike other insecticides which kill the mosquito via the nervous system, the effects of the new bed net mean the mosquito dies from starvation or being unable to fend for itself.
The two-year community randomised trial involved more than 39,000 households and followed over 4,500 children aged 6 months to 14 years in Tanzania. It found that a long-lasting insecticidal net treated with two insecticides, chlorfenapyr and pyrethroid (chlorfenapyr LLIN),reduced the prevalence of malaria by 43% and 37% in the first and second year respectively, compared to the standard pyrethroid only long-lasting insecticidal net (LLIN).
Chlorfenapyr LLIN also reduced clinical episodes of malaria by 44% over the two years and the number of malaria-infected mosquitoes captured by 85%.