International coalition works to develop a cocktail of drugs to combat Malaria

As Africa marks its own Malaria Day in recognition of the fact that it bears 90% of the deadly disease’s burden, an international research coalition is working to develop a cocktail of drugs that overcomes increasing resistance to conventional treatment exhibited by the elusive parasite.

Although the HIV/AIDS pandemic in Africa catches the lion’s share of international attention, the challenge posed by a number of other diseases, including tuberculosis and malaria, is sobering. For instance, malaria – a parasitic infection transmitted by female mosquitoes – kills between 1 and 2 million people per year worldwide, most of them children. Some nine-tenths of these deaths are in Africa.

Malaria is the largest cause of death among under-fives in Africa and constitutes 10% of the continent’s disease burden. It exacts an enormous toll both on those who contract it and on society at large. The scourge is estimated to have slashed Africa's economic power south of the Sahara by half. This is because sufferers are often bedridden and incapable of carrying out normal daily activities.

Malaria treatment exists but, in recent decades, traditional remedies such as chloroquine and sulphadoxine-pyrimethamine have become increasingly ineffective due to drug resistance. “Scientists and doctors agree that the most effective treatment against malaria is a combination of drugs using artemisinin derivatives, highly potent extracts of a Chinese plant Artemesia annua,” says the World Health Organisation (WHO). The UN body now actively encourages malaria-endemic countries to switch to artemisinin-based combination therapy (ACT) – a call that has been answered by 40 countries globally.

ACT alone is not enough to ensure effective treatment and prevent future resistance from developing. Patients have to stick to the prescribed dose for the duration of the treatment period. However, without proper guidance, patients in developing countries might not take all the necessary drugs or may fail to complete the entire course.

“New fixed-dose combinations are urgently needed to offer endemic countries, patients and doctors a wider range of treatment options adapted to their needs,” explains the WHO.

An international coalition set up to combat neglected diseases and a leading French pharmaceuticals company have joined forces to bring together two programmes they had been working on separately. The Drugs for Neglected Diseases Initiative (DNDi) and Sanofi-Aventis are currently developing the artesunate-amodiaquine (AS/AQ) fixed dose combination which should be ready for registration next year.

“This will be an important addition to our aramanetarium against malaria and will help improve compliance,” said Fatoumata Nafo-Traoré of the WHO’s Roll Back Malaria Department.

DNDi – a coalition of governmental and non-governmental organisations set up in 2003 –established its Fixed-dose Artesunate Combination Therapy (FACT) project in association with various international bodies, including the WHO. Independently, Sanofi-Aventis was working on the same combination.

The brainchild of international humanitarian NGO Médecins sans Frontières (MSF), DNDi is a 'needs-driven' global drug development network that provides treatment at cost to the end-user. The initiative seeks to fill the gap left by profit-driven drug development. It works on the premise that a great deal of valuable research lies disused in research laboratories around the world and that drugs already on the market can be adapted for other diseases. It capitalises on existing, fragmented R&D capacity, especially in the developing world, and complements it with additional expertise as needed.

For its part, the EU is also a major backer of efforts to combat neglected diseases afflicting poorer countries. For example, to help new drugs and vaccines speed through the development pipeline, the EU helped set up the European and Developing Countries Clinical Trials Platform (EDCTP).

Funded by the EU and comprising 14 EU Member States plus Norway, the platform supports “development of new clinical interventions to fight HIV/AIDS, malaria and tuberculosis in developing countries, particularly sub-Saharan Africa, and to improve generally the quality of research in relation to these diseases”. In 1998, the Union also helped set up the European Malaria Vaccine Initiative (EMVI) to speed up development and testing of anti-malarial vaccines.