Breakthroughs Blog: Malaria

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign-up now to receive our weekly R&D News Roundup email. A large-scale study has shown that monthly injections of two long-acting HIV drugs are just as effective as taking daily pills. The phase III study, led by ViiV Healthcare—a London-based collaboration between GlaxoSmithKline and Pfizer—tested an experimental drug, cabotegravir, and rilpivirine in 618 HIV-infected people from 13 different countries over a 48 week period. It found HIV viral suppression levels were the same in both individuals taking daily pills and individuals receiving a monthly injection of each drug. Long-acting HIV medications have the potential to transform the way HIV is both treated and prevented, offering an alternative option for people who find it challenging to adhere to taking daily pills. It is possible ViiV could apply for regulatory approval for these drugs as early as next year. The world could be one step closer to a universal flu vaccine, according to a study out of the University of Pennsylvania Perelman School of Medicine. Researchers there have developed a flu vaccine candidate that was found to elicit a strong antibody response to a structure on the surface of flu viruses, called the hemagglutinin (HA) stalk and protect mice from infection of various flu strains. The HA stalk has been a target for universal flu vaccines as it does not vary from one flu subtype to another, unlike seasonal flu vaccines that target the “head” region of the HA protein which tends to mutate rapidly and varies by flu type. The experiment was repeated successfully in ferrets and rabbits. The scientists’ next step is to test the vaccine in non-human primates and then humans. A group of students at Makerere University in Kampala, Uganda have invented a low-cost, reusable device to detect malaria quickly without drawing blood. Deemed a “game changer” by the Royal Academy of Engineering, which recently honored the product’s research team with its Africa Prize for Engineering Innovation, the simple device, called Matibabu, uses magnets and a matiscope to detect the deadly disease. A matiscope is a custom-made device that shines a red beam of light on to a user’s finger to detect whether a substance known as haemozoin crystals, a by-product of the malaria parasite, is present. The latest prototype of the device only requires two minutes to detect malaria, as opposed to 30 minutes or more when using a microscope. Since no blood is drawn, the device has the potential to be administered by non-specialists at the community level. The inventors of the device still have a few hurdles to overcome. For example, the current model only detects 80 percent of malaria cases, which misses the mark of the international norm of 99 percent. With supplemental funding, the developers hope to further refine the device and bring it to market within two years.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign-up now to receive our weekly R&D News Roundup email. Clinical trials have begun for the latest vaccine candidate against the Zika virus. The trial, which will include 28 adult participants, will test the safety and immune response from the vaccine, which contains a weakened form of the virus created from the combined genetic material of different viral strains. If the vaccine candidate is found to be safe, it could be added to another vaccine candidate currently undergoing testing for effectiveness against four types of dengue—creating a single vaccine against both diseases. Both vaccine candidates were developed at the National Institute of Health’s National Institute of Allergy and Infectious Diseases. On August 10, the US Food and Drug Administration approved Annovera, the first-of-its-kind self-insertable contraceptive vaginal ring that can be used for an entire year. Annovera, developed by the Population Council, is being heralded as a revolutionary new option for low-income women as it can be used for a year without a return trip to the physician or pharmacy and does not require refrigeration. Along with the benefits it offers regarding convenience, Annovera also offers women versatility. “Annovera offers the convenience of a long-acting method like the IUD because there is no daily action needed, but the control of a short-acting method like the pill because a woman can start or stop it at any time,” said Julia Bunting, president of the Population Council. Although pricing for Annovera has not yet been made public, the Population Council is continuing its efforts to make the product available to the approximately 214 million women in low- and middle-income countries that have an unmet need for contraception. Annovera is expected to hit the market at the end of 2019 or early 2020. A new type of bednet—that combines a chemical that kills mosquitoes with another that impedes their reproduction—was found to reduce clinical malaria cases by 12 percent, compared to conventional nets, during a two-year clinical trial in Burkina Faso. The study also showed a 51 percent reduction in risk of a malaria-infective mosquito bite in areas with the combination bednets. The bednets used in the study combine a pyrethroid insecticide, which repels and kills mosquitoes, with pyriproxyfen, an insect growth regulator that shortens the lives of mosquitoes and reduces their ability to reproduce. With mosquitoes increasingly becoming resistant to the pyrethroids used in conventional nets, these bednets offer an alternative to fighting malaria in areas where mosquitoes have become resistant.

Mosquitoes: This pervasive posse of pests and the deadly diseases they carry have terrorized towns and sickened citizens for far too long. For decades, a fearless force of heroic health workers has fought to keep these bloodthirsty bugs at bay, but to finally put an end to these murderous mozzies and the dastardly diseases they distribute, they need new tools, including vaccines, drugs, diagnostics and vector-control products. For World Mosquito Day, GHTC is taking a moment to shine a spotlight on the ghastly gang of mosquito-borne diseases and the innovations we need to finish these frightening foes for good. Malaria Mal A. Ria is old, cruel, and has killed more people than all of humanity’s wars combined. Since the 1950s, countries have fought a sustained war against this nefarious nemesis. Increased global action led to the development and introduction of cheaper drugs, rapid diagnostics, and child-friendly medicines, as well as mass distribution of insecticide-treated bednets, which help drive Mal A. Ria from several countries where she formally had a foothold and weakened her forces. Yet, today progress has stalled and Mal A. Ria is fighting back hard, having developed resistance against commonly used insecticides and treatments Fortunately, scientists are fighting back too. A new generation of insecticides and vector control products is advancing through the pipeline, the first vaccine is undergoing pilot roll out in sub-Saharan Africa while other candidates progress through development; and researchers are employing cutting-edge gene editing techniques to alter Mal. A Ria’s ability to pass on her parasite. Continuing support for these efforts is critical to wipe out this formidable foe. Dengue   Also known by the aliases “Breakbone Fever” and “Dandy Fever,” Den Gue has largely operated under the radar as a member of the Neglected Tropical Disease crime syndicate, attacking as many as 400 million people annually. Den Gue often induces a painful fever, and his attacks can leave victims with long-term neurological and liver problems, or in some cases kill them. He typically attacks during the day, rendering bednets a less effective tool to fight him. Unfortunately, health workers have no specific treatment or cure to deploy against Den Gue. While there is a vaccine, it is only appropriate for use in certain circumstances and better point-of-care diagnostic tests are needed to ensure its safe administration. Ultimately, a variety of tools will be needed to vanquish this adversary, so researchers are hard at work testing other vaccine candidates and exploring whether infecting mosquitoes with a bacterium known as Wolbachia could prove to be an effective tactic. Chikungunya While he may be a lesser-known member of the Neglected Tropical Disease crime syndicate, Chiku N. Gunya is still a dangerous adversary reaching over 60 countries in Asia, Africa, Europe, and the Americas. An attack by Chiku N. Gunya can leave victims with debilitating joint pain that can sometime persist long after the attack. Unfortunately, health workers have few tools at their disposable to reign in his criminal activity: There is no vaccine, specific treatment, or cure, and current diagnostic tools are challenging to employ in remote regions. Researchers are working feverishly to deliver new tools to fight this foe. Several promising vaccine candidates are now undergoing testing in human clinical trials and researchers are exploring whether currently available antivirals could be repurposed to combat Chiku N. Gunya, as well as developing new antivirals treatments. Zika While Zi Ka has been operating since at least the 1940s in certain places in Africa and Asia, her crimes did not capture widespread public attention until she carried out a large-scale attack on the Americas from 2015-2016, leading the World Health Organization to declare a public health emergency. Her crimes are particularly cruel, as the victims she targets are pregnant women, resulting in severe birth defects in some children. When Zi Ka captured her spot on the most wanted list in 2015, health workers had few tools to stop her reign of terror and that remains the case. There is no vaccine, specific treatment, or cure, and diagnostic tests have trouble distinguishing her attacks from that of Den Gue or other mosquito-borne disease miscreants. Scientists are working to ensure the world is better prepared if she decides to undertake another major attack. While it could be many years until they are available, several vaccine candidates are currently under development, and experimental diagnostic tests have been made available on an emergency basis as researchers continue to test and refine these tools.  R&D: The key to ending these enemies While our heroic health workers have made strides in stifling these diabolical diseases and protecting the populace, these cronies still cause considerable calamity in communities worldwide. Our call to action should be clear: We need research and development (R&D) and new technologies to exact an end to these enemies for good.

Interested in more global health innovation news? Every week GHTC scours media reports worldwide to deliver essential global health R&D news and content to your inbox. Sign-up now to receive our weekly R&D News Roundup email. In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The latest Ebola outbreak in the Democratic Republic of Congo was officially declared over last Tuesday, following a 42-day observation period since the last new case was reported. Health experts credit the use of an experimental vaccine and a speedy and effective response by both the government and the World Health Organization as key factors in controlling this outbreak. Two clinical studies revealed that GlaxoSmithKline’s two-drug treatment for HIV, a combination of dolutegravir and lamivudine, also known as 3TC, is as effective as the standard triple therapy. Crucially, the studies showed that the efficacy of the treatment was consistent whether individuals had higher or lower levels of HIV in their blood, dispelling notions that the two-drug regimen might not work as well in people with more virus. Questions remain regarding the durability of treatment and potential drug resistance, given that the data only spans a 48-week period. The two-drug combination is slated for regulatory submission later this year. The US Food and Drug Administration approved the first new treatment for Plasmodium vivax malaria in 60 years. The drug, tafenoquine, is a single-dose treatment developed by GlaxoSmithKline and Medicines for Malaria Venture. P. vivax malaria causes around 8.5 million infections every year in Asia, Latin America, and parts of Africa. The disease is tricky to combat because the P. vivax parasite can lie dormant in the liver, where it reactivates, and can cause new episodes of malaria weeks, months, and years after the initial infection. In a study of 522 patients, 60 percent saw no relapse six months after taking the drug. Tafenoquine has been submitted for approval to the Australian regulatory authority and is slated to be submitted for approval in malaria endemic countries.