The UNICEF has secured a four-year supply of the newly WHO-approved R21/Matrix-M vaccine that could revolutionize malaria prevention, especially in Africa where 90% of fatalities occur.



Malaria, one of the most widely-known parasitic diseases to mankind, takes the life of a child every minute according to World Health Organization (WHO) estimates, with almost 620,000 deaths per year. A staggering 241 million people contract the disease annually, illustrating the global scope of this public health crisis.



Now, a new vaccine has joined the world in the fight against the disease, having obtained WHO approval earlier this month. The United Nations Children&#8217;s Fund (UNICEF) has entered into an agreement to procure a four-year supply of the newly approved R21/Matrix-M vaccine from mid-2024.



The new vaccine is a product of over 35 years of vaccine research, a collaboration between the University of Oxford and the Serum Institute of India, notable in that it is only the second malaria vaccine approved for public use. The first, known as RTS,S, initiated the ground-breaking work in this field but was less efficacious.



Dubbed R21/Matrix-M, it is the first to surpass a 75% efficacy rate, providing protection of up to two years against symptomatic malaria with a single booster – which could be a ground-breaking shift in the fight to eradicate the disease, particularly on the African continent, where some 90% of the fatalities from the illness occur.



&#8220;It is heartbreaking and unacceptable that almost half a million children die of malaria every year. This agreement is a critical step towards protecting more children from this deadly disease,&#8221; said Director of UNICEF Supply Division Leila Pakkala in a press statement announcing the signing of UNICEF&#8217;s supply agreement.



The obtaining of the WHO&#8217;s endorsement earlier this month was critical to allow international bodies such as UNICEF to begin procuring the vaccines, with WHO having vetted the safety profile and efficacy of R21/Matrix-M.



Adar Poonawalla, CEO of the Serum Institute of India, commemorated the WHO endorsement in a press release: &#8220;For far too long, malaria has threatened the lives of billions of people across the globe, disproportionately affecting the most vulnerable amongst us. This is why the WHO recommendation and approval of the R21/Matrix-MTM vaccine marks a huge milestone on our journey to combat this life-threatening disease.&#8221;



The Serum Institute of India has already begun to prepare the production capability to deliver up to 100 million doses per year, to be doubled in the coming two years.



Cost and Delivery



Critically, for a vaccine that aims to prevent severe disease primarily in lower-income countries, the R21/Matrix-M is expected to cost only between $2 and $4 per dose, with an initial regimen consisting of one dose every month for three months, and one booster within the next 12 months – meaning that a full treatment protocol offering high levels of protection for almost two years costs less than $16.



Countries have already begun to factor in the new vaccine into their epidemiological planning, with both Ghana and Nigeria having obtained approval for the vaccine&#8217;s use – Ghana too has begun establishing a vaccine factory in Accra for this purpose in collaboration with the Serum Institute of India.



The Path Forward



Despite the leaps in vaccine development, challenges persist. While vaccines like R21/Matrix-M are revolutionary, they are not the final answer to a disease as complex and historically persistent as malaria. In the interim, nations continue to deploy traditional methods like insecticides, improved housing, and swamp drainage, especially in regions where malaria remains prevalent. It&#8217;s also worth mentioning that mRNA technology, catalyzed by COVID-19 research, holds the promise of even more effective vaccines in the future.



Global efforts have already made significant strides; the WHO reports a 90% decline in malaria mortality rates in the 20th century, but with many in the world still suffering under high rates of the disease, the new vaccine could be key in reducing fatalities in the years to come.

R21-Vaccination (11 of 20); image credit University of Oxford, Tom Wilkinson

The Vaccine That Could Turn The Tide On Malaria In Africa, Where The Disease Is One Of The Biggest Killers

TOPLINE The World Health Organization <a href="https://www.who.int/news/item/06-10-2021-who-recommends-groundbreaking-malaria-vaccine-for-children-at-risk" target="_blank" rel="noreferrer noopener">endorsed</a> the safety and efficacy of the world’s first malaria vaccine on Wednesday, clearing the way for it to be rolled out to treat children in sub-Saharan Africa and other regions that are hard-hit by the disease, which is one of the leading killers in low-income countries.



<h2 class="wp-block-heading" id="h-key-facts">KEY FACTS</h2>



WHO expert advisory groups on vaccines and malaria said the RTS,S/AS01 vaccine, also known as Mosquirix, which was developed by GlaxoSmithKline, was recommended based off the results of a pilot program involving more than 800,000 children in Ghana, Kenya, and Malawi.



The pilot program showed the vaccine was cost-effective and helped to reduce the incidence of life-threatening severe cases of malaria by 30% in areas where other preventative measures were being taken.



<h2 class="wp-block-heading">BIG NUMBER</h2>



More than 260,000. That is approximately how many children under the age of 5 die of malaria in Africa annually, according to the WHO.&nbsp;



<h2 class="wp-block-heading">CRUCIAL QUOTE</h2>



“Today’s recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease, and we expect many more African children to be protected from malaria and grow into healthy adults,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.



<h2 class="wp-block-heading">WHAT TO WATCH OUT FOR</h2>



The WHO said it will make funding decisions for a broader rollout of the vaccine, and countries will need to decide whether they want to adopt the vaccine.



<h2 class="wp-block-heading">KEY BACKGROUND</h2>



GlaxoSmithKline, <a href="https://www.gsk.com/en-gb/responsibility/improving-health-globally/using-our-science-for-global-health/guardian-article-the-30-year-quest-for-a-malaria-vaccine/" target="_blank" rel="noreferrer noopener">said</a> it has been working to create a vaccine that would help protect against malaria for 30 years. The company first made a breakthrough in 1996 with the RTS,S/AS01 vaccine, which protected six out of seven volunteers in an initial trial. Additional studies in 1999 on adults in Gambia and in 2004 on Mozambique children also proved that the vaccine was effective. Based on various trials, the company submitted a regulatory application with the European Medicines Agency last year, taking the first step to getting the vaccine approved for widespread use.



By Kimberlee Speakman, Forbes Staff

GHANA-HEALTH-VACCINES-MALARIA

WHO Backs Widespread Use Of First Malaria Vaccine

With Africa having a big share of the global malaria burden, technologists are developing new, cost-effective ways to detect the disease – minus the needle. 

A needle, blood drawn and waiting time are the three aspects of a traditional malaria test.
In Kampala, Uganda, 24-year-old Brian Gitta has created a device that eliminates all of the above, in a first for malaria testing.
Matibabu, meaning ‘treatment’ in Swahili, tests malaria without drawing blood and can deliver results instantly.
The device, clipped on to a patient&#8217;s finger, beams a red light, and the results are available within a minute on a mobile phone linked to the device.
Growing up, Gitta had a passion for computers and went on to pursue a degree in computer science at the University of Makerere in Kampala.
Little did he know his eagerness and passion for tech would lead him to the medical field.
“I’m not one who grew up saying I wanted to be a doctor or a lawyer. I mean I’m not a doctor but I’m glad I can make a change in the medical realm from there,” Gitta tells FORBES AFRICA.
Gitta, who is often in and out of hospitals, now runs Matibabu, a company that takes its name from the device he created. He runs it with a team of six full-time staff. Although he is the CEO and founder of Matibabu, he prefers to be called a team leader.
It all started six years ago. In his first year at university, Gitta got together with his fellow students to change the way malaria was diagnosed. The prevalence of malaria continues to be high in Africa, rated as a top killer.
“I remember the first year when we started it, a lot of people were excited about what we were doing,” Gitta says.
Their project got them accolades such as the UN Women&#8217;s Empowerment Award in 2013.
“I think what we are doing has a lot of potential and we can definitely do something about this.”
The team decided to turn the project into a company with a social objective. But nothing prepared them for what was to come.
<div id="attachment_36983" style="width: 750px" class="wp-caption aligncenter"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-36983" class="wp-image-36983 size-large" src="https://www.forbesafrica.com/wp-content/uploads/2018/08/Brian-Gitta_18a-1024x683.jpg" alt="" width="740" height="494" srcset="https://cms.forbesafrica.com/wp-content/uploads/2018/08/Brian-Gitta_18a-1024x683.jpg 1024w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/Brian-Gitta_18a-300x200.jpg 300w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/Brian-Gitta_18a-600x400.jpg 600w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/Brian-Gitta_18a-768x512.jpg 768w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/Brian-Gitta_18a.jpg 2048w" sizes="(max-width: 740px) 100vw, 740px" />Brian Gitta. Picture Provided: James Oatway</div>
<blockquote>“As a bunch of people that didn’t know how to run a company, neither did we know how to do anything in terms of management; we actually had to learn on site, so we made a lot of mistakes in the beginning,” says Gitta.</blockquote>
But the more word got out about the company, the more support Gitta and his team received.
They got to learn more about strategic solutions, and managing development processes and the expectations of partners.
The prestigious 2018 Africa Prize for Engineering Innovation they won in Kenya in June, have now helped them map the product for the world.
Gitta won prize money of $33,000. He will also receive support, funding, mentoring and business training from the Royal Academy of Engineering in the United Kingdom.
In 2016, he was on an MTV Base panel discussion with billionaire Bill Gates to share his views on the future of technology, innovation and development in Africa, with a group of African youth.
Gitta aims to create a low-cost malaria-testing device for medical institutions. Currently, the price is set at $100, but he hopes to lower the cost so it’s more accessible.
<a href="http://www.forbesafrica.com/woman/2017/11/24/birth-control-mosquitoes-malaria-cure/" target="_blank" rel="noopener">READ MORE: Birth Control For Mosquitoes – Is This The Malaria Cure?</a>
Gitta, himself once a victim to malaria, was frustrated with the healthcare system in Uganda. Blood tests had failed to diagnose his condition. He says this is one of the common problems malaria patients face. Another is people would rather self-diagnose than seek medical help.
“There’s a lot of self-medication because people tend to treat every fever as malaria and that creates additional strain&#8230;,&#8221; says Gitta.
But he believes with Matibabu, these issues may be eliminated.
Far from Kampala, in the South African capital of Pretoria, Professor Leo Braack at the University of Pretoria has been studying malaria for over five years.
“The new device developed by Gitta and his colleagues suggests multiple potential benefits not just for patients, [but] especially small children intimidated by the current need for a drop of blood,&#8221; says Braack.
According to the World Health Organisation (WHO), children under the age of five are at a high risk of malaria because they are more susceptible to infection, illness and death.
Braack believes this device could be the first of its kind in the world. However, that may provide a challenge for Matibabu to enter the market.
<div id="attachment_36984" style="width: 310px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-36984" class="size-medium wp-image-36984" src="https://www.forbesafrica.com/wp-content/uploads/2018/08/DSC_4660-300x199.jpg" alt="" width="300" height="199" srcset="https://cms.forbesafrica.com/wp-content/uploads/2018/08/DSC_4660-300x199.jpg 300w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/DSC_4660-600x398.jpg 600w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/DSC_4660-768x510.jpg 768w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/DSC_4660-1024x680.jpg 1024w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/DSC_4660.jpg 2048w" sizes="(max-width: 300px) 100vw, 300px" />Leo Braack. Photo Provided.</div>
&#8220;The device still has a way to go before it will be widely accepted within the medical and scientific communities, and ultimately it will depend on cost-effectiveness, and particularly how accurate and sensitive the diagnosis is,&#8221; he says.
“If the device has a margin of error, it is better that it has false-positives than false-negatives. It is better to treat a false-positive person than to ignore a false-negative person who may go on to get seriously ill.
“The ideal is to get the device to reach as close to 100% accuracy and sensitivity, [it’s] very difficult to reach.”
Despite the immense strides taken in eradicating malaria, one of the biggest challenges is the mosquito’s resistance to insecticides and drugs.
Technology has introduced short-term solutions to combat outdoor mosquitoes.
<div id="attachment_36985" style="width: 210px" class="wp-caption alignright"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-36985" class="size-medium wp-image-36985" src="https://www.forbesafrica.com/wp-content/uploads/2018/08/option1-highRes-200x300.jpg" alt="" width="200" height="300" srcset="https://cms.forbesafrica.com/wp-content/uploads/2018/08/option1-highRes-200x300.jpg 200w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/option1-highRes-300x451.jpg 300w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/option1-highRes-600x902.jpg 600w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/option1-highRes-768x1155.jpg 768w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/option1-highRes-681x1024.jpg 681w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/option1-highRes.jpg 1362w" sizes="(max-width: 200px) 100vw, 200px" />Vinet Coetzee. Photo provided</div>
Like Gitta, Dr Vinet Coetzee, a lecturer from the University of Pretoria, has been on the quest to identify affordable, non-invasive ways to detect malaria. Her method was tested in Nigeria on children.
“The device uses sensitive skin color measurements in the palm of the hand coupled with Artificial Intelligence to accurately detect whether a person has malaria or not,” says Coetzee.
According to Coetzee, sensitivity is the ability of the method to correctly identify people who have the disease. In this case, WHO recommends a sensitivity of 95%.
The University of Pretoria has filed a provisional patent for this method and Coetzee and her team are currently working on improving the device and its overall accuracy.
She was selected as a Next Einstein Forum fellow and member of the World Economic Forum Young Scientist Community for her work on the bloodless malaria detection device.
Dr Taneshka Kruger, who has been studying malaria since 2012, also believes technology can aid in the fight against malaria. Her focus in malaria research is malaria education and awareness, and public health, looking into new and modern ways to inform communities in both malaria-endemic and non-malaria areas through the use of social media and mobile apps.
<div id="attachment_36987" style="width: 217px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-36987" class="size-medium wp-image-36987" src="https://www.forbesafrica.com/wp-content/uploads/2018/08/20180613-MR2_9443-207x300.jpg" alt="" width="207" height="300" srcset="https://cms.forbesafrica.com/wp-content/uploads/2018/08/20180613-MR2_9443-207x300.jpg 207w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/20180613-MR2_9443-300x436.jpg 300w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/20180613-MR2_9443-600x871.jpg 600w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/20180613-MR2_9443-768x1116.jpg 768w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/20180613-MR2_9443-705x1024.jpg 705w, https://cms.forbesafrica.com/wp-content/uploads/2018/08/20180613-MR2_9443.jpg 1410w" sizes="(max-width: 207px) 100vw, 207px" />Taneshka Kruger. Photo provided</div>
<blockquote>“In order for malaria elimination to be achieved in sub-Saharan Africa and globally, new and innovative methods and strategies need to be developed that focus on all aspects of the disease,” she tells us.</blockquote>
“The institute [University of Pretoria], in collaboration with Travel with Flair, also developed the ‘Malaria Buddy’ app to inform mainly tourists about malaria. The app is continuously expanding with the aim to become a one-stop malaria information app,” she adds.
WHO is tracking the E2020 initiative in 21 countries identified as having the potential to eliminate the disease by the year 2020. Six of them are African – Algeria, Botswana, Cape Verde, Comoros, South Africa and Swaziland.
The African region carries a disproportionately high share of the global malaria burden.
In 2016, the region was home to 90% of malaria cases and 91% of malaria deaths. Therefore, a lot more effort and focus to eradicate malaria is necessary.
Despite only being in the field for a few years, Gitta is positive that with these technological enhancements, the fight against malaria will surely end.
&#8220;I think the strides toward elimination are happening although it will take a bit of time. But we just want to be a part of the journey as a whole,” says Gitta.
“I think the opportunity has been humungous and I don’t look at age as a definition of how to be an entrepreneur and that’s what makes this generation a big difference,” he says. 
Hopefully, the new generation of tech tools they develop will also offer a big difference to malaria cure.
<blockquote>&nbsp;</blockquote>

Brian-Gitta_36x

The Bloodless Battle Against The Malaria

The buzzing of a single mosquito is enough to break a good night’s sleep.
So imagine when that same sound is multiplied a hundred times – it can at best be described as eerie.
Especially when these mosquitoes are in a white mesh cage, in a vacuum-sealed laboratory, and it’s around feeding time.
It is at this opportune moment that Lizette Koekemoer, dressed in a red jersey and white lab coat, sticks her hand into the cage.
While most would squirm at the thought of dozens of mosquitoes making a blood meal of your arm, Koekemoer hardly seems to notice. For her, feeding mosquitoes is as normal as breathing; she has done it so many times she no longer gets itchy from the bites.
&#8220;When you are working on them, you learn to appreciate them as a living organism. When you put a mosquito under a microscope, they are actually beautiful. I think people laugh when I tell them I work on mosquitoes and I get paid for it,&#8221; says Koekemoer.
For 23 years, Koekemoer has been at the forefront researching these insects across Africa. She is part of the Malaria Entomology Research Unit on the 10th floor of the Faculty of Health Sciences building at the University of the Witwatersrand in Johannesburg.
Koekemoer&#8217;s passion goes beyond the laboratory to barbeques where she gets excited to tell you what species you&#8217;ve just squashed on your leg, having been bitten more times than most she would know.
The reason we are here today, in this sealed laboratory with Koekemoer&#8217;s arm in a cage and mosquitoes sucking her dry, is to talk about a mosquito called Anopheles vaneedeni, discovered by her team on the Makhathini Flats, in northern KwaZulu-Natal (KZN).
&#8220;Anopheles vaneedeni has been known about since 1977, it has never – before now – been identified as a malaria-carrying vector in nature,&#8221; says Koekemoer.
Up until now it was thought two other mosquitoes, called anopheles arabiensis and anopheles funestus, were the main vectors of malaria transmission. Vectors are living organisms that can transmit infectious diseases between humans or from animals to humans.
<div id="attachment_34517" style="width: 310px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-34517" class=" wp-image-34517" src="https://www.forbesafrica.com/wp-content/uploads/2017/11/Lizette-Koekemoer_JC-6-copy-200x300.jpg" alt="" width="300" height="450" />Lizette Koekemoer sticks her arm in a mosquito-infested mesh cage in her laboratory. (Photo by Jay Caboz)</div>
It is not just a new carrier species that has Koekemoer worried. On the rise are mosquitoes with an increased resistance to insecticides.
According to the scientist, conventional insecticide-based mosquito control methods, such as bed nets and repellents are now becoming redundant.
&#8220;A mosquito&#8217;s whole body is designed to keep it alive. If you have one female that has formed a resistance, when she lays eggs, you then have gene resistance going all over the place. You need to monitor this and then move on to a new insecticide to kill those ones.&#8221;
While these methods may have proven to be effective tackling funestus, which prefers to feed on humans indoors, it means arabiensis and now vaneedeni can never be completely eradicated. This is because both arabiensis and vaneedeni snack on people outdoors.
&#8220;All malaria species are active from dusk to dawn. That&#8217;s their peak period. As soon as the sun goes down, they start feeding. People socialize at night, when it’s warm. They don&#8217;t go to bed. Bed nets only protect you when you are sleeping. They don&#8217;t protect you when you are outside cooking and socializing,&#8221; says Koekemoer.
Sterilized males to combat malaria
Back in the lab, it is Koekemoer&#8217;s job to come up with ways of controlling malaria vectors. One of the team&#8217;s more radical solutions is sterilizing males with radiation.
&#8220;We&#8217;ve got a gamma radiator. So it&#8217;s fast and quick – 60 seconds. We put the pupae in a radiation chamber, put them on a jig and then one minute later, they are sterilized.&#8221;
Called the Sterile Insect Technique (SIT), Koekemoer wants to build a rearing facility that will pump out 50,000 sterilized males per week. Once nuked, these sterile males are reared and released into the wild to mate with wild females.
&#8220;At a small scale, it works really well. The key to this research is female mosquitoes mate only once in their lifetime and if the male is sterile, she will not produce viable eggs. It&#8217;s like birth control&#8230; In the lab we have up to 96% reduction in progeny,&#8221; says Koekemoer.
<a href="http://www.forbesafrica.com/focus/2017/05/01/rat-race-silent-killer/" target="_blank" rel="noopener">READ MORE: The Rat Race Against The Silent Killer</a>
It has taken seven years of research to get to this point. Once built, Koekemoer estimates they would need R1.5 million ($113,000) to R2 million ($150,000) per year for SIT to run successfully.
&#8220;The thing to remember is a lot of research is done in colonized mosquitoes, in a controlled environment in a lab set-up. It&#8217;s difficult when you take this into the field, when your situation is a lot more complex and there is more than one species of mosquito,&#8221; says Koekemoer.
SIT was first used to control screwworm fly in America in the 1950s.
&#8220;It hasn’t been done with malaria, because malaria is complicated. Countries that are affected by malaria are also often not politically stable and financial resources are limited,&#8221; says Koekemoer.
The threat of new species? 
Although vaneedeni&#8217;s emergence is worrying, it&#8217;s not yet time to panic.
&#8220;To put it into perspective, we collected a large number of species. So percentage wise, it&#8217;s not high. Out of the 3,000 we have collected, we had one KZN sample that was infected,&#8221; says Koekemoer.
Vaneedeni is also considered a minor vector because the mosquito prefers to feed on livestock rather than humans.
The question the team are trying to answer is why now? One theory they have is because of the changing environment in KZN. At the time the team found the mosquito, the area was drought-stricken.
&#8220;We need to look at the bigger picture of the environmental impact. Was it a once-off because it was so dry? That&#8217;s what we need to determine. Your environmental factors influence everything. Because there was drought, the impact on the number of cattle available, or the availability of water might have diminished, which is their preferred host and sites. If you are the only blood source, then the mosquito has no choice but to come to you and you could get affected,&#8221; says Koekemoer.
The field site is naturally isolated, between a mountain range and the ocean, in the Mamfene district 60kms from Sodwana and close to the town of Ndumu. A team member collects mosquitoes twice a week throughout the year. The mosquitoes fly into clay pot traps and are then catalogued by species.
&#8220;The fact that we now know about vaneedeni means we can target our research towards knowing more about this vector’s behavior,&#8221; says Koekemoer.
<a href="http://www.forbesafrica.com/focus/2016/09/01/deadly-75-billion-business/" target="_blank" rel="noopener">READ MORE: Counterfeit Drugs &#8211; A Deadly $75-Billion Business</a>
Until effective controls for outdoor mosquitoes are developed, eliminating local malaria transmission in southern Africa will be extremely difficult.
&#8220;Thanks to other malaria control measures, the number of cases is down to around 9,000 per year from over 60,000 in 2000, but it has proven hard to bring the insect population – and infection rates – down any further using the traditional method of indoor residual spraying,&#8221; says Koekemoer.
&#8220;There are countries that have resistance to all the classes of insecticides. There are only four classes approved by the World Health Organization for mosquitoes. In some countries, there is resistance to all four classes. It highlights the need to invest and start looking into alternative control methods.&#8221;
Coming up with new methods is a race to diffuse a ticking time bomb.
&#8220;These genes will eventually move into our borders whether it is the mosquito or the parasite, it’s only a matter of time, it will come into South Africa. You need to be one step ahead. If something happens, what&#8217;s Plan B? &#8221;
Thanks to a buzzing mosquito in a pot and a little radiation therapy, scientists are a step closer to solving the malaria malaise. Until then, it’s sleepless nights for them.
<div id="attachment_34518" style="width: 510px" class="wp-caption aligncenter"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-34518" class="wp-image-34518" src="https://www.forbesafrica.com/wp-content/uploads/2017/11/Lizette-Koekemoer_JC-2-e1511509351996-300x200.jpg" alt="" width="500" height="333" />Mosquitoes suck blood from Lizette Koekemoer&#8217;s arm. (Photo by Jay Caboz)</div>
<h2>Facts About Malaria</h2>
Malaria is a life-threatening disease caused by parasites transmitted to people through the bites of infected female Anopheles mosquitoes.
According to the latest WHO estimates, released in December 2016, there were 212 million cases of malaria in 2015 and 429,000 deaths.
The WHO African Region carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths.
In 2015, 91 countries and areas had ongoing malaria transmission.
Between 2010 and 2015, malaria incidence among populations at risk (the rate of new cases) fell by 21% globally. In that same period, malaria mortality rates among populations at risk fell by 29% globally among all age groups, and by 35% among children under 5.
Vector-borne diseases account for more than 17% of all infectious diseases, causing more than one million deaths annually.
[Source: WHO]

Birth Control For Mosquitoes – Is This The Malaria Cure?

It’s a familiar scene on a hot day in Accra, the capital of Ghana. The alleys are packed with women, carrying children on their backs, selling vegetables and fake Louis Vuitton bags while men sell anything they can get their hands on. Here, you could be sold a drug that could kill you.
The danger is counterfeit drugs that masquerade as healers but threaten to do the opposite.
Victoria Amponsah claims fake drugs almost robbed her of her unborn child like a thief in the night. The day she was diagnosed with malaria she also learned she was two months pregnant. She went to the nearest pharmacy, in Accra, and bought prescribed anti-malarial drugs she thought would save her and her child.
“That evening, I took the medicine. After about two to three hours, I started shaking and vomiting. I felt weak. I called a cotenant and showed her the drug and she said ‘I know this drug, its ok’. But when she [took out the pills from the box] she said ‘this is not the drug that is supposed to be in this box,’” Amponsah told the NGO, United States Pharmacopeia (USP).
&nbsp;
<div id="attachment_5209" style="width: 310px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-5209" class="size-medium wp-image-5209" src="/wp-content/uploads/2017/05/Bright_Pharmacy_Lonart_Phone_2015_hi-res-300x200.jpg" alt="" width="300" height="200" />Bright B. Simons is the brain behind mPedigree, a technology that&#8217;s used to counter counterfeiting of pharmaceutical products, wax prints and other products that are prone to piracy. Accra, Ghana.</div>
She was rushed to the hospital where a doctor confirmed the drug she took was fake. She managed to complete her pregnancy, but this was not the end of her struggle.
Near the end of her pregnancy, she almost died from a fake version of oxytocin, disguised in convincing packaging. Within 30 minutes of administration, Amponsah was sweating, shaking, vomiting and bleeding.
“I was bleeding so bad. [The doctors] were scared and didn’t want me to move,” she says.
She nearly lost her baby and was hospitalized for two days. For months later, she had to return to the hospital often, for checks.
“Sometimes I hear stories of a person who was fine, gave birth and the next minute the person has died and you find that they gave the person an injection and they died from it. I didn’t know it was that bad,” says Amponsah.
It is the poor, like Amponsah, that suffer. According to the Dutch Malaria Foundation, malaria is responsible for the death of one child dies every 45 seconds, but a third of malaria drugs sold in Africa are fake.
“My son was my biggest present; the center of my life. He is all I have… I am hoping that globally people understand that our lives are more important than the little money they will make out of bringing a fake drug out. [I hope] people will understand that it’s not all about money. It’s about life… the smallest thing, like just a tiny drug which is bad can cause so much damage in one’s life,” she says.
Amponsah and her son Denzel are among the few lucky ones. Over 30% of antimalarials in Africa contribute to nearly 450,000 preventable deaths each year, according to a report in the medical journal The Lancet. Fake tuberculosis and malaria drugs kill an estimated 700,000 people a year, according to the International Policy Network.
The manufacturers of this fake medicine make it look like the real thing. Mario Ottiglio, the Director of Public Affairs, Communications and Global Health Policy of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), says fake medicine thrives in countries with weak regulation.
“In areas of infectious disease, like malaria and tuberculosis, fake products with incorrect dosage of ingredients can result in antimicrobial resistance to genuine treatments. At a global level, analysis of reports over a five-year period, from 2005 to 2010, indicates that incidents of fake medicine increased by 122 percent, while diversion and theft increased by 66 percent,” says Ottiglio.
In 2009, 84 Nigerian children were killed by toxic chemicals that were laced with teething medications for babies. In 2012, Angolan custom agents busted counterfeiters importing what turned out to be one of the largest fake medicine imports in history, when containers shipped from China to Luanda, the capital of Angola, were filled with over 1.4 million packets of a fake version of the antimalarial drug, Coartem.
“In 2013, the World Health Organization (WHO) launched a global surveillance and monitoring system… Thus far, 48 percent of cases reported [to the system] have been in the African Region,” says Ottiglio.
A study published in the International Journal of Tuberculosis and Lung Disease found one in every six pills in Africa to be fake. Furthermore, a survey conducted by the National Institute of Health, which examined over 2,600 malaria drug samples across 21 sub-Saharan African countries, found 20% of these drugs were fake and a third were of poor quality.
Ottiglio says the first line of defence is to always buy medicine from licensed and certified sellers. People can check the packaging of the product for spelling mistakes or grammatical errors. Check for expiry dates and that the details on the outer package match up with the inner packaging. Those who are familiar with the medicine can check that the pill looks correct, is not discolored, degraded or doesn’t have an unusual smell.
Even with checks, there is still a problem. Some fake products are almost visually identical to the genuine ones. Often it’s difficult to tell the fake from the real thing.
Patrick Lukulay, Vice President of Global Health Impact Programs at United States Pharmacopeia, says during the outbreak of Ebola in Liberia, there were fake drugs on the market purporting to cure Ebola and people were attracted to them.
“The drugs most counterfeited though are lifestyle drugs such as Viagra and Cialis&#8230; Antibiotics and antimalarials are heavily counterfeited also because of demand for these drugs and the tendency for people to self-medicate. ARVs (antiretrovirals) are also counterfeited because of demand and the fact that people might seek to buy them in private settings for confidentiality purposes instead of getting them free from public facilities,” says Lukulay.
These drugs, according to Lukulay, are made in countries that have developed capacity for pharmaceutical manufacturing and packaging, such as India, China, Vietnam and Malaysia.
He says the ingredients used for fake drugs are usually cheaper versions of legitimate ingredients. An example is diethylene glycol, which is toxic but 10 times cheaper than the legitimate pharmaceutical grade ingredient, glycerine.
“They may also include impure cheap raw materials, such as over-sulphated chondroitin sulphate, the one found in blood thinner, heparin, a few years ago that killed people in the US,” says Lukulay.
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Unfortunately, the problem grows at an alarming rate. Lukulay estimates the counterfeit drug market is worth over $75 billion per year.
Like many problems in Africa, it is seen as an opportunity by private money.
In Ghana, entrepreneur, Bright Simons, says he has developed a program that is helping to curb the counterfeit drugs.
In 2007, he launched mPedigree, a company that has created software manufacturers can use to label their product packaging with a random code hidden beneath a scratch-off covering. If a consumer wants to know if their product is fake or not, they can just scratch off the covering and SMS the code to a toll-free number. They will then be notified whether the product is authentic.
Simons claims his services are used by around 100 million people per year in 12 countries, from India to Uganda.
“Our biggest frontier now is predictive analytics, in particular the use of our EarlySensor technology to predict hotspots and flashpoints of emerging counterfeit activity by looking at large data sets across time and space. If we can predict retail points that are likely to be targeted by counterfeiters by disrupting upstream distribution networks, we can actually stop counterfeiting from even getting to the level of the consumer,” he says.
This will help prevent the suffering that Amponsah experienced. She at least lived to tell her story; many more were not so lucky.

A Deadly $75-Billion Business

Emmanuel Katongole is a brisk, no nonsense, entrepreneur with a powerful desk and a sharp suit. If you look closely, beneath his distinguished grey hair, you can see the traces of pain that steeled one of Uganda’s leading entrepreneurs.
Katongole watched his three elder sisters die for want of medical care. It is no coincidence that he has dedicated his life, as an entrepreneur, to making pills to fight two of Africa’s great killers: malaria and HIV/Aids.
“My elder sister got pregnant at 15 and died while giving birth, she bled to death because she couldn’t go to hospital. The other two died of HIV/Aids, leaving me alone. This is not only hearing of it, I saw it. So many other families have gone through this,” says Katongole.
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“It was an influence in this kind of business. I think about them often and now we see our medicines being made and thousands upon thousands surviving. That gives you a good feeling.”
To say Katongole grew up the hard way is an understatement. He was born in 1962 in the rural Mityana district in the hills of Uganda and spent most of his childhood herding goats and fighting off hyenas.
“We grew up right from childhood being independent and had to work to survive. That has grown with me,” he says.
Neither his father, nor his mother, could read nor write; his father worked as a laborer, his mother sold roasted maize by the side of the road. In 1965, Katongole senior moved the family to Kampala, in search of a better life, when he secured a job working as a night porter at the Palace of Kabaka – the seat of the King of Buganda. One day Katongole senior went to work, never to return.
“It is believed that he was caught in the gunfire that resulted from the soured relations between the Buganda kingdom and the central government at the time. We never saw him again,” says Katongole.
It meant more hardship for the family. Veronica Katongole had to make the tough decision to withdraw her three daughters from education so she could afford to pay for her son to go through school. Young Katongole did not wear shoes, ride in a vehicle nor switch on a light bulb until he won a scholarship to Namilyango College near Kampala. The hard work paid off and Katongole graduated from Makerere University – known in Kampala as the ivory tower – in statistics and applied economics. He got a job and began looking for areas of business not yet saturated. As it turned out, 1987 was a good year for entrepreneurs in Kampala. The Ugandan government was easing state controls and liberalizing the foreign exchange market.
Katongole saw that 1.5 million, out of 30 million, Ugandans were HIV positive. On top of this, malaria killed 300 people a day; the equivalent of an Airbus A340 crashing seven days a week, he says. In 1997, Katongole and five partners put in $5,000 each to found Quality Chemicals on a patch of dusty land on the poor fringes of Kampala. The first year was lean; the company turned over less than a million dollars.
“The turning point came in 2001. This is when the world became very tough about intellectual property and patents. When the World Trade Organization came in, we saw this as an opportunity. Uganda was among 16 of the poorest of the poor nations made exempt. Patented medicines were expensive &#8211; do you allow poor people to die because of patents?”
It cleared the way for Quality Chemicals to manufacture six million pills a day to tackle both deadly diseases. The coup was a joint venture, in 2005, with Indian pharmaceutical giant, Cipla, which was looking for a foothold in the continent. This poured capital and expertise into the company and by 2013 turnover was $65 million; this year, the accountants project $76 million. In November, Cipla spent $15 million on increasing its stake to 51%. Katongole and his fellow five founders retain 23%.
It is a late autumn morning in the outskirts of Kampala and Quality Chemicals is humming. Outside there are goats grazing in the sun, it is nearly noon and more than 30 degrees Celsius; inside it is cool and busy. Hundreds of people in white coats are hard at work making the handfuls of pills that can be the difference between life and death for a village full of people.
The company exports to Kenya, Rwanda, Tanzania and South Sudan. It is far from an easy business.
“The infrastructure problems of the country notwithstanding, we have problem with access to markets. You know, we have got a lot of donor products coming in and these hinder the development potential of our market. There are also subsidies given by other countries which hurt our market. Then there is the power shortage. It is not so much of a big problem since we bought our own generator,” says Katongole.
“We could do better, but if you compare what is happening globally, there has been a concerted effort by the state to sustain the economy. Inflation has been between 8 and 12 percent for many years; that is not bad for African countries. If you look at the exchange rate, it is largely under control, fluctuations here and there, but not bad. Interest rates, of 20 to 24 percent, are relatively stable, but they are high. Banks are helpful, but the economy is relatively small.”
Despite this, Quality Chemicals is thinking big.
“Our dream is to be the number one company in our field in Africa. For now, the problem of malaria and aids is still big – we are also looking at making pills to tackle cancer and hypertension. These are the serious diseases we are thinking about.”
The next thought will be the completion of a second factory that will increase the workforce to 700.
“I tell you I always believe that every generation has its revolution and the revolution of our generation is entrepreneurship. A lot can be done. Well-handled entrepreneurship can do so much,” says Katongole.
This confident man has one tinge of regret; that he never had the chance to offer his hard working mother more of the fruits of his success. Veronica Katongole died of skin cancer in 2002. Among her last wishes were for her son to build an iron sheet roofed house for her – the family had grown up under mud and wattle. The second was that she wanted her funeral to be led by a Catholic priest.
The first request was built in Katongole’s first year of work; the second was led by the Archbishop of Kampala.
In a tribute to his mother, Katongole has launched bottled water, called Vero after her, where the proceeds go to charity, in her honor. Proof, that the legacy of an entrepreneur can be far more than money.
<h4>In The Business Of Caring</h4>
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In Uganda entrepreneurs are known for the money they have made but their reputations are often tainted with rumors of dishonest practices and dealings that helped pave their path to success. This is not the case when you mention Emmanuel Katongole in Uganda’s business community.
Katongole is widely recognized for his social entrepreneurship, philanthropy and unrelenting spirit. For someone who had to team up with his illiterate mother to sell local liquor to earn school fees, it is inspirational to now see him as a member of the Initiative for Global Development (IGD), a group that aims to reduce poverty worldwide and consists of successful business leaders from Africa, Asia, Europe and the United States (US).
Katongole is part of the esteemed company of former secretaries of state of the United States Madeleine Albright and Colin Powell, who co-chair the governing council of IGD.
Back in 1997, Katongole, along with five colleagues, founded Quality Chemicals. It grew to become the only company in sub-Saharan Africa that manufactures triple-combination antiretroviral (ARV) drugs. Today, the company manufactures and sells antiretroviral and antimalarial drugs. Given the crippling effects of malaria and HIV/Aids on the continent, Katongole has made a significant contribution towards reversing the effects of these diseases.
There have been accusations of him being too close to the Ugandan government and subsequently using his close connections to get ahead in business. Others, however, argue that the scourge of HIV/Aids and malaria has long been a major priority for the Ugandan government and any major player within that sphere would require a collaborative relationship with them.
Besides Quality Chemicals, Katongole founded Vero Mineral Water, in memory of his late mother, Veronica.
The business commits 10% of its proceeds towards social development causes such as education. For Katongole, entrepreneurship should solve society’s most pressing challenges and his businesses are testimony to this.
His background is one of extreme poverty and disease. He used this as inspiration to build an enterprise that not only creates wealth but confronts the twin evils of poverty and disease within its community. Katongole is the district governor of the Rotary Club in Tanzania and Uganda, which provides humanitarian services in that region of Africa.
“I think he has done a lot for Rotary and that is a good thing,” says Ugandan business mogul Patrick Bitature.
He adds that although Katongole has achieved a lot as an entrepreneur, he is bound to achieve a lot more in future.
“He is going places,” says Bitature.
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Tag: Malaria

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