Africa’s ‘Q’ cooks up arsenal of gadgets to fight malaria

20 November 2024 1:47pm GMT

Bed nets and insecticides have long been used in the battle against malaria but now mosquito-repellent flip-flops are being put through their paces.

They are one of many innovations being tested by a team of scientists at Ifakara Health Institute, a disease research facility in rural Tanzania that would make James Bond’s Q green with envy. 

Entering the institute feels like stepping into MI6’s basement. There are researchers in white coats injecting neon serums into insects and another in a hazmat suit testing new pesticides.

The enemy isn’t Blofeld or Goldfinger but a more insidious enemy – malaria, a disease that is estimated to have killed six million in the last decade alone.

Malaria is notoriously difficult to control, because scientists are forced to deal with not one but two complex challenges – that of the malaria parasite itself and the disease-carrying mosquito.

To make matters worse, the parasite is constantly evolving and building resistance.

While global malaria deaths steadily declined from a peak of 1.8 million in the 1990s to around 580,000 in the early 2010s, numbers have crept up again over the past decade.

Resistance to pesticides, climate change, and global conflict are all thought to have contributed to a spike in cases, with more than 620,000 fatalities in 2022 – the highest annual death toll since 2011 – the majority of which are African children under five.

While two new malaria vaccines, RTS,S and R21 were rolled out earlier this year, they aren’t expected to be game changers, due largely to their relatively low efficacy rates and the complexity of delivering them. They each require multiple shots.

As things stand, the World Health Organization’s (WHO) global ambition to end the malaria epidemic by 2030 will not be met. 

Nevertheless, scientists at the facility in Ifakara are determined to turn the tide.

The institute has a strong connection with the UK, one of the biggest investors in malaria research and development globally. Several British universities and institutions have provided critical funding and technical expertise to the Tanzanian research centre. 

Many of the scientists who work here have had malaria themselves and know people who have died of the disease. For them, this isn’t just work, it’s personal. 

“The goal here is for African scientists to drive our own agenda,” Dr Emmanuel Kaindoa, head of the Environmental Health and Ecological Sciences Department, told The Telegraph. 

“We understand the communities affected by malaria, and we’re building simple, scalable, and affordable solutions that can finally put an end to this disease.” 

“We have lived with malaria and we are the ones facing the problems of disease – so it’s important we do the work ourselves,” Ruth Shirima, a 29-year-old research scientist at Ifakara added. 

What’s clear, they say, is that ending malaria won’t come via a silver bullet, but a multifaceted strategy that tackles the disease across all fronts.

The Telegraph was granted exclusive access to Ifakara’s state-of-the-art laboratories and testing units to see the innovations they are cooking up.

Insect-repellent sandals

Two men chat beside a well on a dusty village track. 

It’s a typical afternoon in a rural African village: mosquitoes hum around the water as women pump it into plastic containers, children trailing behind them.

What sets this scene apart is what the men have on their feet. At first glance, their footwear is nothing of note – simple leather sandals with a woven strap attached to the top. 

But this strap is something special – a product of the Ifakara Health Institute. 

It’s made of locally produced hessian and has been treated with transfluthrin, a low-cost insecticide highly effective at repelling mosquitoes.

Malaria control has traditionally focused on the nighttime activity of the female Anopheles mosquito, the species responsible for the transmission of malaria between humans. 

Bed nets, introduced in the 1980s, have helped prevent an estimated 633 million cases of malaria in the 21st century alone. 
But they miss a critical point: mosquitoes don’t only bite at night or indoors.

“People aren’t protected 24 hours a day,” Dr Kaindo explained. “We’re seeing malaria vectors shift to early morning and evening hours when people aren’t under nets.”

In fact, up to 30 per cent of bites from the female Anopheles occur during the day, explained Dr Kaindo, and mostly around the feet and ankles – given it’s an area of the skin that tends to be consistently uncovered. 

Through a series of field tests, which involve an army of local volunteers donning the sandals as scientists unleash wild mosquitoes around them (Ifakara has its own colony of malaria-free mozzies for human testing), scientists found the shoes reduced mosquito landings by 48 per cent. 

No one claims the sandals will eliminate malaria – especially given the fact that 300 million Africans don’t own a pair of shoes – but they may help. 

The prototypes are currently effective for up to six months and are said to be affordable, easy to make, and could fit relatively easily into daily life. 

The sandals haven’t been rolled out on a large scale yet but work is ongoing.

“We hope to get them into the [WHO] pre-qualification stage,” said Dr Kaindo. 

When a medical product targeting one of the WHO’s ‘priority diseases’ like HIV, malaria, Zika virus, dengue fever, or cholera has been developed, scientists are required to submit their findings to the WHO, so that the agency can verify its safety and efficacy before it can attract UN backing.

Eaves-ribbons

Next up on Q’s production line are the ‘eaves ribbons’.

Like the sandals, they are made from strips of cheap fabric treated with potent transfluthrin. 

But instead of protecting just one pair of feet, the eaves ribbons are designed to protect entire families. 

About 15cm thick, the fabric is made to fit around the top of basic mud and brick housing typical to sub-Saharan Africa.

“Most rural homes here have these gaps for air, but they’re also entry points for mosquitoes,” explained researcher Ms Shirima, who arrived at work on the back of a rickety old motorbike, riding side-saddle.

Most things designed to protect from mosquitoes provide a physical barrier of sorts but their main impact is the result of the pesticide they are soaked in. 

This is also the case with the bed nets used across the developing world. When mosquitoes land on the net they are not just physically prevented from biting but are killed by the pesticide they come into contact with.

The sandals and eves ribbon being tested in Tanzania have a similar but subtly different function. The pesticide – transfluthrin – that they are soaked in does not work by touch but its evaporation into the near environment. It is picked up by the odour receptors of mosquitoes and repels them.

“The chemical compound and the continual release of these chemicals creates a barrier space, or buffer, between humans and vectors, preventing blood-meal acquisition and consequent parasite transmission,” says a 2020 paper in the Malaria Journal.

The beauty of the eaves ribbons, Ms Shirima noted, is that they protect not just people inside the home, but also those outside who may be cooking, cleaning, or socialising outside at night. 

It’s another example of a cheap and scalable tech that could be easily introduced, she says.

“You don’t need special storage or containers and you don’t need electricity – the idea is any kind of house, and any kind of village can use them,” Dr Kaindo said. 

The eaves ribbons should last up to one year, and they currently cost around $7, although the hope is that, like bed nets, they could be subsidised to cost even less - somewhere in the remit of $2-$3.

To put them to the test, Ifakara built a series of mud huts that mimic those of surrounding areas in what they call the “mosquito marathon tunnel” – a 110-metre-long shoot where they test things like how far mosquitoes can fly. 

Their volunteers, mostly young men, sleep in the huts, whilst scientists release the hungry female mosquitoes, purposefully starved for six hours before the experiment.

The results so far have been promising – researchers found the ribbons on average lead to an 82 per cent drop in mosquitoes present inside the house, and a 62 per cent drop outdoors in the vicinity of the ribbons. 

The Telegraph visited a family who had put them around their home. 

Abed Mkeyange, a 45-year-old farmer, said he’d seen a big difference since they put the fabric up. 

For him, the concern over contracting the disease is not so much about getting sick, but its financial consequences. 

“Being struck with malaria is a huge blow,” he explained, as his wife, Zuhula, picks the leaves off the top of some potatoes. The leaves will be the family’s dinner, and the potatoes they will sell. 

“The kids can get malaria three to four times a year and sometimes that means we have to sell whatever produce we have from the field to go and get treatment. Then you have a situation like this,” he says, pointing to his modest hut, which has just one room barely large enough to stretch both arms out inside. 

Genetically modified mosquitoes 

What if mosquitoes became resistant to all insecticides – or the malaria parasite to all antimalarials? 

Both are looming threats. Resistance to advanced insecticides is already spreading across Africa, while new research from Uganda shows the malaria parasite developing partial resistance to artemisinin – the main drug for treating severe malaria in children.

But there’s a potential game-changer: genetic modification. 

Ifakara has launched a project that has successfully modified mosquito genes in a bid to rid the insects of the ability to carry and transmit the malaria parasite. 

The project is being run in collaboration with Imperial College London, which has sent scientists to Tanzania. It’s one of several British universities that have developed close links with Ifakhara. 

It makes sense, given the UK’s role in malaria eradication; both Labour and Tory governments have invested billions in research, innovations, and partnerships since the start of the millennium. 

The work, conducted in a laboratory housed in a converted shipping container, is fiddly: scientists must inject a specially designed gene into hundreds of thousands of mosquito eggs one at a time – and by hand. 

Currently, only about 10 per cent of mosquitoes infected with the malaria Plasmodium parasite live long enough for the parasite to become infectious. The researchers want to lower that percentage further. 

The gene they’ve introduced slows the parasite’s development in the mosquito’s gut, ensuring the mosquito dies before the parasite can fully mature. 

The new gene is dominant, meaning that when a genetically modified mosquito mates, the modified gene is passed on.
Even with a relatively small number of mosquitoes modified, the gene will become “dominant in just four to five mosquito generations,” says a researcher. 

It’s an ambitious and expensive experiment. 

The modified mosquitoes are still undergoing testing. It might be 10 years until they are released into the wild. The teams here are still making sure the technology works – and crucially, that it is safe. 

“We do not expect to have any adverse effects. But we are planning clinical trials to see if when one of the mosquitoes bites you it can cause anaphylactic shocks and so on,” Prisca Kweyamba, a PhD student and researcher on the project told The Telegraph.

“It’s important to have antimalarials, bed nets, and vaccines - but technologies like these mosquitoes are important and could overcome barriers to healthcare,” Ms Kweyamba said. “Regardless of your socio-economic status or geographical location these technologies can reach you.”

The researchers run tests using malaria parasites found in the blood of local people, ensuring the research is specific to the region. 

“Our partners at Imperial have tested the same thing with a lab strain of the malaria parasite, but now we want to see what happens in the real-life setting here in Tanzania if the mosquitoes can do the same job with naturally infected individuals,” Ms Kweyamba said. 

Vaccines 

Over the past couple of years, not one but two malaria vaccines have launched onto the market: the RTS,S made by pharmaceutical company GSK and the R21/Matrix-M developed by the University of Oxford and Serum Institute in India. 

It’s an important milestone – more than 200 vaccines have been tried and tested since 2002, and none have worked until now. 

Both RTS,S and R21 have been recommended by the WHO for children under 5, and are starting to be rolled out in several African countries. 

Ifakara has been involved in running the clinical trials for both jabs in Tanzania.

Currently, the institute is facilitating ongoing efficacy tests for R21 – the cheaper of the two jabs – on behalf of the Jenner Institute at the University of Oxford. 

The trials involve more than 4,800 participants and are run out of Ifakara’s Bagamoyo campus just outside Tanzania’s former capital, Dar es Salaam, as well as in Burkina Faso, Kenya, and Mali. 

Initial evidence suggests they are up to 78 per cent effective, although some scientists dispute the figures, suggesting that because trials were carried out in low transmission season the results have been distorted.

“We have a dilemma where in the context of vaccines, the malaria jabs aren’t very good. We think they only provide between 30-50 per cent protection,” Chris Drakeley, professor of Infection and Immunity at the London School of Hygiene & Tropical Medicine told The Telegraph.

Regardless, “you tell a doctor that a vaccine could cut even 30 per cent of their malaria cases and they’d bite your hand off,” said Dr Drakeley. 

Maximilian Mpina, a senior immunologist at Ikfhara, describes how he felt when he first realised the R21 was going to work. 

“We were so excited. To see that the two vaccines we’ve been working with had been approved by the WHO was huge. We’re doing something for the world and we’ve participated in changing children’s lives,” he said.

Both jabs require multiple doses – 4 for RTS,S and 3 for R21. It’s another potential hurdle. Not only do millions of people in sub-Saharan Africa live many miles from a health centre, but distrust in medicine is a problem. 

“A lot of these poor African communities have been exposed to a lot of contradictory messaging about vaccines, their side effects and so on – so you really need a robust public education exercise and need to build people’s confidence.

“We need to make sure they are accepted by mothers and used in the right way,” Joy Phumaphi, a former Minister of Health of Botswana and Board Chair of the Rollback Malaria Partnership to End Malaria told The Telegraph.

“Though the vaccine is a fantastic thing, we cannot assume it will stop malaria alone, because it won’t,” Dr Drakerly added. 

AI diagnostics

Although hundreds of thousands of children contract malaria every week, diagnosing them is difficult without specific tests.  This is because the early symptoms of malaria are much the same as a cold.

“It’s a big problem because the malaria life cycle is very fast. Within 48 hours, the blood is filled with lots of parasites. So misdiagnosis of malaria is dangerous,” Dr Maximilian Mpina said. 

Microscopy and PCR tests for malaria are not practical in many of the continent’s remote locations because of the time they take and the cost. 

Rapid diagnostic tests – which look and operate much like lateral flows for Covid – have changed the game since their large-scale introduction in 2010 as they are simple and quick to use and can be distributed even to the most remote clinics.

But they are not perfect and don’t pick up those with a low level of the malaria parasite in their blood. Low-density infections can progress to severe illness if left untreated and people with low-level infections can also still transmit the disease to others via mosquitoes. 

The University of Glasgow is collaborating with Ifakara to overcome this problem with an infrared AI-diagnostic tool. The aim is to quickly measure the exact amount of the parasite in the blood. 

“We are innovating a new diagnostic tool that works like a rapid test in that it’s cost-effective but can give accurate results with the same sensitivity as a PCR. It could also be used in local settings without any expertise,” Idrisa Mchloa, a research scientist on the project told The Telegraph. 

Such a tool could be especially useful in low-transmission zones that are close to eliminating malaria. 

“This will be very important for the area where the malaria transmission is very low, so that you can find the asymptomatic patients who act as a reservoir for the disease and make sure it’s completely eliminated,” said Mr Mchloa.

The Telegraph visited one of Ifakara’s outreach clinics, where scientists were collecting blood samples for testing. 

People seemed keen to participate – not only to determine if they or their child had malaria, but for the greater good.
An achievement for an institute whose name, Ifakara, translates to “a place to die” – a hangover from when the town suffered from a high burden of tropical disease. 

Desdeira, a 30-year-old pregnant with her first child, told The Telegraph she plans to be first in line for the R21 malaria vaccine, set to roll out in Tanzania early next year.

What now? 

The research at Ifakara is impressive – all the more so as so much of it is home-grown. 

But funding remains a problem. Global research and development funding for malaria fell sharply during the pandemic and has yet to fully bounce back.

Some fear a Trump presidency could see aid spending cut further.

America is the biggest global health donor, with an annual spend of more than $12 billion a year.

It provides a hefty chunk of the WHO’s core annual budget and is also a main funder of other UN agencies and international campaigns to combat disease, including the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Gavi: The Vaccine Alliance – the two principal funders for malaria programmes around the world. 

Meanwhile, the UK, which funds roughly 9 per cent of global malaria research, pulled back on its overseas aid spending in 2021, leaving hundreds of initiatives to tackle disease in Africa and other parts of the developing world dependent on an uncertain pipeline of support. 

Victoria Fowler, Head of Advocacy at charity Malaria No More UK, stresses that maintaining this pipeline is critical: “It’s going to come down to ensuring the development work reaches the people who need it.”

Encouragingly, the UK’s new budget emphasises funding for British scientific research and development which will hopefully continue to trickle into malaria efforts, she said. 

“It’s so important to the fight against malaria that research and product development happens collaboratively.  People now understand since the pandemic that when something happens in one part of the world, it can have repercussions on the other,” Ms Fowler said. 

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