Letters from the lab: Malaria

Miranda Harington, AMREF

What are the biggest challenges AMREF faces in the fight against malaria?

AMREF is Africa’s leading health charity, and so we feel these challenges acutely, especially given that our focus is on community health. Even where governments want to have an impact at this level, they often cannot afford to set up and sustain community health workers even to respond to major diseases such as malaria.

People living in high-risk malarial areas face severe challenges in accessing tools and services for malaria prevention and treatment, especially disadvantaged communities and people in rural areas. The heavy economic and social burden that malaria inflicts on families and societies maintains communities in an unbreakable cycle of disease and poverty.

What is AMREF’s role in preventing malaria and supporting those with the disease in Africa?

AMREF’s longstanding relationships with both governments and communities in Africa mean that we are uniquely positioned to have an impact on many different levels. One excellent example of this is the work we have done in Uganda which has been funded by AstraZeneca.

In 2006, Uganda had the third highest deaths from malaria in Africa. AMREF had already worked with AstraZeneca on TB in South Africa, and was looking at new activity which could respond to a new Ugandan health policy which integrated TB treatment with HIV treatment – at the time, only 25% of TB patients in Uganda were tested for HIV. Together, we developed a project which would strengthen the impact of this strategy, and also respond to the high incidence of malaria by widening the integration policy to include this third disease.

This project was one of the first to respond to HIV and TB in conjunction with malaria, and has had impressive results. We have introduced a system of 5,966 health volunteers grouped by village in 3 districts. They now act as the first point of referral for suspected cases of all three diseases, as well as a host of other health issues, and they also support treatment. Alongside this work, we’ve built 10 new laboratories, which have vastly improved the local diagnostic ability. We’ve trained 352 health system staff, and 100,104 people have attended community sensitization sessions or been reached through peer educators.

The result of this is not just that malaria deaths in hospital have declined by half between 2007 and 2011 in the three districts, but also new TB cases have dropped by 10%, and new HIV diagnoses have fallen from 11% to 7%, with 69,730 tests now carried out per year, three times the annual figure from the start of the project.

Given these successes, it is a major ambition of the project to advocate for the Ugandan national policy of combined treatment of TB and HIV to be extended to include malaria and for the integrated model for the three diseases to be adopted more widely in Uganda and elsewhere in Africa. In this way we can bring about lasting health change.

How important is it for industry, NGOs and others to partner in the fight against malaria?

Working with the pharmaceutical industry is particularly important because of our shared expertise. Our joint planning work with AstraZeneca, meant we both met Ugandan government directorates, visited district hospitals, parish health centres, outpatient clinics, and sub-county facilities and spoke to national disease programme staff for each disease. This built knowledge at both our organisations and meant that learnings could be applied not just to the project but also back into AstraZeneca’s work in these areas too. 
 

Scientists in AZ’s lab in Bangalore study infectious disease

My name is Nikhil and I am a Research Associate at AstraZeneca’s R&D unit in Bangalore, India. Working as a Research Associate, I test compounds from the AZ library for their activity against the malaria causing parasite which is grown in our laboratory in Bangalore. It is a very exciting time to be working for AstraZeneca and with our partners on this project where the concerted efforts are looking immensely positive.

World Malaria Day holds a special value to me and reminds me of the task ahead that we all have to eradicate a disease that has been affecting us for years. I was brought up in a region which is endemic to the disease; every year you hear tragic stories of how it has affected people’s lives. Also, having personally suffered from malaria myself, it gives me a sense of deep involvement that I represent AstraZeneca in a partnership with the Medicines for Malaria Venture which is one of the very few collaborations that work on malaria and shares the same passion that I have towards fighting the disease.

Although the disease has been eradicated from most of the developed countries, it still remains the second highest killer in the world. The biggest challenge has been early evolvement of resistance to every drug available which highlights the need for new drugs. The past few years have seen a renewed effort to tackle the disease head-on through constructive collaboration - one that I am part of. A united effort with partners through sharing of experiences and information is already bearing fruit by upping the pace of drug discovery.
 

Scientists in AZ’s lab in Bangalore study infectious disease

My name is Pavithra and I am a Senior Research Scientist at AstraZeneca’s R&D unit in Bangalore, India. For the last three years I have been leading the malaria drug discovery project for AstraZeneca in Bangalore. This is an endeavor to discover new drugs for malaria in conjunction with the Medicines for Malaria Venture (MMV), a non-profit organization based in Geneva, Switzerland.

Malaria is a terrible disease that has been plaguing humanity since antiquity. Every year almost a million people die of malaria, most of them children under the age of five. The disease burden is highest in sub-Saharan Africa where it is a primary cause of poverty. A major problem with malaria control lies with the fact that the parasites rapidly evolve resistance to existing treatments. In the search for an effective vaccine we’ve had some success, but a large part of malaria control depends on developing new drugs.

AstraZeneca collaborates at a global level to increase understanding of fast-emerging and existing health threats in the developing world, and to lend our skills and resources to addressing these.The R&D centre in Bangalore, India has a concerted effort specifically towards discovering new medicines for TB and malaria. As part of our efforts on malaria we have screened our proprietary collection of compounds against Plasmodium falciparum, the agent causing the deadliest form of malaria. In collaboration with MMV, we are working towards bringing new medicines for malaria to patients all over the world. I am very committed to the work we do and hopeful of the progress we are making. It is my dream to see the work we do here benefit all the people that suffer from this dreadful disease.