Major progress has been made over the last decade in combating malaria, but experts warn that much more needs to be done to eradicate the disease.
Today is World Malaria Day 2014, organised by the World Health Organisation, and is aimed at raising awareness and co-ordinating initiatives to cut infections and deaths caused by the disease.
Malaria deaths are estimated to have fallen 42% globally and 49% in Africa since 2000 – but the disease is still claims 627,000 lives every year, most of these victims being children under the age of five.
WHO estimates about 3.3 million lives have been saved since the turn of the century through global efforts to control and eliminate the disease.
There are still an estimated 200 million cases of malaria infection every year, with most never being tested or registered. Global health groups are investing in a number different projects to develop an effective vaccine and other approaches to help beat the disease.
A number of pharmaceutical companies, including GSK and Sanofi, are making valuable contributions to efforts, usually through alliances with non-profit organisations and governments.
The first malaria vaccine
The most advanced vaccine candidate is RTS,S or Mosquirix, which is being developed by GlaxoSmithKline in partnership with the Gates Foundation's PATH.
A Phase III clinical trial for the vaccine has been completed with over 15,000 children from seven countries in sub-Saharan Africa participating.
The trial results showed the number of malaria cases was halved in children who received the vaccine aged between five and 17 months. Mosquirix works by stopping the malaria parasite from infecting, maturing and multiplying in the liver and infecting red blood cells.
GSK says it plans to file the drug with regulators later this year, which means the vaccine could be licensed and rolled out as early as 2015.
PATH is working on a number of other innovative approaches, such as developing a novel semisynthetic artemisinin compound with Sanofi. Artemisinin is the main ingredient in the most effective existing treatment for malaria, and is based on Artemisia annua, the sweet wormwood plant which is grown largely in China. But its production process is drawn out and has a low yield from the crops grown. This problem now looks set to be overcome by synthesising the active ingredient - Sanofi and PATH began large-scale production of the compound in Italy last year, and plan to produce 50-60 tonnes of the active ingredient this year.
PATH is also developing point-of-care diagnostics to help the worst affected countries achieve malaria elimination. PATH MVI has set itself the goal of ensuring 18 to 20 million people live in malaria-free areas by 2020.
Another strategic initiative is being led by the Managing Malaria Consortium and Clinton Health Access Initiative. These organisations are helping governments introduce injectable artesunate in six African countries: Nigeria, Cameroon, Uganda, Malawi, Ethiopia and Kenya.
The initiative aims to provide the drug to 2.5 million patients, putting 15 million vials into six countries. MMV estimates this could save more than 100,000 lives over the lifetime of the project.