The Novartis Malaria Initiative: lessons from a
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Buoyed by progress of the past decade, major international agencies and many governments are now aiming for elimination of malaria, the interruption of mosquito-borne transmission to eliminate the local reservoir of parasites. Currently 32 nations are pursuing an elimination strategy, with success a prospect for the next decade provided they are adequately supported. Elimination is a more distant prospect for many countries, however, reflecting both the high intensity of local transmission and substantial movement of people across borders which creates the constant potential for malaria importation.
Innovation again promises to be the driving force in elimination. Sir Richard Feachem, the former executive director of the global Fund and currently director of the Global Health Group at the University of California, San Francisco, says: "The speed of progress will depend on the development and deployment of better drugs, better diagnostics and a series of increasingly effective vaccines."
Novartis is contributing to elimination of malaria in part through a number of important research programs and clinical studies. Today, the declining number of malaria cases and widening use of rapid diagnostic tests are helping to reduce intensity of malaria transmission. According to experts, some form of focused screening and availability of novel medicines will be essential to elimination of malaria.
Gametocytes, the sexual stage of the malaria parasite, do not cause malaria symptoms but are responsible for transmission of the disease when ingested by a mosquito in a blood meal and inoculated into the next person bitten. Several studies have confirmed that rapid clearance of gametocytes by Coartem helps to break the cycle of transmission between the mosquito and human hosts. In Burkina Faso, Novartis is conducting the first comprehensive study to evaluate the effect of mass screening followed by targeted treatment of asymptomatic patients. If effective, this strategy could lead to substantially decreased parasite transmission.
In recent years, there also has been growing concern that the poor quality of some antimalarial medicines available in many countries not only could jeopardize the health of patients but also hasten the emergence of malaria parasites resistant to ACTs.
The WHO has presented a global plan for containment of artemisinin resistance. There may, however, be a limited window "for containing or eliminating artemisinin resistance before it spreads to high transmission areas, endangering all recent advances in malaria control," a recent WHO report warns.