I hate malaria with a passion. Growing up in the poor villages and townships of Zambia, I experienced its impact first-hand. As a boy, I was infected several times and once spent days in hospital. My family and friends struggled with the costs of treatment and inability to work while ill. All this inspired me to dedicate my life to tackling the disease.
Africa is often described as the “next frontier” in the global economy but malaria — both driven by and causing poverty — still chokes economic growth. Yet we have made advances to break that cycle in recent years.
The coronavirus outbreak has taken a heavy human toll and temporarily slowed malaria drug development by freezing new clinical trials and delaying existing ones. But as a reminder of how a pandemic can wreck lives and livelihoods, it reinforces the importance of infectious disease research.
Recent testing of two malaria drugs, chloroquine and hydroxychloroquine, for use against Covid-19, highlights the value of funding in the field. Co-infection — people with Covid-19 and one or more of malaria, tuberculosis and HIV/Aids — is bringing fresh focus on these conditions. It is catalysing new forms of research and co-operation between the public and private sectors, pioneered in neglected fields including malaria.
For example, the Bill & Melinda Gates Foundation has worked with 15 pharmaceutical companies and supported the Covid-19 Therapeutics Accelerator to speed up the search for treatments. Such efforts provide a blueprint for preparations against outbreaks of as yet unknown infectious agents and suggest new approaches to address unmet medical needs.
Africa is starting to play a more important role. Pharmaceutical research and development historically occurred mostly in richer countries with concentrations of infrastructure, technology and scientists and clinicians. While the difficulties are formidable in Africa, strong progress has been made recently, illustrated by the Holistic Drug Discovery and Development Centre (H3D) at the University of Cape Town.
The centre’s flagship molecule, an experimental anti-malaria medicine identified in partnership with the non-profit Medicines for Malaria Venture, has completed trials in South Africa and is being tested in patients in Ethiopia. It has potential to protect, treat, block transmission and be part of a single-dose cure that would be a significant advance. H3D helped lay the foundation for the growing contribution of African malaria researchers and scientists, working with other organisations to contribute to a pipeline of medicines. It has also created a platform to develop drugs for other diseases including TB.
Eliminating malaria requires that we halt transmission. One approach is to prevent an infected person passing on the parasite. Another is the use of “endectocides” such as ivermectin, the drug to treat river blindness, which make the blood toxic and kill both mosquito and malaria parasite.
The development of technologies is pointless without access to the affected communities. They need greater engagement with researchers, such as through the Isdell: Flowers Cross Border Malaria Initiative. This brings together governments, international partners and scientists with the Anglican church, non-governmental organisations, traditional leaders and community activists on the borders of Angola, Namibia, Zambia and Zimbabwe.
Such groups must work together to build consensus around a framework for infectious disease research. We also need to remove the financial, regulatory and legal barriers that often get in the way.
Applying northern hemisphere solutions to southern problems will not always work. There is a strong interplay between genetics, the socio-economic and physical environments in which patients live and effective treatment. It is vital for African countries to build drug discovery and development capacity close to patient populations to understand the continent’s needs.
We need to improve outcomes by using Africa-focused approaches to help the countries where the burden of malaria is greatest — designing trials and prioritising drugs and dosing that reflect the physiology of African patients.
Regulation remains a roadblock. For more Africans to be enrolled in clinical trials, we must harmonise rules across the continent, shorten timelines and raise approval rates for clinical trials.
We also need more partnership between regulators, industry and academia to support innovation, drug development and registration. National agencies must accelerate their vetting of innovative medicines, without the traditional lag of up to a decade after US and European approval. By building a stronger and more co-ordinated base for research in Africa, we can help the continent and the wider world.
Professor Kelly Chibale is founder and director of the Drug Discovery and Development Centre (H3D) at the University of Cape Town.