Two new therapeutic chemical compounds and new community-based approaches to combating malaria, driven partly by lockdowns to combat the Covid-19 pandemic, have reinforced internationally agreed objectives that malaria can be eliminated by 2030, says social benefit organisation Goodbye Malaria cofounder Sherwin Charles.

The two new compounds were discovered as part of an ongoing project by the universities of Pretoria, the Witwatersrand and Cape Town, as well as the Council for Scientific and Industrial Research and their international partners.

The compounds hold significant promise to combat active malaria infection within people’s bodies and eliminate the development of malaria germ cells – called gametocytes – in a patient’s blood, thereby preventing mosquitoes from ingesting these cells and spreading malaria parasites to new hosts.

This disrupts a part of the life cycle of the malaria parasites and, in addition to preventing infection through the use of prophylaxis – or preventive medicines – and mosquito control measures, these compounds can help to significantly reduce the spread of malaria, says Charles.

However, the lengthy asymptomatic incubation period – those infected with malaria can be asymptomatic for between a week and a month – means there is a reservoir of people who are asymptomatic and it is not possible to get to zero malaria without addressing this issue.

“Eliminating or eradicating is defined as no local transmission of the disease. The new medical compounds and other malaria medicines can help to realise this goal and could play a critical role in removing these reservoirs.”

Charles explains that, when used with proven malaria treatments and control interventions, such as indoor spraying and the availability of healthcare to allow for diagnosis and treatment, the new medical compounds are another tool in the toolbox to achieve the African Union goal of eliminating malaria by 2030, which would prevent about 500 000 deaths a year, based on current infection and mortality rates.

Further, combating malaria requires a holistic approach of tackling the parasite at each stage of its life cycle, as well as its infection vectors, which are mosquitoes. Most government, local and international organisations in malaria- endemic areas have agreed to support the work of international, health and social-benefit organisations to ensure that prevention campaigns are conducted, durable and insecticide-treated mosquito nets are distributed, and cases are quickly diagnosed and effectively treated.

“The pandemic and its global impact showed us how fragile our progress in fighting malaria was, and the lockdowns and restrictions threatened to undo 25 years of progress within a matter of weeks.

If we could not successfully complete the preventive measures before the rainy season starts, such as the spraying of indoor surfaces with long-duration insecticides that protect people against mosquitoes for at least six months in malaria-endemic areas, then we could be looking at a significant increase in malaria-related deaths, possibly topping deaths resulting from the Covid-19 virus in these regions.”

All stakeholders in the fight against malaria cooperated to help organisations to overcome unique challenges, including disrupted supply chains, logistical problems and accessing personal protective equipment after the prices had shot up during the pandemic. This cooperation helped to prevent a resurgence in malaria, Charles adds.

The need to ensure that work continued, despite the restrictions on movement and the disruptions of medicine and protective equipment, supply chains prompted the team of Goodbye Malaria to use novel approaches, including establishing mobile training facilities within communities – thereby allowing for capacity building without requiring that people travel – and using digital platforms to coordinate teams.

“It was heartening to see the development of capacity on the ground and within the communities, which is crucial to solving the problems preventing the elimination of malaria, and to have donors who were aware of the challenges and the importance of the work.”

The organisation achieved its objectives during the 2020 season within time and budget, and helped to protect about two-million people in south-east Africa.

“While our teams have done amazing work, a significant benefit of this disruption to the conventional approaches to combating malaria is that communities have taken ownership to ensure that the necessary preventive measures are in place through behavioural change,” he highlights.

Behaviour change in communities, such as eliminating standing pools of water, keeping residential areas clean to limit mosquito breeding and deploying preventive measures before the rainy season arrives, is crucial to reduce infections and, we believe, to achieve the long-term goal of eradicating malaria,” he says.