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The menace of malaria

Feared since the days of the Roman Empire, malaria remains a major health problem. GlaxoSmithKline is supporting several major programmes to answer the challenge.

The humble mosquito may be tiny, but it carries some of the worst diseases in the world and kills more people than any other animal.

One of those diseases is malaria, an infection caused by a parasite that is carried from person to person by the bites of female mosquitoes. The symptoms of malaria include fever, shivering, vomiting and it also leads to anaemia. If left untreated, malaria can cause coma and death.

The scale of the problem is huge - over half of the world’s population lives in areas affected by malaria and nearly 800,000 people a year die from its effects, mostly children under five years of age and pregnant women. Malaria is the world's leading cause of childhood mortality, killing one child every 45 seconds.

Along with tuberculosis and HIV/AIDS, malaria is one of the World Health Organization's 'priority' diseases and it's not difficult to understand why.

About 90% of acute malaria infections occur in sub-Saharan Africa, and the World Bank reports that malaria costs the continent more than US$12 billion yearly in healthcare expenditures and lost productivity, a figure roughly equivalent to all of the aid provided to the continent each year.

Some say that this puts much of the debate about helping Africa to prosper through aid and trade into stark perspective – simply stopping malaria would be an enormous boost.

Treatment and prevention of malaria

For many years, chloroquine had been the treatment of choice for malaria, although resistance of the malaria-causing parasites to this medicine has made it largely useless today.

There is a range of other drugs available for treatment as well as prevention of malaria and their use is decided by the level of resistance in the country where they are to be used. Despite this, access to medicines and the cost of treatment remains a barrier for people living in malaria-affected regions.

Prevention of malaria in endemic areas is focused on the use of preventative medicines for pregnant women and, increasingly, young children. Other methods include mosquito control using insecticides and larvicides and the prevention of bites by the use of mosquito nets impregnated with insecticide.

Developing new medicines through partnership

GlaxoSmithKline’s commitment to tackling diseases of the developing world involves a range of partnerships with other committed organisations. GSK has several projects underway at its laboratories in Tres Cantos, Spain, with the aim of developing products that treat resistant strains of the malaria parasite.

The Medicines for Malaria Venture (MMV) is a non-profit organisation created to discover, develop and deliver new and affordable treatments for malaria. GSK supports the MMV with research efforts aimed at identifying new medicines at Tres Cantos.

The search for a vaccine against malaria

As with many infectious diseases, the ultimate goal is to develop a vaccine that will protect large numbers of people against infection. GSK has been working on the development of a malaria vaccine for over 20 years.

The PATH Malaria Vaccine Initiative (MVI), a team backed by the Bill & Melinda Gates Foundation and GSK Biologicals, the vaccines division of GSK, under the MVI is currently carrying out clinical trials on a malaria candidate vaccine with the hope that it will protect children against malaria caused by Plasmodium falciparum (the most prevalent species) in Africa.

Results of clinical studies to date have shown that RTS,S has a promising safety and tolerability profile and has significant efficacy. Findings published in the New England Journal of Medicine in December 2008, showed that RTS,S reduced the risk of clinical episodes of malaria in young children by 53% over an eight-month follow-up period, and provided 65% protection against risk of infection in infants over a six-month follow-up period. Another study published in the same issue indicated that RTS,S can be safely administered to infants in conjunction with traditional childhood vaccines.

A large-scale Phase III multi-center efficacy trial in both infants and in young children will be launched at 11 sites in seven African countries, pending required local and national approvals. This study is designed to further determine the efficacy and confirm the safety of the vaccine in the target population. This trial will enroll up to 16,000 infants and children and is expected to be the largest malaria vaccine trial to date.

GSK’s ongoing commitment through partnership

Another effective way to control malaria is through education and changing behaviour. In 2001 GSK set up the African Malaria Partnership (AMP) which aims to build awareness of malaria and how it is spread and to promote effective behaviours in at-risk communities, such as the use of insecticide-treated bed nets and early treatment.

Through our African Malaria Partnership (AMP), GSK works at the local level to improve the prevention and treatment of malaria in sub-Saharan Africa. Since 2001, we have committed over £3 million to community initiatives and have partnered with organisations on the ground to promote the use of existing interventions, such as bed nets, indoor residual spraying and current treatments.

Initial activities focused on behavioural change programmes across eight African countries. In partnership with the Malaria Consortium, we support the ‘Mobilising for Malaria’ initiative, which builds awareness, political commitment and sustained funding for malaria control through advocacy initiatives. National Coalitions Against Malaria have now been launched in the UK, Belgium, France, Ethiopia, Cameroon and Mozambique.

In late 2009, the AMP announced new partnerships to build the capacity of community health workers and encourage behaviour change. With a total commitment of £1.5 million over three years, the new projects include:

• African Medical and Research Foundation (AMREF) in Mtwara province, Tanzania: The partners will train community health workers and mobilise communities to become frontline advocates in the fight against malaria.
• Family Health International (FHI) in the Brong Ahafo region of Ghana: Working with community health workers and household caregivers, the project aims to improve early recognition of malaria and provision of appropriate treatment, and to encourage health-seeking behaviours and community mobilisation.
• Planned Parenthood of Nigeria in six selected communities: This project will promote a community response to malaria through partnership with community committees, government agencies, vendors, community health workers and peer educators in schools.
• Save the Children in North East province, Kenya: Through community campaigns, education, bed net distribution and community health worker trainings, the project aims to ensure targeted communities receive effective coverage and have access to diagnosis and treatment services.