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the disease have been kept alive with steady<br />
and robust funding by international donors<br />
since 2010. With population growth and the<br />
emergence of resilient transmission patterns,<br />
existing levels of funding proved inadequate<br />
in recent years, especially in highest burden<br />
countries. Global funding for malaria control fell<br />
short of the estimated US$ 4.4 billion needed<br />
in 2017, with total funding estimated at US$<br />
3.1 billion, representing a yearly shortfall of<br />
US$ 1.3 billion. Investment in malaria R&D too<br />
fell in 2016. At a total of US$ 588 million, it<br />
represented about 85% of the US$ 693 million<br />
needed every year for malaria basic research<br />
and product development R&D, as estimated in<br />
the Global Technical Strategy (GTS) for malaria<br />
2016-2030.<br />
Investment in malaria vaccine development<br />
too is limited. Most financing into the<br />
development of vaccines to combat malaria<br />
comes from the public sector.<br />
The fact that malaria affects some of the<br />
world’s poorest means that there is a limited<br />
‘market’ for investment from the private sector.<br />
In the meantime, financing for vector<br />
control products and diagnostics have<br />
significantly increased.<br />
Among the systemic and technical<br />
measures identified by the WHO to accelerate<br />
malaria control are inadequate performance<br />
of health systems, weak management<br />
of supply chains, an unregulated private<br />
health sector in countries like India, a lack<br />
of surveillance systems, monitoring and<br />
evaluation, a dearth of adequate technical<br />
and human resource capacities to scale up<br />
efforts, and insufficient tools to diagnose and<br />
Malaria is caused<br />
by a different<br />
kind of pathogen<br />
– a parasite, as<br />
opposed to a virus<br />
or bacterium. You<br />
have to take into<br />
account a more<br />
complex lifecycle.<br />
We don’t have<br />
any vaccines in<br />
human use against<br />
parasites. They<br />
transit between two<br />
organisms—humans<br />
and mosquitoes.<br />
Dr Ashley Birkett<br />
Director of PATH’s<br />
Malaria Vaccine Initiative<br />
ARTEMISININ COMBO THERAPIES:<br />
STATUS OF EFFICACY<br />
TREATMENT OF P. FALCIPARUM<br />
OVERALL<br />
EFFICACY<br />
TREATMENT<br />
FAILURE RATES<br />
Artemether-lumefantrine<br />
98.2% >10% (occurred in four of the<br />
159 studies conducted)<br />
Artesunate+sulfadoxine-pyrimethamine<br />
97.7% >10% (occurred in eight of<br />
the 101 studies)<br />
Artesunate-amodiaquine<br />
98% 13.8% and 22.6%<br />
(two studies conducted in<br />
Cambodia in 2016 detected<br />
high treatment failures)<br />
Artesunate-mefloquine<br />
94.9% 12.5–49.1<br />
(high treatment failure rates<br />
were observed in seven<br />
studies conducted in Thailand<br />
between 2010 and 2013)<br />
Artesunate-pyronaridine<br />
96.9%. >10% (Two studies conducted<br />
in western Cambodia in 2014,<br />
10.2% and 18%),<br />
Dihydroartemisinin-piperaquine<br />
94.5% >10% (observed in 19 studies<br />
from Cambodia, Lao People’s<br />
Democratic Republic and Viet<br />
Nam.)<br />
Most studies show that the ACTs currently<br />
recommended in national malaria treatment<br />
policies remain effective, with overall efficacy<br />
rates of >95%. However, studies show<br />
treatment failure rates of >10% associated<br />
with treatments currently recommended in<br />
the national treatment policy.<br />
TREATMENT OF P. VIVAX<br />
Chloroquine<br />
97.4% 22% (Ethiopia)<br />
ACTs<br />
93.4% >10% (observed in four<br />
studies)<br />
SOURCE: WHO<br />
<strong>April</strong> <strong>2019</strong> / FUTURE MEDICINE / 25
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