"If we could have a single-dose treatment, it would be wonderful in terms of adherence"

Dr Veronica Soto Calle

Dr Veronica Soto Calle, Executive Director of the Directorate for the Prevention and Control of Metaxenic Diseases and Zoonoses for the Ministry of Health of Peru discusses the challenges Peru faces in managing malaria, particularly in the context of COVID-19, and some possible solutions.

1. What is the main challenge Peru faces in eliminating malaria?

The main challenge is securing political support. Malaria has existed in Peru for many years, so people assume it will always be there. Ensuring the political authorities understand that elimination is possible will be critical because they need to commit to the elimination plans and ensure that the necessary funds are disbursed from the Ministry of Economy and Finance. Sustaining this commitment will be a huge challenge.

The Malaria Zero Plan (MZP) has been programmed to last until we achieve malaria elimination, estimated to be in the next 15–20 years. With around 15,000 cases it is not difficult to justify the budget spend, but if we are successful in reducing case numbers, we will need to maintain substantial spending to ensure complete elimination of the malaria parasites. It will be a real challenge to keep the political and financial commitment for elimination when there are very few cases.

2. What additional challenges has the COVID-19 pandemic brought to malaria control in Peru in 2020 and how have you overcome them?

One of the major challenges has been patient follow-up. It has been even more difficult during the COVID-19 pandemic in terms of reaching patients in remote areas and ensuring treatment follow-up. Many of the primary healthcare facilities closed during the pandemic, so access to medical care was greatly affected. Fortunately, community health workers have been an invaluable support, especially during 2020. They have continued diagnosing and treating patients in remote rural areas and have led the activities of the MZP. We have also been able to maintain a dedicated team for the MZP, despite many resources having been reallocated to COVID-19 activities. Keeping this dedicated human resource helped us a lot. Another challenge has been the lack of reporting in the national surveillance system. In a non-pandemic year, around 5% of cases do not get reported. Last year this number increased.

3. What benefit do you feel single-dose tafenoquine and the quantitative glucose-6-phosphate dehydrogenase (G6PD) test could bring to malaria control and elimination efforts in Peru?

Most malaria patients have P. vivax, which means that they receive treatment for at least seven days. Currently, treatment adherence is only around 60%, partly due to patients living in remote areas far from health facilities. If we could have a single-dose treatment, it would be wonderful in terms of adherence. The next phase of the MZP aims to reduce malaria by 99%. We need tools that allow us to achieve that objective. Drugs such as tafenoquine could really boost adherence in future years, combined of course with a safety test such as the G6PD test.