For the past three years, the worldwide Covid-19 pandemic has captivated headlines and prompted scientific inquiry, with specialists from all walks of life devoting time, energy, and every available tool to finding a solution. Although media attention has shifted away from Covid-19, it is still a top worldwide issue, often at the disadvantage of other infectious diseases tied to poverty and disproportionately impact the South. In 2021, there were 247 million instances of Malaria globally, and an estimated 619,000 people died from it. Most of those murdered were young children in Sub-Saharan Africa.
Researchers have made significant progress in both preventing and treating Malaria. Two new types of insecticide-treated bed nets, one with a more potent combination of pesticides and one able to inhibit mosquito growth and reproduction, were recommended by the World Health Organization in March to combat the spread of Malaria by Anopheles mosquitoes. Antimalarial drugs that are not too expensive are another useful tool. About 45 million children between three and five years old received monthly doses of therapeutic medications for seasonal malaria chemoprevention in 2021 at less than $4 per person. GSK’s Mosquirix (also known as RTS, S), a revolutionary vaccine, was recently announced, providing some hope, but at a rather hefty cost of roughly $40 per child for the first year.
Malaria remains a public health problem despite attempts to combat it. Despite $26 billion spent on combating the illness in Sub-Saharan Africa between 2000 and 2019, the number of cases has climbed (but deaths have reduced). We need new preventative measures and ones that are specifically designed with kids in mind. One positive outcome of the avalanche of Covid-19 research is that it revealed the great potential of monoclonal antibodies, which should serve as a model for future innovation.
These medications are synthetic analogs of natural proteins the immune system uses to combat harmful pathogens. Cancer and autoimmune illnesses, including rheumatoid arthritis and lupus, have historically been effectively combated with monoclonal antibodies. Although monoclonal antibodies against Covid-19 and respiratory syncytial virus are rarely used prophylactically, they have shown considerable potential. In addition, their high selectivity allows them to avoid unwanted side effects by targeting specific molecular targets rather than generic ones. This means the drug is safe for children and other vulnerable populations.
Two antibodies against CSP-1, the protein the malaria parasite needs to enter liver cells and establish infection, have been discovered by a research team at the National Institutes of Health in the United States led by Robert Seder. As a result, inhibiting CSP-1 should serve to avert infection. L9LS, the most advanced of the two antibodies, is currently undergoing safety and efficacy testing in children in Mali and Kenya. Success is being measured in a Mali trial in a context where Malaria is seasonal. In Kenya, the focus is on a region where infection is likely all year round.
The development of monoclonal antibodies offers hope that the disease can finally be eradicated. A single dose of the latest generation of antimalarial antibodies can protect a child from Malaria for at least three months and probably longer. Clinical trials are necessary to determine how long the protection lasts and how much of an improvement is needed to get to a dosage that can be injected once a year.
Increasing the efficacy of this cutting-edge treatment might drastically reduce costs, despite antibodies’ notoriously high price tag (those used to treat cancer cost over $20,000 per month in Europe and the US). According to some estimates, one milliliter of the antibody medication currently being tested in Mali and Kenya might potentially protect children for as little as $5-10 per person.
To date, high-income regions have been the primary drivers of demand for monoclonal antibodies, with Africa contributing a negligible percentage (1%) to global sales. Given this discrepancy, collaboration with national regulatory bodies is essential to guarantee that submitted product data effectively address public health issues and, in the long run, affected countries are involved in manufacturing these biologics. Investment in the technology to manufacture antibodies now would be a godsend for emerging economies burdened by chronic Malaria, even though this is a difficult and highly regulated procedure.
Although monoclonal antibodies provide a promising new direction in the fight against Malaria, getting the word out will require a concerted effort from multiple sectors, including government, academia, and industry. (The same organizations should advocate for creating biologics to treat all infectious diseases).
The first generation of antimalarial antibodies won’t be used until at least 2027, so we have a long way to go. Along with bed nets, medications, and new vaccines, they show great promise in the fight against this killer of children. The clinical studies determine whether or not this potential can be achieved, but in the meantime, we should act as though we will be successful.
