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Injecting hope into the fight against malaria

Access to life-saving anti-malaria drugs is improving and the first vaccine against the disease may be on the way.

Last updated: 25 Apr 2014 13:50
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Ten-month-old Daniel Obok lies in a hospital bed, his tiny body motionless as his anxious mother watches over him.

The baby was rushed to a hospital in southeastern Nigeria in January, slipping in and out of consciousness,  and diagnosed with severe malaria.

"I thought I was going to lose him forever," said Daniel's mother Eme Obok, recalling how she watched helplessly as her son endured an hour-long convulsion. "I thought he was going to leave me behind."

An estimated 207 million malaria cases were registered globally in 2012, with at least 627,000 people dying - making it among the deadliest diseases in the world. Like Daniel, most victims are young children in sub-Saharan Africa.

The disease is caused by parasites transmitted to humans by mosquito bites. Infected mosquitoes inject people with immature forms of the parasite, which can multiply, invading the liver and bloodstream. If untreated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs.

Until recently, Daniel would have received quinine, an anti-malarial drug that is difficult to administer and has dangerous side effects. Too much of the drug can affect the rhythm of the heart, with potentially fatal consequences.

'Lifesaver' drug

Yet Daniel is lucky. As soon as doctors diagnosed malaria, he received injectable artesunate, the fastest-acting anti-malarial agent. Since 2010, it has been recommended by the World Health Organization (WHO) as the preferred first-line treatment for severe malaria.

Artesunate is a potent and rapidly acting drug that kills the parasite causing malaria. Despite its effectiveness, it has remained unavailable to millions of people who need it the most.

Malaria vaccine breakthrough

But access to the drug is now being scaled up through a programme funded by the global health organisation UNITAID .

In 2012, UNITAID awarded a $34m grant to the Swiss-based Medicines for Malaria Venture (MMV) as part of a three-year project to help countries switch to the life-saving drug. This programme enabled young Daniel to receive the drug that doctors hope will save his life.

MMV, together with the not-for-profit organisations Malaria Consortium and Clinton Health Access Initiative, are helping governments introduce the drug in six African countries: Nigeria, Cameroon, Uganda, Malawi, Ethiopia and Kenya.

Pierre Hugo, MMV's head of access and delivery in Africa, is leading the project, known as Improving Severe Malaria Outcomes. " If all patients with severe malaria received injectable artesunate, an estimated 50 million vials would be manufactured and supplied each year. Yet we know less than 20 percent of this total is actually supplied. This project is about quickly increasing the reach of this lifesaving drug.

"We are working towards an estimated 2.5 million patients getting injectable artesunate who do not have it, putting 15 million vials into six countries. We estimate that over the lifetime of the project, more than 100,000 lives will be saved."

Young children in sub-Saharan Africa like Daniel Obok are most at risk of contracting malaria [Daniel Nikolaison/Al Jazeera]

The project was first rolled out in Nigeria, where doctors and nurses from at least 190 hospitals have been trained to administer the drug, which is given intravenously. Training is nearly complete in Malawi and Uganda, will get under way soon in Cameroon and Kenya, and will begin later this year in Ethiopia.

MMV is also working with state-level health ministries to make the drug freely available. Nigeria alone has 37 states, and each decides which medications are provided for free. Of the 13 states with which MMV is working, at least half now provide the drug for free to children under the age of five.

"Doctors see for themselves just what a lifesaver this treatment is," said Hugo. "You get an unconscious child on their feet again within 48 hours of receiving the drug."

MMV also provides technical support to help ministries predict how much of the drug will be required over the course of treatment, and monitors its effect on survival rates.

Survival rates on the rise

Doctors and nurses are supportive of the treatment.  Dr Binta Jibir Wudi is the head of paediatrics at Murtala Mohammed Specialist Hospital in the northwestern state of Kano, the first state in Nigeria to offer injectable artesunate for free.  In the rainy months of July and August, the peak period for malaria, up to half of the hospital's 300 or so child inpatients suffer from a severe form of the disease. But Jibir said the treatment has dramatically improved survival rates.

With three doses usually required, [injectable artesunate] is out of reach for most Nigerians who usually live on less than a dollar a day.

- Dr Binta Jibir Wudi

"The results are fantastic," she said. "The drug is easy to administer, we have been trained on properly preparing it and giving the correct dose and it is so much more effective than the alternative, quinine."

Jibir explained that on April 13, an unconscious child with a temperature of 40.2 degrees Celsius was admitted to the hospital. Without injectable artesunate, the child's chances of survival would have been slim. The following day, Jibir said, " the girl was smiling at staff and her temperature had reduced to 37.7".

While injectable artesunate is available here, Jibir said patients pay about $2.50 per dose. "With three doses usually required, it is out of reach for most Nigerians who usually live on less than a dollar a day," she said.

Free access to the drug is a massive boost in the fight against malaria. Since 2010, more than 12 million vials of injectable artesunate have been delivered, saving an estimated 80,000 to 90,000 additional lives compared to treatment with quinine.  But Jibir cautioned against overuse, explaining that in order to prevent drug-resistant forms of the disease from developing, it must only be used by trained staff on patients with severe cases.

First malaria vaccine?

Meanwhile, in the next few months pharmaceutical company GlaxoSmithKline will seek regulatory approval from the European Medicines Agency for the world's first malaria vaccine.

The vaccine - known as RTS,S and developed in partnership with the PATH Malaria Vaccine Initiative - was found to almost halve the number of cases in infants aged five to 17 months. It also reduced malaria cases in infants aged six to 12 weeks by almost 25 percent, 18 months after vaccination. The vaccine triggers the immune system to defend against the most deadly form of the malaria-causing parasite when it first enters the human host's bloodstream, and when it infects liver cells.

The vaccine trial involved almost 15,500 children from seven African countries: Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique and Tanzania. Participants were given three doses of the vaccine, one month apart, and followed up for 18 months.

Scientists have been developing the vaccine for three decades, and it is hoped that if it is approved by the European Medicines Agency, the WHO could recommend the vaccination by 2015.

But even if that happens, clinical data from the trial suggests it is unlikely to wipe out severe malaria completely. So for now, for Daniel and thousands of children like him, increased availability of injectable artesunate looks to be their best hope.

The international drive to increase access to injectable artesunate in sub-Saharan Africa will feature on the next series of Al Jazeera's health show The Cure , on June 16, 2014. 

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Al Jazeera
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