Improving access to radical cure: accelerating elimination of relapsing P.vivax malaria

The WHO’s Global Technical Strategy for Malaria 2016–2030 has set the ambitious target of eliminating malaria from at least 35 countries by 2030. A major challenge in reaching this target is the elimination of Plasmodium vivax (P. vivax), a species of malaria that accounts for half of all cases outside sub-Saharan Africa. To support WHO’s goals, GlaxoSmithKline (GSK) and MMV have developed tafenoquine, a single-dose treatment for prevention of relapse of P. vivax malaria.

In 2021, MMV and PATH launched the Partnership for Vivax Elimination (PAVE), to support malaria-endemic countries in achieving their P. vivax elimination goals. PAVE is working with governments and partners to develop and implement new strategies to increase the number of vivax patients cured and reduce the disease burden towards eventual elimination in endemic countries.

Supporting access to diagnostics, G6PD testing and treatment

P. vivax requires treatment of both the blood stage and liver stage infection. Blood stage treatment is with chloroquine, or in areas where chloroquine resistance is prevalent, artemisinin-based combination therapy (ACT). To treat the liver stage infection and prevent relapse, an 8-aminoquinoline drug, either primaquine or tafenoquine is required.

8-aminoquinoline drugs including primaquine and tafenoquine can cause adverse events in patients deficient in the glucose-6-phosphate dehydrogenase (G6PD) enzyme. G6PD deficiency is a common genetic variant that occurs in over 400 million people globally. As a result, it is best practice to test for G6PD deficiency prior to treatment.

Limited access to testing for G6PD deficiency has made it difficult for physicians to prescribe these relapse prevention drugs. Through PAVE, MMV is working with partners to tackle this challenge and support countries in ensuring access to point-of-care G6PD testing before treatment with either single-dose tafenoquine or primaquine.

In addition to work on G6PD deficiency diagnosis, PATH is also working to introduce improved diagnostics to rapidly detect the malaria parasite. Read more on PATH’s work on rapid diagnostic tests for malaria.

PAVE is engaging with national malaria programmes to increase knowledge of these tools, support policy change processes, procurement, and roll-out of these products.

Generating data and supporting introduction

A key objective of PAVE is to conduct feasibility studies and operational research supporting Ministries of Health to look at the best way to use different P. vivax relapse treatments and diagnostics at different levels of the healthcare system in support of their elimination goals. Research is planned or currently taking place under the PAVE initiative in Brazil, Colombia, Ethiopia, India, Indonesia, Lao PDR, Papua New Guinea, Peru, Thailand and Vietnam.

Towards quality-assured treatment options for children

Medicines are urgently needed to fulfill the unmet need of relapse prevention in young patients. There are currently no quality-assured paediatric formulations of tafenoquine or primaquine, yet children are especially vulnerable to mortality caused by cumulative severe anaemia from repeated P. vivax malaria episodes.

Between 2017 and 2020 GSK and MMV conducted a Phase 2b clinical study known as TEACH  to evaluate the dosages of tafenoquine based on weight for children between the age of 6 months and weighing at least 5 kg, up to 15 years. The data from TEACH formed the basis of a submission to the Australian Therapeutic Goods Administration (TGA) requesting to extend the indication of single-dose tafenoquine to children. The submission included data for a new, 50 mg tablet that can be dispersed in water facilitating its use in children.  

Through PAVE, MMV is also supporting the development of a quality-assured, child-friendly formulation of primaquine with funding from Unitaid.

→Take a look at the product availability map to see where tafenoquine is registered. 

  • Past and current partners:

    PATH, WHO, NMCPs, Ministries of Health, Unitaid, the Bill & Melinda Gates Foundation, the UK Foreign, Commonwealth and Development Office GlaxoSmithKline, the Australian Department of Foreign Affairs and Trade

    Updated December 2021