Mothers and children first: rethinking malaria drug development

07 Aug 2017

By MMV's David Reddy and George Jagoe

This article is part of Mediaplanet's Maternal Health Campaign

Malaria affects mothers and children more than anyone else, so it’s about time this is reflected in drug development.

How does malaria affect mothers and children?

Dr. David Reddy: "One of the most frequently stated statistics when it comes to malaria is that under-fives account for around 70% of the estimated 429,000 malaria deaths worldwide. Statistics for pregnancy are less readily available, but we do know that 125 million pregnancies a year are at risk of malaria and as many as 10,000 women and 200,000 neonates die as a result of malaria in pregnancy1. What's more, pregnant women also have an increased risk of life-threatening outcomes, including cerebral malaria or severe anaemia."

How can we protect these vulnerable groups?

George Jagoe: "Preventive drugs are available for these vulnerable groups, but are still not being used to their full potential. Intermittent preventive treatment in pregnancy (IPTp) is a simple oral treatment that needs to be taken at least three times during pregnancy. Despite its low cost and high effectiveness, just 31% of pregnant women in sub-Saharan Africa receive the minimum dosing. Recently, a new approach to protecting children from malaria has enjoyed rapid success and remarkable expansion: Seasonal malaria chemoprevention (SMC) is given to children in the Sahel region of Africa during the three to four months of the year when malaria transmission is at its highest. It’s a brilliant method that has been shown to reduce malaria cases by up to 75%."

What are the ethical challenges in developing drugs?

David Reddy: "Typically, clinical development of paediatric medicines lags behind adult ones. When it comes to malaria, we always strive to consider the needs of children as early as possible. From the moment we think we have a viable malaria medicine candidate, we consider whether it can be optimally formulated and developed for use in paediatric populations. And we not only consider efficacy, but also the tolerability and acceptability of these medicines by children. By working to reduce the dosing burden (e.g. through single-dose malaria cures and flavour-masked medicines), we strive to make these medicines easier for children to take."

Who is prioritising new medicines for pregnant women?

George Jagoe: "There are still huge gaps in knowledge regarding malaria and pregnancy. The World Health Organization (WHO) recommends artemisinin-based combination therapies during the second and third trimesters, but little is known about their safety and tolerability during the first trimester.

To build a clearer picture of the impact of antimalarials on pregnancy and newborns, Medicines for Malaria Venture (MMV) is working with partners to establish registries to track pregnancy outcomes. In Mozambique, we are collaborating with partners to establish a pregnancy registry which will follow women who receive antimalarials as part of a mass drug administration pilot programme.

In Tanzania, MMV and the London School of Hygiene & Tropical Medicine are conducting a safety study focused on repurposing an existing malaria treatment as a potential new IPTp option for pregnant women."

1. Dellicour S et al. “Quantifying the number of pregnancies at risk of malaria in 2007: a demographic study.” PLoS Med. 7(1):e1000221 (2010).