Breakthroughs Blog: Malaria

Researchers at the University of Cape Town discovered a compound that blocks the cycle of malaria within the human body, regardless of its drug-resistant status. The compound acts a preventative tool as well as a treatment for those infected with malaria, as it can block transmission and prevent infection. The compound, MMV390048, began phase I clinical trials in 2014, but subsequent data has not yet been published. The drug will enter phase II clinical trials this year in Ethiopia, and it is hoped this drug will be on the market within the next ten. With the world circling in on polio eradication, global public health professionals have run into a major obstacle that makes ridding the disease incredibly complicated: A vaccine shortage. There currently isn’t enough injectable polio vaccine for the world to use, as demand is so high. There isn’t enough of the vaccine in production for each child to receive two shots, which is what researchers suggest to protect against contracting polio. An alternative is the oral polio vaccine, but due to its heightened risk of complications, professionals believe this vaccine will soon be phased out. While polio vaccine manufacturing may be ramped up to treat children in the next few years, it is essential that health care professionals continue to vaccinate children ten years post-eradication to ensure there is no resurgence of the disease. Funders, including the Gates Foundation, are now putting efforts toward the next surge in vaccine demand, and hope to overcome this obstacle to reach global eradication of polio once and for all. An outbreak of Ebola has been confirmed in the Democratic Republic of the Congo (DRC), and health researchers around the globe are working to distribute an experimental vaccine. While the outbreak is contained due to the geographic isolation of the cases, the WHO and Gavi are still working quickly toward an effective and globally approved vaccine that can be used in future outbreaks. The DRC has not requested a vaccine at this point in time, but these organizations are prepping for when the country requests it, or for if the outbreak spreads past the DRC. The vaccine is experimental, and requires special modes of transportation, yet proved incredibly successful during the Ebola outbreak of 2014.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The US Centers for Disease Control and Prevention (CDC) reported that they expect rates of multidrug resistant tuberculosis (MDR-TB) in Russia, India, South Africa, and the Philippines to rise significantly in the next 25 years. These four countries carry the heaviest burdens of resistant (both drug-resistant and MDR) TB, accounting for 230,000 cases in 2015—nearly 40 percent of cases worldwide. It is predicted that one third of all TB cases in Russia will be drug resistant by the 25-year mark. The CDC suggests that efforts should be taken to prevent the airborne transmission of TB. In addition, CDC notes the need to expand diagnostic capabilities in low- and middle-income countries and access to rapid diagnostics and effective treatments. Zoonotic diseases, or diseases passed from animal to humans, such as Ebola, HIV and AIDS, swine flu, Spanish Influenza, malaria, and the bubonic plague, have been around for hundreds of years. With increased disease surveillance efforts globally, PREDICT, a global surveillance network financed by the US Agency for International Development and other partners, has recognized something important: healthy ecosystems and wildlife leads to less disease, which lowers disease burdens and makes humans safer. In tracking outbreaks like Ebola and swine flu, PREDICT has taken samples from over 55,000 wild animals and have tracked down 815 novel viruses. When ecosystems are damaged and the animals living in those systems are displaced, disease rates are higher. This research suggests that climate conservation can also help prevent pandemics. The United Nations Environment Agency and partners launched a new surveillance platform called the Global Mosquito Alert designed to survey mosquito patterns. Leveraging a global network of scientists and volunteers, the platform will track mosquito populations and disease patterns around the world. The global alert will provide real-time open access data via cloud computing networks, allowing the general population to engage and contribute to documenting and observing the patterns of mosquitoes.  

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. For many years, ineffective treatment plans and archaic diagnostic tools have stood as a barrier to tackling tuberculosis (TB). More recently, new drugs and diagnostics have emerged. Yet, availability has not always translated to widespread access. For example, despite the availability of new rapid diagnostic tools like GeneXpert, it is estimated that over 40 percent of new TB cases go undiagnosed or are not reported and use of older, less accurate sputum tests still outpace use of the GeneXpert. Though new drugs like bedaquiline and delamanid are not available, more than 75 of patients who need them do not have adequate access. A number of hurdles to adoption and scale-up exist from lack of funding for TB programs to high costs to implementation failures Action is needed by global leaders and innovators to break down these barriers if the global community wants to achieve its goal of eradicating TB by 2030. Malaria is more complex than scientists previously thought. In a recent study published in the Proceedings of the National Academy of Sciences, scientists used DNA fingerprinting to track malaria on a cellular level. They found that the parasite has a heightened level of genetic recombination developed during meiosis, leading to a wide variety of malaria strains. This suggests that malaria can evade immune system response, acting as a chronic disease—and it means there is no one-cure-fits-all solution. Because of the incredible amount of genetic diversity malaria can have in the body, one vaccine solution may not work for all individuals, casting doubt on the efficay of vaccines now in development. While this discovery makes malaria harder to prevent and eradicate, scientists have also discovered that malaria isn’t as transmissible as it first seemed, with the parasite only causing five or six secondary cases from one original infection, whereas it was previously thought one case could subsequently infect dozens of individuals. The International Partnership for Microbicides (IPM) has announced a clinical trial that is hopeful to significantly reduce cases of HIV in Sub-Saharan Africa and around the world. The clinical trial will use the IPM-developed dapivirine ring, a small silicone ring inserted in the vagina, releasing a contraceptive (levonorgestrel) and an anti-HIV drug (dapivirine). The ring is easy to insert and lasts three months. Building on the previous ring that only released dapivirine, having the ring also act as a contraceptive will not only reduce the likelihood of HIV infecting women, but will also provide women with the choice to protect against unwanted pregnancy. This trial is especially important because women are most at-risk for contracting HIV, especially in countries with low rates of condom use. IPM hopes to have the ring ready for shipment globally by 2020.    

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Researchers in Brazil have discovered the structure of the protein responsible for replicating the Zika virus thousands of times in cells, causing the virus to break through the cell wall and infect the body. Through many months of collecting data and studying the origins of the virus, the researchers put together a three-dimensional model of the protein and published their findings in Nature Communications. Zika is a flavivirus and in the same genus as diseases like yellow fever, dengue, and hepatitis C. Because of the genetic similarity, researchers and scientists have found that sofosbovir, a commonly used drug to treat hepatitis C, is a good therapeutic option for those suffering from Zika. The unlocking of Zika’s genetic code will lead to the development of new solutions to the virus. It recently became global news that RTS,S (trade name Mosquirix™), the candidate malaria vaccine furthest along in development, is beginning vaccine pilot programs in three chosen countries: Ghana, Kenya, and Malawi. The vaccine, created through a partnership with PATH’s Malaria Vaccine Initiative and GlaxoSmithKline, is given in four doses over a specific period of time. It is not yet known if tracking of these vaccine doses will be 100 percent. Any vaccine administered in multiple doses, whether for malaria or HPV, requires a lot more work in educating individuals about the need to return for all treatments necessary to ensure the vaccine’s success. UNICEF and members of the vaccine community will work with government authorities to ensure the supply chain delivers vaccines to children in need. If successful, the burden of malaria could decrease drastically. While this vaccine is promising to many individuals in these three countries, the search for a more perfect vaccine is high on the priority list for health researchers around the globe. In order to increase global access to immunization, successful and smooth-moving supply chains are necessary. The problem? Immunization supply chains are complex and every part of the chain needs to be working perfectly to ensure access to the vaccines. Many members of the immunization community have neglected the supply chain facet of vaccine delivery, and as a result, these supply chains have suffered and grown obsolete. With these chains being out-of-date, many children remain unvaccinated from even the most common diseases. A special issue published in Vaccine highlights these issues and brings the need for supply chain renewal to the forefront of the conversation. But even after this publication, more has to be done to ensure all members of the vaccine community work together to guarantee access to vaccines is in reach for all. Despite vaccine initiatives being stronger than ever, there is still a glaring gap in the number of children receiving basic vaccines. Currently, there are over 19 million children who are unvaccinated, leaving them susceptible to diseases that can be protected against. The American Academy of Pediatrics and the Centers for Disease Control worked together to establish the Global Vaccine Action Plan (GVAP) aimed at closing the gap of vaccine inequality around the globe. GVAP has already seen many successes, including fostering a working relationship with government institutions to implement surveillance techniques to figure out what vaccines children need most in each country. Kenya and Nepal, for example, have initiatives through pediatricians to educate families about the importance of vaccines for children’s development and longevity of life. GVAP is in the forefront of bridging the gap of health inequity and bringing immunization to all.