Malaria has been a major public health threat, particularly in tropical and subtropical regions of the world. According to the World Health Organization (WHO), there were an estimated 247 million cases of malaria worldwide in 2021, with the vast majority (95 per cent) occurring in the Sub-Saharan African (SSA) region.

However, there is notable progress in terms of the elimination of malaria over the last couple of decades. The most recent World Malaria Report indicated that 27 countries had less than 100 cases of malaria in 2020 up from 6 countries in 2000.

Artemisinin-based combination therapies (ACTs) are the current recommended treatment for uncomplicated malaria, and they are highly effective in killing the Plasmodium parasite. According to WHO, partial artemisinin resistance has emerged as a threat to global malaria control efforts. Reports have confirmed partial artemisinin resistance in Africa in Eritrea, Rwanda, and Uganda.

Several malaria vaccines are in development, with some showing promising results in clinical trials. The RTS, S/AS01 vaccine has been shown to provide partial protection against malaria in young children in clinical trials, and the roll-out has begun.

Malaria vaccines are recommended for children above five months and there are no optimised treatments for babies under five kilogrammes.

Currently, babies are treated with tablets meant for children weighing more than 5kg adjusted to weight). Yet, weight adjustment alone could lead to overdose and potential toxicity as babies metabolise drugs differently.

It is against this backdrop that Novartis is working with Medicines for Malaria Venture (MMV) to develop a formulation optimised for infants under 5kgs, so they receive the right amount of treatment. Closing the gap for these infants is essential to malaria elimination and no child should die of malaria.

There is a need for relevant policies and regulatory guidelines from relevant bodies as well as regular monitoring of antimalarial drug efficacy to inform treatment policies in malaria-endemic countries and to ensure early detection of, and response to drug resistance.

The writer is the Medical Affairs Head, Specialty Medicines & Programmes, Novartis sub-Saharan Africa