Building A Strong Response to Drug-Resistant Malaria in Africa

For over two decades, the preferred drug treatment for malaria has been artemisinin-based combination therapies (ACTs). Lauded for their potency and speed in eliminating the mosquito-borne parasites that cause the disease, ACTs have helped significantly reduce the number of lives lost to malaria. Over time, however, parasites can develop genetic resistance to antimalarial drugs, rendering these medications ineffective. Researchers have detected increases in antimalarial resistance around the world, and this urgent and growing threat could lead to more malaria infections, treatment failures and deaths.

In response, the U.S. President’s Malaria Initiative (PMI) and the U.S. Centers for Disease Control and Prevention (CDC) developed the Partnership for Antimalarial Resistance Monitoring in Africa (PARMA) network. Launched in 2014, PARMA was designed to bring together malaria experts across Africa and the U.S. to track emerging resistance so countries can adapt treatment protocols. Nowhere is this work more critical than in the hard-hit countries of sub-Saharan Africa, which account for 94% of the world’s 249 million malaria cases and 95% of the over 600,000 deaths from the disease globally.

In recent years, PARMA has increased its focus on leadership of African institutions to perform analyses and train scientists on the continent. In 2022, with support from the CDC Foundation and the Bill & Melinda Gates Foundation, PMI and CDC established the first PARMA hub in the International Center for Research and Training in Applied Genomics and Health Surveillance (CIGASS) at the Cheikh Anta Diop University (UCAD) in Dakar, Senegal. This state-of-the-art laboratory is the first of its kind in Africa, training scientists and researchers from neighboring countries to identify the genetic mutations associated with antimalarial resistance. This marks an important step forward in the fight against drug-resistant malaria.

“What we have in PARMA is the mobilization of resources that we need, and the mobilization of expertise,” said microbiologist Awa Deme, PhD, coordinator for the PARMA hub.

Tracking drug resistance starts with therapeutic efficacy studies (TES) which monitor symptoms and blood samples from patients being treated with antimalarial drugs. TES results can show early indications of resistance, but further tests are needed to find clear evidence of a drug-resistant strain of malaria. A lab like the PARMA hub can provide detailed surveillance of the TES samples on a molecular level, to identify specific genetic markers associated with resistance.

What we have in PARMA is the mobilization of resources that we need, and the mobilization of expertise.

Before the creation of the PARMA hub, African scientists and researchers—Dr. Deme among them—traveled to CDC headquarters in Atlanta, Georgia, to be trained in the highly specialized techniques for monitoring antimalarial resistance in the center’s malaria lab. With the launch of the PARMA hub in Senegal, research teams are now able to access the same level of training and expertise from their peers in neighboring African countries.

“One of the goals of the PARMA hub is to create opportunities and capacity for more antimalarial monitoring to be done in Africa, where malaria is endemic,” said Irene Cavros, epidemiologist for CDC’s President’s Malaria Initiative. “Researchers are trained using malaria samples from their countries, and they generate valuable data that can help inform their national malaria control programs.”

When Dr. Deme began the process of inviting trainees to the new facility in Senegal, she was met with both excitement and skepticism from researchers who questioned the PARMA hub’s capacity.

Much of that hesitation disappeared, however, once the trainees paid their first visit to the impressive lab. “They said, ‘Wow!’ They were very surprised at everything we have for their training,” Dr. Deme said. “They were excited then, and they want more and more and more.”

The PARMA hub was designed to give the visiting researchers access to cutting-edge technology and lab infrastructure to conduct molecular analysis of their TES malaria samples. Providing instruction in the latest techniques of antimalarial resistance monitoring using meticulous standard operating procedures and strict safety protocols, Dr. Deme and the training staff created a sense of trust and support for the trainees as they completed the intensive, 45-day program.

“I needed to build this confidence with my trainees,” Dr. Deme said. “I am here to help answer questions, to provide 100% assistance, and they were able to call me anytime.”

While the PARMA hub’s initial goal was to train scientists from two countries in two years, the program exceeded expectations by welcoming seven researchers from four countries: Cameroon, Guinea, Democratic Republic of Congo, and Niger. With antimalarial resistance on the rise, there is a need to expand this work beyond the hub in Senegal.

For Dr. Deme, it is the appreciation of her hardworking trainees that continues to motivate her. The researchers who took part in these initial trainings at the PARMA hub not only learned advanced surveillance skills but gathered valuable, potentially lifesaving data about drug-resistant malaria that could shape the future of malaria treatment and prevention in their countries.

“A participant told me, ‘You know we were waiting so many years to have this information, and now it’s happening so quickly,’” Dr. Deme said. “‘We finally have the data. We are so grateful.’”

Photos courtesy of CIGASS