Invest, Innovate and Implement – How LONGEVITY can help deliver ZERO malaria

Posted on: 24 April 2023 by Andy Sloan in LONGEVITY Blog

World Malaria Day was established to provide education and understanding of malaria. Each year the Centre of Excellence for Long-acting Therapeutics (CELT) takes this opportunity to reaffirm our commitment to revolutionising malaria prevention and control to reduce the malaria burden in low- and middle-income countries (LMICs). The theme this year is “Time to deliver zero malaria: invest, innovate, implement” – Three aspects that are critical to our strategy to reduce the malaria burden.

Malaria in Africa

The burden of malaria in Africa is overwhelming. In 2021 the WHO Africa Region was home to 95% of all malaria cases and 96% of deaths. Even more concerning, children under 5 years of age accounted for around 80% of all malaria deaths in this region. In fact, every minute in sub-Saharan Africa a child dies from malaria. The region accounts for approximately 93% of all malaria deaths globally.

These staggering statistics highlight the urgent need to ramp up efforts and intensify investment, innovation and implementation of new strategies to protect vulnerable populations. There are currently a number of approved malaria prevention regimens available in LMICs but a huge barrier in their success is poor adherence and low completion rates of orally administered medication.

Source: World Malaria Report 2022

The LONGEVITY Blueprint

Our strategy is to address the issue of non-adherence to current malaria prevention regimens which require taking daily tablets. The LONGEVITY Project will deploy a long-acting injectable prophylactic which can provide protection from malaria with just one injection a year. This long-acting medicine can replace current oral regimens which are difficult to maintain for several reasons.

Many people in malaria endemic communities have poor access to healthcare, some are overwhelmed with pill burden when required to take lots of tablets orally so they forget, miss doses or simply stop taking their medicines and others have misconceptions or lack of understanding about the medicine so are unwilling to accept preventive medicines.

Our innovation will simplify drug delivery to improve adherence, control transmission and support future strategies to eliminate the disease. Crucially, we hope to alleviate the pressure on healthcare facilities by reducing the frequency of visits for those requiring anti-malarial medicine. Furthermore, we have a team of community experts conducting critical community engagement work with healthcare workers and at-risk communities to understand the needs and educate about our innovative prevention strategy.

Invest

In 2020, CELT was granted $40 million (USD) by global health agency Unitaid to lead the LONGEVITY project, a global consortium committed to developing revolutionary long-acting medicines and reducing the burden of lethal diseases in low- and middle-income countries (LMICs). The LONGEVITY consortium's investment in Malaria prevention is allowing us to reformulate atovaquone, a commonly used drug that is proven to be safe and effective in preventing malaria transmission, and develop a long-acting injectable version that fits the needs of those living in malaria endemic communities.

Innovate

CELT scientists have found a way to create nanoparticles of atovaquone using our patented Solid Drug Nanoparticle Technologies (SDNs). Atovaquone is a poorly water-soluble drug, and has poor bioavailability when taken orally. Reformulating this drug into SDNs allows us to create a product that readily disperses in water and allows us to achieve a high drug loading that can then be administered by injection. Delivering this formulation by either subcutaneous or intramuscular injection may provide enough drug to offer protection against malaria over an extended period of time, whilst current oral medications require daily dosing.

To alleviate any concerns over atovaquone resistance, our partners at Johns Hopkins University have recently concluded preclinical studies with atovaquone-resistant parasites, to characterise the impact of key mutations on transmission. The results of JHU’s brilliant work are nearing publication and we expect to be able to share a paper on this very soon.

Implement

To ensure patient acceptance of our new medicines when they’re implemented, the needs and requirements of those living in LMIC communities are at the forefront of the development process. To provide this platform our project partners Treatment Action Group have been doing fantastic work in consulting with vulnerable communities to better understand the requirements of those in most need are met.

TAG and University of Nebraska Medical Centre have successfully administered surveys assessing the preference of long-acting regimens among various populations at most risk of malaria in LMICs. These surveys were administered amongst both patients and healthcare providers. 79% of respondents say they “definitely would try” a long-acting injectable as an alternative to oral regimens. More detailed data analysis should be available very soon so keep an eye our website for more information.

We for World Malaria Day we interviewed Dorothy Onyango from the Long-acting Technologies Community Advisory Board who shared interesting insights in some of the shortcomings of the current malaria prevention provisions and how long-acting injectable medicines could have a significant impact on the future.

Read the interview with Dorothy here

Hope on the Horizon

The collective work from the LONGEVITY consortium has seen us make huge progress in our development programme since we began in 2020. There are more challenges to overcome but those vulnerable to malaria can be hopeful that a new and innovative prevention strategy will be implemented in LMICs in the near future, providing new hope in the global efforts to see a malaria free world.

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The LONGEVITY Project is funded by Unitaid

The project also involves critical partners and collaborators in the Clinton Health Access Initiative, Johns Hopkins University, Medicines Patent Pool, Tandem Nano Ltd., Treatment Action Group and the University of Nebraska Medical Center