EP 171: New Malaria Drugs are Coming, but is Africa Ready?

In this episode of the Root of the Science Podcast, Dr Anne Chisa talks to a Nigerian malaria policy researcher Michael Audu to unpack what it will take for next-generation antimalarials to reach the people who need them.

They discuss drug resistance, Ganaplacide-Lumefantrine, Nigeria’s malaria burden and Michael’s Africa Readiness Index (ARI) in rolling out new malaria treatments.

Listen to the full conversation!

Transcript

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SPEAKER_01 0:00

When you are talking about malaria, uh is a time-based is is usually time-based. You need to uh get the right treatment at the right time. Once you fail it, it can actually uh metamorphosize into something else. Yes, uh um is one of those motivations you people often um think that um malaria is only about mosquitoes, so when you meet an average person, you're you're talking about malaria, uh, the first thing that comes to their mind is to protect themselves from mosquitoes. Mistake of the past, for instance, there was a particular period where um uh chloroquine was once thought to be the best anti-malaria, but due to uh the situation and the health system that we have, uh we develop resistance at the end of the day. And then we now move to ACTs. So having that same issue.

SPEAKER_02 1:00

But if you if you plot the graph very well, this new hello everyone, and welcome back to another episode of the Root of Science Podcast with your girl, Doctor Anne with the knee. It's been a minute, but we are finally back for a new season. I am so, so, so excited. New season, new titles, so many new things, but the vision still remains the same. The vision is still consistent, and we are so excited as a team to come back and showcase all the wonderful research and innovation that comes from Africans and STEM and you know, disseminate that information. Now, let's get into today's episode. Over the past few years, malaria research has delivered some promising breakthroughs. New anti-malarial medicines are showing strong results in clinical research trials, including treatments designed for drug-resistant malaria and for the first time, formulations tailored for the smallest infants. But new medications can only save lives if countries are ready to use them. And our guest today, Michael Adu from Nigeria, helps us understand what this preparation means in Africa. Michael Adu is an independent malaria policy researcher based in Abuja, Nigeria. He specializes in the African malaria landscape. His most recent research paper introduces the Africa Readiness Index, otherwise known as ARI, a new framework for assessing how prepared African health systems are for the arrival of the next generation anti-malarial medicines. In this conversation, which is based on this paper, he explores the challenges in rolling out the next generation anti-malarials and what African countries can do now to ensure that future scientific breakthroughs reach the people who need them the most. Now, let's get into all of this and of course so much more. Let's go. Hi, Michael. Welcome to the show.

SPEAKER_01 3:37

Thank you so much, and I'm so happy to see you. Happy to be here too. Thank you.

SPEAKER_02 3:43

I'm so excited to have you. So, Michael, as a form of an introduction, if someone doesn't know who you are and why we have you on the show, how would you introduce yourself?

SPEAKER_01 3:54

I would like to introduce myself as an independent malaria policy researcher based here in the city of Abuja and uh fighting uh malaria for Africa to make sure that Africa has uh a more better health system that can that can accommodate the new innovations, the next anti-malarias that are coming in into Africa such that we don't repeat the mistake of the past.

SPEAKER_02 4:27

Yeah.

SPEAKER_01 4:27

Thank you.

SPEAKER_02 4:28

Fantastic. You know, malaria is such a big um burden, particularly here in Africa and in many different parts. So I'm curious what actually drew you um into this area of research and uh, you know, what why has it become such a personal mission for you?

SPEAKER_01 4:49

Yes, and I would like to mention that um if you are in Nigeria, malaria has always been uh uh more than a disease uh to me in particular. You know, growing up uh growing up here in Nigeria, I saw uh quite a number of families, you know, um lose their work, children miss schools and hospitals, uh, you know, particularly the primary healthcare centers in the rural areas where I've worked for some time. I've seen uh them being overwhelmed, particularly during the peak seasons. And uh as I began to, you know, venture into public health and uh uh most especially into the malaria program, I realized uh something, something very, very unique, you know. And um I've noticed that um we have medicines available, we have medicines that usually save life, but too many people, you know, don't don't usually um have access to them. The end users, the people at the health facilities that should have access to these drugs at the end of the day, they don't have access to it at the same at at the right time. Okay, when you're talking about malaria, uh malaria is a time-based um um is is usually time-based. You need to uh get the right treatment at the right time. Once you fail it, it can actually uh metamorphosize into something else. So growing up, I've seen this um this disadvantage of uh being with malaria. And uh for me, I think the the bigger question that we need to be asking ourselves is uh how do we actually make every scientific breakthrough, you know, uh actually uh succeed and also reaches the last mass, that is the the the people that these particular drugs are actually being meant for. People who actually need it at the end of the day. So uh today that's that's the focus of my work, actually. It has been the focus of my work growing up, uh seeing the devastating effect of malaria in our society, in our communities, that it became my life work on how to uh those. I know that the the the medicines are there, but uh, however, the systems that actually keep these uh medicines um uh working such that it can actually lead to the last night are uh where the problems are. And uh I am here working to make sure that the systems are actually in place uh so that the new innovations that are coming in will actually uh be uh to the the innovations that are actually coming in, it will actually uh meet a prepare, a more robust, uh more prepared um health system that can actually accommodate them such that we don't make the mistake of the past. Mistake of the past, for instance, there was a particular period where um uh chloroquine was once thought to be the best anti-malaria, but due to uh the situation and the health system that we have, uh we develop resistance at the end of the day. And then we now move to ACTs. ACTs also having that same issue, but if you if you plot the graph very well, these new innovations keep on coming in every now and then. But the health system that accommodates these new innovations remain the same. So that's the reason uh why I'm actually uh here in Africa to make sure that the health system are actually fixed before the new uh interventions, the new anti-malarias will be rolled out in Africa entirely. Thank you, Anne.

SPEAKER_02 8:58

Thank you so much for that, Michael. Um I can just hear from how you're describing this issue from the initial, let's say, the why um to what's kept you doing the work that you're doing. And one thing that comes through is that you're saying that the interventions are there, but there's sort of a break in the system. So you recently um wrote a paper uh which is titled Preparing for the Next Generation Anti-Malarials Um in Nigeria. So was this also one of the motivations that made you write this paper, some of these things that you've previously mentioned?

SPEAKER_01 9:40

Yes, that um um is one of those motivations. You know, people often um think that um malaria is only about mosquitoes. So when you meet an average person, you're talking about malaria. Uh, the first thing that comes to their mind is to protect themselves from mosquitoes. But um in reality, uh for me it is all about the health facilities. The health facility is equally very, very important. When you're talking about um um malaria and you remove the health facility, uh at the end of the day, you are indirectly saying that the uh health intervention will actually not give to the people who actually need them. So when you talk about malaria in African context, you're talking about health facilities with um the right uh malaria drugs. Not just with the right malaria drugs, but with sufficient uh malaria drugs that will be able to cater for uh the community at that specific time.

SPEAKER_02 10:43

Yeah.

SPEAKER_01 10:43

So uh malaria is is more than mosquitoes. Yeah, you have to talk about health facility equipped with the right commodities. You also have to talk about um the health workers, the service delivery people that are well trained to be able to deliver. And you're also talking about uh the right roads, I mean the the uh the the good road network that connects uh the warehouse where those drugs should be taken to the health facility. So if you look at uh um um malaria, if you're talking about malaria or malaria intervention in Africa, it's a multi-factorial, yeah, uh it's it's a it's multi-faceted. You you you need a whole you you need to look at a whole um lot of things that go into malaria intervention at the end of the day. So that's that's that's what brings about the success of malaria. You have to talk about the good road network that reach that that we take these drugs to the remote areas, and you also have to talk about uh the government having the ability to be able to pay for these uh interventions, for these drugs, and also if a family can actually have access to them. So uh malaria in reality, I want to say here that uh malaria actually tests uh whether a country actually has a strong uh health system. Malaria will test you. You know, I I consider malaria as uh as as um one of those diseases that will test a system, I mean the the the the health system of a nation. If you can actually be able to contain malaria, it means that your health system is actually very, very strong. Thank you, Anna.

SPEAKER_02 12:41

Thank you so much, Michael. It does really sound, like you said, a very multifaceted and even very complex system. Um and as someone who might not be in the field like myself and our listeners, you're right. We do think of it in a very single lens. We just think of the disease and whatnot. I mean, the insect, pardon me. So, for example, in Nigeria, because this is a context that you wrote this paper in, what what are some of those major blocks that really test, um, like you said, that really test the whole system and makes fighting this malaria a very big problem?

SPEAKER_01 13:23

If you look at it, and for instance, in in Nigeria, um, I would like to to say that um the health system in Nigeria needs to be strengthened. And the reason for this is because uh we are talking talking about uh Nigeria in context. Nigeria is having having the largest population, for instance, you know, a population of 200 million plus people, and then you're also um talking about being the you know having the highest prevalence of malaria in the sub-Saharan Africa, one of those uh countries and one of those states I've worked in, particularly in KB State, Nigeria. And so if there is any country in Africa that should be giving a serious priority to be for to malaria is actually Nigeria. Why am I saying this? Uh because when you go down to the rural um environment, you will find out that this is where uh these um um interventions are actually needed, this is where the end users actually need it. So by the time you go there, most times you find out that uh while you are in the office uh uh doing your forecasting and uh you know doing all the meetings at the end of the day, doing all the Excel and the word documents, sending emails here and there, the rework is actually on the field. And then by the time you get there, you'll discover that um there is no good road network that will take commodities from the um from the warehouse to the health facility. And so that's those that that has become one of these challenging issues that we have here in Nigeria. Um we have issue with flooding in some parts of the country, and that means um um, and then the insecurity that we are experiencing. It's possible that you are going to have uh people in their communities this week, and then by the time you get there next week, they're no longer there again due to insecurity. So a lot of challenges affecting uh the fight against malaria and uh another factor that uh is not just peculiar to Nigeria, it is on the approval, uh on the regulatory approval that when we have these new drugs coming in, yeah. Part of why I keep on pushing for this is that um it will be a it will make the country not to look very, very good that we all that we have uh this next uh uh generation anti-malarias coming in, and then our approval mechanism, the regulatory mechanism is the one delaying it. And that's why in my write-up I uh make a case for early approval and for early engagement uh with this uh pharma industry that are actually uh making these drugs such that we don't have to wait um um uh another 12 months, another longer period. I want to see a situation here in Nigeria such that by the time these drugs are being approved, we have them readily available in Nigeria, not to wait for another month. You know, why am I saying this? If we wait for another month, it means that it will averagely take uh close to uh nine to you know nine to another 18 months for this uh life uh um uh saving drugs to actually get into the country. So you are roughly looking at two two years. So getting those regulatory approval uh on time is one of those things that we actually ensure that we have these drugs uh available in the country, is one of those health system um um readiness network. And then the other one, which I think Nigerians are actually getting it right. I usually call it uh the malaria diplomatic uh framework, uh which our minister have actually made use of that effectively, is how to negotiate the price of these uh commodities, these drugs, these new anti-malarias that are coming in into the country. It is how um the poor man on the street can be able to have access to it. And that means that there will be a high um uh delegation, high diplomatic um um communication to ensure that once these drugs are approved and they are in country, uh that they are actually uh not only accessible, but that they are also uh being available, that a common man, somebody in the village can have access to them and such that they can be able to protect themselves from uh the scourge of malaria. Thank you, Anne.

SPEAKER_02 18:06

Thank you so much. Thank you for laying out all of those um points. And I think the idea of those regul the regulations is it's not only a Nigerian problem, like you say, many people and um in different parts of the Africa and the world face so many of those issues when it comes to dealing with pharmaceuticals. Now, to just further deep dive into your article, Michael, one of the key things that your paper focuses on is on these next generation anti-material malarials. So, what does that term actually mean?

SPEAKER_01 18:44

So um the next generation anti-malarials, what this what this actually means, we've been having uh you know um a lot of um anti-malarias coming in. I mentioned chloroquine in the past, yes, and then now we have uh ACT. So uh if if if if if you are in the global space, you will realize that almost uh all the disease areas uh over the years, they've been having uh new intervention, new innovation, particularly in their drugs coming in. For malaria, we do not have that. And uh, we are so happy that um in the last that's in the last 25 years now we've not had that. But recently, um it's like God answered prayer. We have a new formulation uh that is uh actually not uh ACT. So presently now uh the the uh it's been named uh Ghana placite lumifantrin. In some places they call it Galum, but um I think the correct name is Ghanaplacite Lumifantrine. And I am so excited about this. And the reason is because it's um it represents you know a completely new way of fighting uh malaria. Yes, so the the the the current medicine have worked so well uh for so many years, but uh over time we are beginning to see signs of resistance in parts of Africa, particularly uh in the East Africa. I think uh last week I was in touch with um uh some of the government officials there in Uganda uh regarding the rollout, the carry the um preparedness and uh and and also um the health system readiness for the rollout of these um new drugs, new innovation when it's um eventually available. So it presents a new form of um uh uh approach in the fight against malaria. And the reason is because uh it will not only tackle malaria alone, like malaria parasite alone in the body, that it also fights the resistance. What does that mean? It means that even in part of Africa where they're already experiencing uh resistance, with this new innovation uh to be able to um tackle this effectively. So I am so excited, you know. The new uh innovations, this new drug actually uh gives us another power, uh like another uh uh powerful tool in the fight against uh malaria, more like arminos, more like more arsenals, you know, in our armamentarium in the fight against uh malaria, like um having an additional tool uh um uh in in the already uh working tools that we already have in the fight against malaria. I'm so excited about this because it's actually different from what um um uh we've been using over the years. So this uh Excited about it because if it's uh I I I was scared a little bit at some point when I heard that um we are beginning to experience uh resistance to uh uh to um malaria, you know, those those drugs that we have presently now, we are beginning to experience um resistance to them. And then I begin to wonder, you know, Nigeria has the largest population of um that's in the entire Africa. And so I'm I'm just beginning to imagine if this thing spreads to other parts. And you know, Nigerians are actually everywhere, you know, due to our number. So I I I was beginning to think imagine a Nigeria in Uganda or in East Africa, you know, bringing this into Nigeria, you know, we're beginning to have a pool, like more like a cesspool of resistance. And that means Africa is in trouble. So uh hearing this news that we have uh a new powerful tool uh in our uh umitarium to fight these malaria actually gives us uh great hope to know that truly, uh one day in our lifetime, hopefully, we are going to see the end to malaria scourge in Africa. Thank you, Anne.

SPEAKER_02 23:23

Fantastic. That's really, really exciting. Um, that there is hope. So are you saying presently that this is readily available and it's being administered to patients currently?

SPEAKER_01 23:36

Not really, really available right now, but uh plans are already on the way, particularly like I mentioned. Uh that's the purpose why I wrote these um uh uh papers. The reason is because we have to make preparations for them. I believe strongly now. I think um from my research, I've um noticed that a lot of countries are already making preparations for it. And there have been a lot of engagement uh with these um institutions that are into uh drug um production. A lot of countries have been engaged in it. And uh for me, uh one of um, you know, part of uh this write-up is to make sure that we don't repeat the mistake of the past. You know, I want Africa to stop looking at the fight against malaria as uh so long as I can protect my country, I am fine. Uh uh, but it is not the case. Why am I saying this is because if if you already have uh resistance in East Africa, what this means is that it is already, as long as it is in Africa, it means that um you are not safe. So I want Africa, uh the the African countries to begin to see the fight of uh fight against malaria as a more like a collaborative approach. Um more like um I want to see more countries beginning to collaborate. And uh if if Nigeria is going to these uh institutions to negotiate for uh access to these new drugs that is coming in, it will be Nigeria negotiating. So I now ask myself what happened to the other African countries that may not have the financial weight to be able to uh secure this new uh intervention, these new drugs that is coming in. I want to see a situation whereby Africa unites together to make a case for Africa. I mean, this disease is in Africa, right? So we can actually make a case for it, particularly negotiating uh how each of the African countries can be able to uh procure these uh drugs once they become approved and available, once they start rolling them out. Not a situation where um Nigeria can assess it, South Africa can assess it, um Uganda can assess it. What about the other countries that do not have the financial capability to uh have access to these drugs? If we neglect those countries, believe me, the resistance will still be there. It doesn't matter how much we are spending here, at the end of the day, uh all our spending to make sure that we protect ourselves, it will not actually work because uh resistance doesn't need a passport to come into your country. Yes, resistance doesn't need a passport, you just need to ask if you are a human, it just needs to ask if you are uh if you have blood, you know. So I really want to make a case here that um Africa should unite. We should not repeat the mistake of the past. And those were part of the reason why uh we develop resistance in in the fight. Um uh, I mean, to this um um um other other uh drugs that are now failing us in the aspect of malaria. I want to mention here that we should take the case of resistance in the East Africa very, very seriously. We should not see it as an East African issue, we should see it as an African issue that needs to be given uh serious attention. And likewise in negotiating for these new interventions, Africa should negotiate it as one, not as an individual country. When we negotiate it as an individual country, at the end of the day, so long as your citizens can still travel to other African countries and they can still come back, it means that you're still not safe. We should be able to be safe as a continent, not just as an individual country. Thank you, Anne.

SPEAKER_02 27:57

You know, as we are wrapping up this conversation, my final question would be um with everything that you just said right now, that this is an African problem, if policy makers were listening, or African leaders or the people in charge of making these decisions, were listening to this podcast, uh, based on some of those recommendations that you made on your paper, what would be maybe a key starting point you would advise, or you're already advising, since you said that you've already started these conversations that they start with?

SPEAKER_01 28:30

I would like to let our policymakers, if you're listening, don't wait. Please don't wait until this medicine arrives. Do not wait. Preparation should begin now. Negotiations should start now. Uh, countries should begin to assess their readiness. Are you prepared to be able to absorb this into your system? Your supply chain, are they uh agile enough to be able to cater for the millions of people in your country? Do you have a strong supply chain? Do you have a strong enough um capacity in warehousing this new generation anti-malarians that will be rolling out? Identify your weaknesses now, strengthen supply chain, train your healthcare workers, especially those at the primary healthcare centers. You train them, motivate them. And then we need to improve our surveillance so that we don't have to wait until these um uh these drugs start, um these drugs are uh I mean uh uh start uh failing. No, we should also secure financial funding. I mean, uh we can no longer uh wait to be getting funding from donors. Donors can actually come to help what we already have, what we're already doing, and not to wait for uh donors to come and fund us. This is an African problem. This is African uh issue. I want it to be done in an African way. We should not just abandon our fight and expecting donors outside to come and fight for us. So we need to put all the financing uh in place. We need to put them before you know the first shipment of these uh new uh drugs arrive. Preparedness is actually very, very cheap. I see preparedness as cheap, you know, is is is cheaper than you know you uh having to start everything all over again. So we need to actually fix those problems before rollout. And uh one of them that I'll be mentioning here is that our policymakers need to make a very, very strong case for counterfeit drugs in Africa. I'm saying this is because when we are expecting these new uh innovations in the country, there are chances where uh some of these drugs are going to, there will be a lot of counterfeit, which we you know make our fight against malaria not to be effective. So we need to look across board. Our challenges are enormous, and I also believe that um the system and the method with which we are going to meet those challenges need to be multifaceted too in order for us to secure the continent from this from this cult against malaria. Thank you, Anne.

SPEAKER_02 31:23

Thank you, Michael, and you know, I hope some of these recommendations really do um get implemented, actually. Um, and you're absolutely right. It is very, it's much easier, cheaper to be prepared than to start paying for problems later on. Um, we we've learned so much, and I'm sure even my guests have learned so much. Thank you so much for taking time to chat with me today and also for sharing your knowledge in that wonderful paper. We will share the link if people want to read more on the paper and to read more about you, also share your information. But it's been really, truly such a pleasure, Michael.

SPEAKER_01 32:07

Thank you so much, and it's also I'm so happy to also uh be here and to share um the new innovations coming to Africa.

SPEAKER_02 32:16

Yeah, I'm really, really excited. And to everybody else who's tuned in, thank you for listening to another episode of Root of the Science Podcast with your girl and with an E. Until next time. Goodbye. Goodbye.