More dangerous than sharks, crocodiles, snakes, and even humans, mosquitoes are the world’s deadliest animal. Despite their innocuous name – which translates as “little flies” in Spanish – they transmit serious diseases including dengue, yellow fever, Japanese encephalitis and Zika. But the biggest mosquito-borne threat by far is malaria, with 219 million cases reported in 2017.
This week marks World Mosquito Day, and with the spotlight on the devastating diseases that mosquitoes proliferate, the Asia Pacific Leaders Malaria Alliance (APLMA) and the Foundation for Innovative New Diagnostics (FIND) have just formalized a new diagnostics partnership that we believe will not only accelerate malaria elimination, but also help to tackle other mosquito-borne diseases in the process.
South-East Asia is leading the world in malaria elimination, recording the largest decline globally, from more than 1600 cases per 100,000 people in 2010, to 700 per 100,000 in 2017. And while we can start daring to believe that malaria elimination within a generation could become a reality in this region, we are also seeing new challenges emerge, alongside emergencies in other diseases such as the ongoing deadly dengue outbreak.
Drug-resistant strains of malaria parasites have increased in several countries in Asia, causing a major threat to malaria elimination. A published paper in 2013 showed that two of the most commonly used antimalarials failed to clear infections within the normal timeframe in 46% of patients in Western Cambodia, due to the spread of multidrug-resistant malaria.
More sensitive diagnostic tests for malaria are needed to increase case detection and ensure patients with fever and other malaria symptoms are appropriately diagnosed and treated. Currently available rapid diagnostic tools are not sensitive enough to correctly diagnose all malaria cases. In addition, frontline health workers are not well-equipped to diagnose the cause of fever when patients test negative for malaria.
As the number of malaria cases drop and countries approach elimination, distinguishing the cause of fever is crucial to ensure that the right treatment is prescribed. This is important not only to secure the best possible outcome for the patient, but also to prevent the unnecessary prescription of medication that is not needed, and to halt the spread of antimicrobial (and antimalarial) resistance.
To tackle these complications, APLMA is partnering with FIND and other product development partners to support a number of strategies to improve access to new diagnostic tools, including joint awareness-raising and advocacy activities to facilitate accelerated introduction of more specific malaria tests.
New diagnostics in development include those that can detect Plasmodium vivax – a relapsing strain of malaria that is responsible for over one-third of infections in South-East Asia – as well as tests that can identify malaria alongside other common causes of fever. The Mahidol Oxford Tropical Medicine Research Unit (MORU) in collaboration with FIND is developing a tool to help countries identify the best diagnostic response and strategy for a given national context.
To support research and development of new diagnostics for malaria and other causes of fever, the FIND specimen bank has also recently been expanded to include samples relating to malaria and fever-causing agents (some mosquito borne, some not).
Increasing commitment to launch game-changing diagnostic tools among senior officials/policy makers and highlighting the urgency of fast-tracking access to these new tools are key to achieving the 2030 malaria elimination target. Through advocacy, APLMA encourages leaders to promote timely introduction of these tools to help communities at risk of malaria and other mosquito-borne diseases.
Together, these initiatives represent an important step towards expanding our toolkit to tackle the so-called “last mile” of malaria elimination in South-East Asia. Access to new, improved diagnostic tests will enable us to beat the threats carried by these little flies and end it for good. Now that is a hopeful outlook for us beyond World Mosquito Day.
Benjamin Rolfe is Chief Executive Officer, Asia Pacific Leaders Malaria Alliance (APLMA). His expertise is on health policy, systems and financing.
Sabine Dittrich heads the malaria and fever programme at the Foundation for Innovative New Diagnostics (FIND), focused on developing holistic diagnostic strategies for fever managment in tropical settings.