This is the 37th post in a blog series to be published in 2021 by the Secretariat on behalf of the AU High-Level Panel on Emerging Technologies (APET) and the Calestous Juma Executive Dialogues (CJED)

The African Union (AU) is currently amplifying efforts towards combating malaria. In the 2000 Abuja Declaration, the African Heads of States and Governments committed to reducing malaria mortality rate by half across the African continent by 2010.[1] In addition to the 2000 Abuja Declaration, through the African Leaders of malaria Alliance (ALMA), the AU also committed to ending malaria by 2030 through recommitting resources necessary in combating the disease. These targets are aligned with AU’s Agenda 2063 aspiration of eliminating malaria by 2030.[2]

Malaria remains one of the most significant public health concerns across the African continent. The World Health Organisation (WHO) has identified malaria as a leading cause of death in many African countries. Regrettably, the disproportionately affected groups are children and pregnant women.[3] Approximately 229 million people were infected with malaria worldwide in 2019. In addition, the disease caused approximately 409,000 fatalities, and a notable 94% of these fatalities were deaths in Africa.[4]

The malaria epidemic in Africa has derailed the socio-economic development and growth of the continent. Countries adversely affected by malaria have been observed to have up to five times lower Gross Domestic Product (GDP) than African countries without malaria infections.[5] The infection of Africans by malaria has implications on Africans’ socio-economic activities. For instance, there are substantial medical and hospital costs towards the purchase of drugs for combating malaria. This also includes expenses for travelling to hospitals for seeking medical attention, absentia from work and school, and burial expenses for burial in case of deaths. Unfortunately, such negative socio-economic expenses and economic inactivity may further force African families to lose income.[6]

However, since the AU’s declarations were made, the African continent has made tremendous strides in its fight against malaria. Consequently, the devastating effects and momentum of the malaria disease have begun to decrease. This results from the massive rollout of mosquito nets, anti-malaria medicines, and indoor residual spraying of insecticides. For example, between 2000 and 2015, the malaria mortality rates across the African continent have fallen by approximately 66% across all age groups. For children under the age of 5, the mortality rate fell by approximately 71%.[7]

Worth noting, the utilisation of treated mosquito nets has significantly and effectively prevented malaria transmission and infection across the continent, even though more still lies ahead. The treated mosquito nets have reported a significant 70% efficiency rate than untreated mosquito nets towards reducing transmission rates.[8] Furthermore, the utilisation of insecticides such as pyrethroids has also proven considerable effectiveness against malaria.[9] This is even more effective when utilised in conjunction with mosquito nets.[10]

In Africa, malaria is predominately caused by the Anopheles gambiae complex, three of which are responsible for the high transmission of malaria. The predominant parasite species known as Plasmodium falciparum is causing severe malaria infections in Africa and subsequently causing death to numerous Africans.[11] In addition, Africa’s optimal weather conditions allow and enables the mosquitos to breed rapidly, including the malaria-transmitting species. Unfortunately, some of these species have developed resistance to insecticides, making it difficult to alleviate the disease completely.

To completely eradicate malaria from the African continent, the African Union Panel on Emerging Technologies (APET) encourages African countries to upscale their malaria eradication efforts. These efforts include addressing the constraints impeding the efficient delivery of existing effective key malaria control strategies, innovation, tools, and emerging technologies. This can be accomplished by adopting several emerging technologies so to eradicate the disease from the African continent. Notably, most of the current methods being utilised by African countries to combat malaria focus on vector control to limit the spread of the mosquito transmitting insects. In some cases, there have been efforts towards reducing the conducive environment for breeding, such as removing stagnant moisture containing reservoirs. Other efforts include insecticide-treated durable wall lining for malaria control in rural and urban populations in Angola and Nigeria.[12] However, APET is advocating for more technologies that focus on eliminating the three malaria-transmitting vectors to eliminate the malaria-transmitting population.[13]

APET advocates for a combined approach whereby conventional and modern technologies can be adopted and adapted to eradicate malaria across the African continent. For example, in an APET Report titled, “Gene Drives for Malaria Control and Elimination in Africa”, APET encourages African countries to combine gene drive technology with existing control methods so as to eliminate malaria in Africa.[14] Gene drive for malaria control is a genetic engineering technique that specifically modifies genes to eliminate select malaria-transmitting mosquitoes through population suppression or alteration techniques[15] . This technology has great potential in vector control.

In population suppression, gene drives introduce vector population reproduction disruption by influencing that most progenies are males. In population alteration, this distorts the female mosquitoes to reproduce males and thereby dwindle the female malaria-transmitting mosquito populations.[16] As it is the female mosquitoes responsible for malaria transmission, by increasing the male species, there will be limited female mosquitoes that can transmit the malaria disease and reproduce more mosquitoes.

Figure 1: Comparison of population replacement (A) and population suppression (B) strategies.

REFERENCE: The American Journal of Tropical Medicine and Hygiene 98, 6_Suppl; 10.4269/ajtmh.18-0083[17]

It is important to note that there are only 3 malaria-transmitting mosquitoes species being targeted in gene drive vector control, as against approximately 800 species that do not transmit malaria. Thus, by genetically modifying these 3 species, limited negative impacts would be made on the ecosystem.[18]

APET is also calling for efforts and investments in developing malaria vaccines to help curb the infection and hospitalisation rates and ultimately eradicate malaria. On the 9th of October 2021, the World Health Organisation approved a malaria vaccine, “Mosquirix”, which is declared a game-changer in the fight against malaria. The Mosquirix vaccine targets building immunity against the deadliest malaria parasites, such as the Plasmodium falciparum commonly found in Africa.

Preliminary vaccine results have demonstrated about 80% efficacy efficiency in malaria prevention based on trial results from Kenya, Malawi, and Ghana.[19] Currently, the AU is formulating and facilitating vaccine rollout implementation programmes with WHO to vaccinate Africans promptly.[20] Considering Mosquirix was developed over a 30-year period, APET is also suggesting that more investment efforts in research, development, and innovation should be dedicated towards vaccine development to hasten the process, as was observed with the COVID-19 vaccines. About 2.3 million doses of Mosquirix have already been administered for the initial trials since 2019.[21] Therefore, APET encourages African countries to bolster the malaria vaccination process to increase population immunity against malaria.

Figure 2: Model house with SolarMal Mosquito Trapper installed

To increase efforts towards vector control, APET is also encouraging African countries to adopt and adapt the SolarMal Mosquito Trapper. This technology has demonstrated high effectiveness against malaria. This technology was developed by collaborative research between the Dutch University of Wageningen, Kenyan International Centre of Insect Physiology and Ecology (ICIPE), and the Swiss Tropical and Public Health Institute. The SolarMal Mosquito Trapper technology mimics the scent of human beings so to attract malaria-transmitting mosquitos.[22] Thereafter, the mosquitoes are sucked into the trap via a solar-powered ventilator to create a flow of air into the trapper. Once the mosquitoes are trapped within the SolarMel Mosquito Trapper, they are unable to escape.

REFERENCE: Oria, P.A., Hiscox, A., Alaii, J. et al. Tracking the mutual shaping of the technical and social dimensions of solar-powered mosquito trapping systems (SMoTS) for malaria control on Rusinga Island, western Kenya. Parasites Vectors 7, 523 (2014). https://doi.org/10.1186/s13071-014-0523-5

Notably, this technology efficiently and effectively eliminated mosquitoes in Rusinga, on Lake Victoria. Through the 4500 traps deployed on the island, the initial results indicated a 70% elimination of mosquitos and malaria infection decrease of approximately 30%.[23]

The Mosquito Landing Box is another mosquito trapping technology, similar to the SolarMal operational mechanism developed in Tanzania. The initial trials demonstrated a 60% immobilisation rate of the mosquitos within its vicinity. Just like the SolarMal, this technology device uses human scent to lure mosquitos into the boxes and then prevent their escape[24]. Interestingly, the landing boxes can attract mosquitoes from over 100 m2 and immediately electrocute or douse the mosquitoes with insecticides once trapped.

APET notes that malaria is easily treatable when detected in its early stages of infection. Therefore, APET recommends that African countries cost-effectively increase efforts towards early testing mechanisms of malaria, more especially in highly mosquito populated areas. For example, the Mobile malaria Laboratory (MOMALA) is being utilised as a smartphone medical application that enables healthcare workers and malaria patients to identify malaria at early stages.[25] The MOMALA application utilises a built-in technology that acts as a microscope to identify malaria parasites. During trials in Kenya, the application was found to be 98% accurate in diagnosing malaria.[26] Thus, APET believes that adopting the MOMALA application can bolster the testing of malaria, more especially in rural areas, in a timely and cost-effective manner.

The costs of procuring expensive malaria diagnostic microscopes, which are currently in short supply in most healthcare centres across the African continent, is relatively high. Therefore, APET believes that the development and adoption of cost-effective, rapid, and accurate diagnostic tools for mobile phones and tablets would not only break the accessibility barriers of low-resource countries but also facilitate immediate treatment.

APET recognises that Africa is making headway in the fight against malaria, more especially with existing methods such as spraying of insecticide and mosquito nets. Unfortunately, there are environmental concerns whereby the mosquito eliminating insecticides may pollute water sources and the environment and subsequently cause diseases such as cancer.[27] As such, this may require further water treatment so to remove these insecticides and pesticides from water.[28]

In conclusion, APET is recommending the incorporation of emerging technologies into existing interventions so to eradicate malaria effectively. Such interventions may bolster and hasten the efforts of eradicating malaria by 2030. APET urges African countries to increase investments towards research, development, and innovation to boost the incorporation of emerging technologies into existing malaria control interventions. The fight against malaria will reduce not only malaria-related sickness and deaths but also bolster the socio-economic activities of the countries most negatively impacted by malaria. These efforts increase productivity, further the development of African economies, and reduce malaria-related hospitalisation.

Featured Bloggers – APET Secretariat

Justina Dugbazah

Barbara Glover

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[1] https://au.int/sites/default/files/pages/32894-file-2000_abuja_declaration.pdf.

[2] https://au.int/sites/default/files/newsevents/workingdocuments/27513-wd-sa16949_e_catalytic_framework.pdf.

[3] https://www.cdc.gov/malaria/malaria_worldwide/impact.html.

[4] https://www.mmv.org/malaria-medicines/malaria-facts-figures#:~:text=In%202019%2C%20an%20estimated%20229,in%20the%20WHO%20Africa%20Region.&text=In%202019%2C%20there%20were%20an,vulnerable%20group%20affected%20by%20malaria.

[5] https://www.nepad.org/publication/gene-drives-malaria-control-and-elimination-africa.

[6] https://www.cdc.gov/malaria/malaria_worldwide/impact.html.

[7] https://www.un.org/africarenewal/magazine/december-2016-march-2017/gains-made-fight-against-malaria.

[8] Okumu, F. The fabric of life: what if mosquito nets were durable and widely available but insecticide-free?. Malaria Journal 19, 260 (2020). https://doi.org/10.1186/s12936-020-03321-6.

[9] Monica P. Shah, Laura C. Steinhardt, Dyson Mwandama, Themba Mzilahowa, John E. Gimnig, Andy Bauleni, Jacklyn Wong, Ryan Wiegand, Don P. Mathanga, Kim A. Lindblade, The effectiveness of older insecticide-treated bed nets (ITNs) to prevent malaria infection in an area of moderate pyrethroid resistance: results from a cohort study in Malawi, Malar Journal 19, 24 (2020). https://doi.org/10.1186/s12936-020-3106-2.

[10] https://www.science.org/news/2016/10/after-40-years-most-important-weapon-against-mosquitoes-may-be-failing.

[11] https://www.cdc.gov/malaria/malaria_worldwide/impact.html.

[12] Louisa A Messenger, Nathan P Miller, Adedapo O Adeogun, Taiwo Samson Awolola, Mark Rowland, The development of insecticide-treated durable wall lining for malaria control: insights from rural and urban populations in Angola and Nigeria, Malar J 11, 332 (2012). https://doi.org/10.1186/1475-2875-11-332.

[13] Ferguson, N.M. Challenges and opportunities in controlling mosquito-borne infections. Nature 559, 490–497 (2018). https://doi.org/10.1038/s41586-018-0318-5.

[14] https://www.nepad.org/publication/gene-drives-malaria-control-and-elimination-africa.

[15] https://www.livescience.com/gene-drive.html.

[16] https://www.nepad.org/publication/gene-drives-malaria-control-and-elimination-africa.

[17] https://www.ajtmh.org/view/journals/tpmd/98/6_Suppl/article-p1.xml

[18] Liu, W., Li, Y., Shaw, K. et al., African origin of the malaria parasite Plasmodium vivax. Nat Commun 5, 3346 (2014). https://doi.org/10.1038/ncomms4346.

[19] https://www.nytimes.com/2021/10/07/world/africa/malaria-vaccine-africa.html.

[20] https://www.reuters.com/world/africa/african-union-start-talks-with-who-malaria-vaccine-rollout-continent-2021-10-07/.

[21] https://www.aljazeera.com/news/2021/10/6/who-reccomends-rollout-of-malaria-vaccine-for-african-children.

[22] https://en.reset.org/blog/solarmal-how-fight-malaria-mozzies-power-sun-08242016.

[23] Prisca A. Oria, Michiel Wijnands, Jane Alaii, Cees Leeuwis, Options for sustaining solar-powered mosquito trapping systems on Rusinga Island, Western Kenya: a social dilemma analysis. BMC Public Health 18, 329 (2018). https://doi.org/10.1186/s12889-018-5218-y.

[24] https://www.designindaba.com/articles/creative-work/5-innovations-fight-against-malaria.

[25] Pongthep Meankaew, Jaranit Kaewkungwal, Amnat Khamsiriwatchara, Podjadeach Khunthong, Pratap Singhasivanon, Wichai Satimai, Application of mobile-technology for disease and treatment monitoring of malaria in the “Better Border Healthcare Programme”, Malaria Journal 2010, 9:237-251.

[26] https://www.designindaba.com/videos/creative-work/momala-%E2%80%93-healthcare-app-detects-malaria-spot.

[27] https://www.beyondpesticides.org/assets/media/documents/mosquito/documents/citizensHealthEffectsMosqP.pdf.

[28] http://www.wrc.org.za/wp-content/uploads/mdocs/1128-1-031.pdf.