MARC SE-Africa

The challenge

Sub-Saharan Africa bears the brunt of malaria infections. After a downward trend in the global malaria burden, progress has stalled since the COVID-19 pandemic. Moreover, new challenges are on the horizon – particularly the emergence and spread of malaria parasites with reduced sensitivity to artemisinin or other components of artemisinin combination therapies (ACTs).

ACTs were introduced when malaria parasites developed resistance to previous generations of drugs. However, the slow replacement of compromised drugs led to many unnecessary deaths, highlighting the importance of a rapid response to the emergence of resistance. Several actions can be taken in response to reduced ACT sensitivity, including rotation of different ACT combinations, boosting of ACTs with additional drugs (triple combination therapy), and wider use of low-dose primaquine to reduce parasite transmission.

The project

The MARC-SE project is working to ensure that policymakers in multiple countries in Southern and East Africa have rapid access to comprehensive data on patterns of resistance to antimalarials. Although data are generated on resistance, they are typically collected non-systematically and communicated through scientific papers, a format that is not easy for policymakers to use. This can lead to delays in changes to treatment policy.

The MARC-SE project will begin by mapping the stakeholders involved in malaria policymaking, how they interact with one another, and the evidence they need to guide decision-making. Based on these insights, the project team will develop a data-sharing platform that provides a near-real-time and high-resolution map of patterns of drug resistance. The exercise will also highlight gaps in surveillance where more data are needed.

The project will collate all available data and integrate it within the existing infrastructure of the Worldwide Antimalarial Research Network (WWARN), creating a South-East African regional data resource. Through modelling, risk maps will be generated across 19 countries, illustrating where treatment failure is most likely to develop. 

As part of the project, the team will also work with ministries of health to develop a regional action plan, to create a concrete action plan for adaption and implementation of WHO guidance on responding to malaria resistance. The team will also work with four priority countries to adapt the regional action plan according to their national context. Following policy updates, detailed treatment guidelines and decision aids will be developed, using a novel digital platform (MAGICapp). At least two countries will be supported through detailed treatment guideline development. 

Impact

The MARC-SE project will deliver multiple benefits to health authorities in Southern and East Africa. It will:

• Provide near real-time data on patterns of resistance within a country and highlight areas at highest risk of treatment failure.
• Facilitate rapid revision malaria treatment policy in light of changing patterns of resistance.
• Facilitate rapid development of treatment guidelines and implementation of new policies.
• Foster closer links and build trust between researchers and policymakers, enhancing the likelihood that research evidence informs policy action.
• Support a coordinated approach across countries, delivering tools that would be beyond the reach of individual countries.

Ultimately, the project will ensure that countries are better prepared for increasing resistance to ACTs, can respond more quickly and with approaches tailored to local settings, and therefore avoid unnecessary deaths due to the continuing use of ineffective treatments against resistant parasites.