The fight against malaria is facing stalled progress and a disruptive pandemic while the road to malaria eradication is still long and complex. In its World malaria report 2019, the World Health Organization (WHO) concluded that progress in malaria control had almost come to a halt. The progress made earlier is currently threatened by the disruption caused by the COVID-19 pandemic. However, eradication of malaria needs to stay on the global agenda.
On World Malaria Day 2020, Dr Michael Makanga, EDCTP’s Executive Director, stated EDCTP’s full support for WHO’s vision of a world free of malaria. “To achieve this long-term and multifaceted objective, research & development for new and improved transformative tools is essential. EDCTP is already supporting this R&D agenda with investments of almost €134 million.”
Highlights from the portfolio
The EDCTP malaria portfolio comprises 52 projects from international collaborative clinical research projects implemented by African-European research consortia, through to 35 projects conducted by EDCTP fellows, who are leading the malaria research agenda in Africa. The EDCTP portfolio includes several large-scale projects testing some of the most advanced new vaccine and drug candidates that could contribute significantly to the malaria eradication agenda.
EDCTP portfolio of malaria projects
The IMPROVE study is a pivotal study for the preventive treatment of malaria in pregnancy. After a decade of trials to find new prevention strategies, dihydroartemisinin-piperaquine (DP) has been shortlisted as the only potential alternative to sulphadoxine-pyrimethamine (SP) for Intermittent preventive treatment in pregnancy (IPTp), but evidence of its benefits on infant outcomes is needed. The study aims to evaluate IPTp with DP alone or combined with azithromycin, an antibiotic which further reduces adverse pregnancy outcomes, especially sexually transmitted and reproductive tract infections. Acceptability, feasibility and economic studies will explore the potential for integration and scalability within the national malaria control programmes.
This project is led by Professor Feiko ter Kuile (Liverpool School of Tropical Medicine, United Kingdom). It is a multi-centre clinical trial conducted in 11 hospitals in Kenya, Tanzania and Malawi. Approximately 4,680 pregnant women have been enrolled with most fieldwork completed just before the COVID-19 public health crisis started. IMPROVE is a collaboration of partners from Denmark, Finland, Kenya, Malawi, Norway, Tanzania and the United Kingdom. EDCTP awarded a €7.4 million grant to the project, while additional funding of £2.7 million from the Joint Global Health Trials (JGHT) made it possible to add a trial on HIV-infected pregnant women alongside the main study in HIV-uninfected women.
PAMAfrica is a large international collaborative initiative to developed new antimalarial drugs which has just started. EDCTP awarded €21.9 million to the consortium which is led by Medicines for Malaria Venture (MMV). The EDCTP grant will be matched by funding from MMV, Novartis and partners. Over a period of five years, the grant will support the development of a portfolio of antimalarials through clinical trials executed under the umbrella of the consortium. Clinical trial capabilities in Africa will also be strengthened to ensure that each clinical research site involved can effectively operate in compliance with ICH-GCP regulatory standards. The consortium includes seven research organizations from Burkina Faso, Gabon, Germany, Mozambique, Spain, and Uganda.
EDCTP has three large portfolio grants on malaria vaccine development. The projects focus on several candidate vaccines against various stages of the malaria parasite.
MMVC, the Multi-Stage Malaria Vaccine Consortium, is led by Professor Adrian Hill from Oxford University, United Kingdom with partners in Burkina Faso, France, Germany, India, Netherlands, Sierra Leone, Sweden, Tanzania, and the United Kingdom.
The project aims to develop the first combination multi-stage vaccine for malaria designed to target all four stages of the Plasmodium falciparum parasite’s lifecycle. This ambitious project encompasses a series of tightly coordinated lead-in trials. The front runner component is the R21/M-matrix candidate vaccine in phase IIb efficacy evaluation in Burkina Faso.
The MIMVaC-Africa consortium started in February 2020 a programme to conduct clinical trials on a portfolio of five malaria vaccine candidates: three pre-erythrocytic vaccine candidates and two blood-stage candidates. The consortium is led by Dr Sodiomon Sirima of the Groupe de Recherche Action en Santé (GRAS) in Burkina Faso, with partners in Gabon, Germany, Japan, Luxembourg, Mozambique, the Netherlands, Tanzania, and the United Kingdom.
It will leverage its recently developed capacity to work with the controlled human malaria infection (CHMI) challenge model. The project will rapidly test and compare the vaccine candidates in Europe and Africa to select the most promising for the field efficacy trials in Africa. The MIMVaC-Africa programme will also strengthen the research capacity of clinical study sites.
The PfTBVconsortium is coordinated by Dr Issaka Sagara of the University of Sciences, Techniques and Technologies in Bamako, Mali, with research sites in Burkina Faso, Guinea, Liberia and Mali. The consortium aims to evaluate a portfolio of three innovative candidate malaria vaccines that aim to block transmission of the parasite with antigens. Currently, a phase II community trial is ongoing to determine if the experimental malaria transmission-blocking vaccine is safe and can provide a protective immune response in Malian children and adults.
Malaria diagnostics research is supported with a grant of almost €3 million to the malaria diagnostics consortium DIAGMAL. The project is led by Dr Henk Schallig (Amsterdam University Medical Centre, the Netherlands) and aims to assess a small molecular diagnostic device which is controlled via a mobile telephone and may be used as a point-of-care tool. The diagnostic accuracy of the device will be evaluated in five different endemic settings in Burkina Faso, Ethiopia, Kenya, Namibia, and Sudan. The project includes a partner in the United Kingdom.
Several important studies are conducted by EDCTP fellows. The EDCTP fellowship scheme aims to support the development of scientific leadership in sub-Saharan Africa and to provide up-and-coming researchers with the opportunity to develop their clinical research skills.
Professor Faith Osier has created an international network to map the malaria parasite diversity across Africa, a key step in the development of more effective malaria vaccines.
Dr Dominic Mosha evaluates the safety of single low-dose primaquine co-administered with artemisinin-based combination therapy in routine healthcare practices. The aim is to study the implementation of a WHO-recommended treatment regime.
Dr Laurent Dembele aims to establish a screening model for malaria liver-stage infection by Plasmodium vivax and Plasmodium ovale using field-isolated sporozoites from infected mosquitoes.