Royal Society Africa Prize Seminar 2017

The world has witnessed a golden decade in the fight against malaria. It all started with the ministerial conference on malaria in Amsterdam (1992) that brought back the focus to the rampant malaria problem. Political commitment grew, spearheaded by the African Heads of State and key donor countries. This eventually translated into new funding mechanisms such as the Global Fund, the Presidents Malaria Initiative or the UK’s program, and has resulted in a 20 fold increase in investment in the fight against malaria. Importantly it has allowed the scale up of tools and strategies, often the product of the R&D effort of the last decade of the 20th century. Insecticide treated bednets for vector control, rapid diagnostic tests (RDT) providing capacity to expand diagnosis to point of care and ACT for treatment constitute the core malaria interventions. The result has been a 40% decrease in malaria incidence rates and a 60% reduction in malaria attributable mortality. A truly unprecedented progress.

Armed with a new Global Technical Strategy endorsed by the World Health Assembly, that sets ambitious but achievable goals for 2030, we have a clear path to follow. However, the fight against malaria is now at a tipping point. Biological challenges continue to emerge and evolve: multi drug resistance threatening both our first line treatment drugs as well as those used for chemoprevention, insecticide resistance potentially impacting the effectiveness of vector control (our single most important tool during the last decade) and new parasites with HRP2 deletions that could render our mostly used RDT as ineffective. Financial investments in the fight against malaria has clearly plateaued over the last years and current funding is less than 50% of the estimated need. As a consequence, the rate of improvement in our fight against malaria has slowed down and could potentially start to reverse. Very significant coverage gaps to our core interventions remain, as nearly 45% of children under five in Africa are not protected by effective vector control and about 50% of malaria cases go undiagnosed and untreated. The result is that for a disease that is preventable and treatable, we still have in excess of 200 million cases and 400 thousand deaths.  Recognizing that we are at a tipping point, that new tools and smarter control will be needed and a renewed commitment to deploy the financial resources, especially from the affected countries themselves will be critical to achieve the goals of the GTS.

Dr Pedro Alonso, Global Malaria Programme, WHO, Geneva

Dr Pedro Alonso, Global Malaria Programme, WHO, Geneva

Dr Pedro L Alonso is the Director of the WHO Global Malaria Programme in Geneva, Switzerland. The Global Malaria Programme is responsible for the coordination of WHO’s global efforts to control and eliminate malaria and sets evidence-based norms, standards, policies and guidelines to support malaria affected countries around the world. A national of Spain, Dr Alonso has spent over 30 years in public health. His scientific research work has focused on key determinants of morbidity and mortality in the most vulnerable population groups. He has published over 300 articles in international peer-reviewed journals – primarily on malaria treatment, vaccine trials and preventive therapies – and has served on several national and international committees. He is committed to capacity building of both institutions and individuals, primarily in Africa. Prior to taking up the WHO position, Dr Alonso was Director of the Barcelona Institute for Global Health (ISGlobal), Professor of Global Health at the University of Barcelona, and President of the Governing Board of the Manhiça Foundation and the Manhiça Health Research Centre in Mozambique.

Malaria is still a major health problem, especially in sub-Saharan Africa. There has been substantial  progress in malaria control during the past 20 years, but the disease still kills nearly half a million people, mainly African children, each year.  In the part of Africa where I live and work, and in neighbouring countries, malaria is very seasonal and my research is directed at finding the best way of preventing  malaria when this occurs for only a few months each year. During the past 15 years, we have tested several new drugs and vaccines candidates against malaria and bacterial infections. Studies that have been particularly important, and which have had an influence on the management of malaria across the Sahelian and sub-Sahelian regions of Africa, are studies of Seasonal Malaria Chemoprevention (SMC), administration of antimalarials at monthly intervals to young children during the peak period of malaria transmission. These trials have demonstrated that SMC reduces clinical malaria by about 80% during the rainy season in the context of clinical trials. This intervention has now been rolled-out in Mali and many other countries in the Sahel region of Africa, saving many lives. Our current research investigates whether adding additional drugs, such as azithromycin and primaquine, or combining SMC with seasonal vaccination with the most advanced malaria vaccine (RTSS/AS01)  gives further benefits. Results on the  addition of low single dose of primaquine on the infectivity of mosquitoes and  on the addition of azithromycin to the antimalarial drugs used for SMC on  hospital admissions and deaths will be presented.

Dr Alassane Dicko, University of Sciences Techniques and Technologies of Bamako, Mali

Dr Alassane Dicko, University of Sciences Techniques and Technologies of Bamako, Mali

Alassane Dicko is a scientist at the Malaria Research and Training Center of the University of Science Techniques and Technologies of Bamako, Mali. He obtained his MD from the University of Bamako in Mali, a Master of Science in Epidemiology and Preventive Medicine from the  University of Maryland and a PhD from the University of Bordeaux. He received additional training in Biostatistics and Ethics at John Hopkins University, in Baltimore Maryland.

His research has focused on improving ways of preventing and treating malaria in Mali where malaria is the biggest cause of deaths in children. This research has been conducted in collaboration with many international partners including NIAID/NIH, GSK, London School of Hygiene & Tropical Medicine, University of California in San Francisco,  WHO/TDR, UNICEF and MSF.

He has tested several new drugs and vaccines candidates against malaria and bacterial infections. Studies that have been particularly important and which have had an influence on the management of malaria across the Sahelian and sub-Sahelian regions of Africa are studies of seasonal Malaria Chemoprevention (SMC) which have demonstrated that SMC reduces clinical malaria by about 80%. Currently, he is evaluating the combination of a malaria vaccine RTSS and SMC and testing the safety and efficacy of low single dose primaquine in blocking malaria transmission.

He teaches epidemiology, biostatistics and research methodology at the Faculty of Medicine and the Faculty of Pharmacy of the University of Bamako. He has co-authored more than 60 publications including several in high impact journals.

By 2014, Seasonal Malaria Chemoprevention (SMC) had only reached 4% of the eligible children. With funding from UNITAID, Malaria Consortium led a partnership which aimed to implement SMC at scale in multiple countries in the Sahel region, namely Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria and The Gambia. Designed as a catalytic project to develop a sustainable market for SMC and to demonstrate feasibility, acceptability, safety, affordability and impact, the project provided SMC to 3.1 and 6.3 million children in 2015 and 2016 respectively. Preliminary data from costing studies indicate a weighted average cost of 4.2 USD per child reached per year in 2015, and 3.6 USD in 2016.

Dr James Tibenderana, Malaria Consortium, UK

Dr James Tibenderana, Malaria Consortium, UK

James Kananura Tibenderana is a malaria and public health expert with over 20 years of experience in the fields of epidemiology, infectious and tropical diseases and health system strengthening. He trained as a medical doctor at Makerere University, Kampala before studying epidemiology at the Institute of Public Health, University of Cambridge and the London School of Hygiene and Tropical Medicine. Prior to joining Malaria Consortium in 2005, James worked with the Ministry of Health, Uganda, at the National Referral Hospital, New Mulago Hospital. He supported the Uganda Ministry of Health with the development of its national malaria research centre. He then went on to play a key role in the conceptualisation and design of Malaria Consortium’s Africa-based work and contributed to its technical strategy development. As Global Technical Director, he oversees Malaria Consortium’s global technical strategy implementation, the diversification of the organisation’s funding portfolio and partnerships in Africa and Asia, and remains actively involved in operational research on communicable diseases.