Malaria in pregnancy: Why one wrong drug could cost two lives

Are you a pregnant woman in a malaria-endemic zone, such as the Lake Basin region or the Kenyan coast?

When you feel sick – with symptoms that would suggest a malaria infection: fever, chills, sweating, headache, body and muscle aches, nausea, vomiting, and loss of appetite, do not self-medicate.

Buying antimalarial drugs over the counter is strongly discouraged. “It is very important that medicine in pregnancy is safe; meaning it’s not going to harm the developing foetus. Medicines are chemicals, and pregnant women, and foetuses are so vulnerable to chemicals,” says Dr Martin Fitchet, CEO of Medicines for Malaria Venture (MMV), a global not-for-profit whose purpose is to make effective antimalarial therapies available affordably.

Fitchet was in Kenya in June, visiting study sites in Homa Bay County, where a team of researchers affiliated with the Kenya Medical Research Institute (Kemri) are set to conduct a study on treating malaria in women who are expectant.

He also toured Universal Corporation Limited (UCL), a Kenyan pharmaceutical company in Kikuyu town, and the only one around with World Health Organisation (WHO) prequalification for the production of sulfadoxine-pyrimethamine (SP), an antimalarial for treating pregnant women.

“Malaria is very dangerous in pregnancy. It can cause significant mortality and morbidity in the woman and also poor outcomes for the baby,” says Fitchet, who is a medical doctor by training. In the 1990s, the malaria parasite developed resistance to the main drug used to treat malaria, called quinine. This led to an unprecedented increase in mortality: “the parasite had adapted and become resistant,” he says.

The malaria parasite, he explains, is extremely adaptive; it is constantly changing its genetic code to become resistant to drugs that are developed to treat it.

The process of developing a new drug to treat a disease can last at least three years to forever, says Palu Dhanani, the Managing Director at UCL.

It involves time-consuming Research and Development (R&D). The challenge, however, in any drug development process, is the cost. “When pharmaceuticals develop medicine (for malaria), it can be very expensive. The R&D for any new medicine follows the same highest level of quality wherever in the world it’s developed and whoever takes it.

“A typical pharmaceutical company can develop a drug and sell it to the market. However, in the case of malaria, we have a real challenge because the disease affects some of the poorest communities in the world,” says Fitchet.

“The drugs that are needed can’t be drugs developed to make a profit. They have to be affordable and accessible to the communities that need them,” he adds.

The development of SP, which is now used by pregnant women in Kenya, was partly funded by MMV, says Dhanani.

So far, MMV has partnered – with pharmaceutical companies, biotechnology companies, academic establishments, and others – on the development of around 17 brand-new malaria medicines.

“We utilise funding from our donors to support R&D in the development of malaria drugs so that the manufacturer does not need to pass the cost to the end user, making it affordable in the process,” says Fitchet. “We try to absorb the shock of the actual cost of the drug.”

Why seventeen? “Because the parasite adapts very quickly to new drugs.” But also, Fitchet says, his scientific team is always in pursuit of better drugs: “such as drugs that can be used safely by broader populations.”

He says it is important that malaria-vulnerable populations (pregnant women and children) utilise the safe drug options tailored for them.

UCL is pre-qualified to manufacture not only SP but also SPAQ. “SPAQ is used to prevent malaria in children,” says Dhanani.

The UCL–MMV partnership, Dhanani confirms, has significantly reduced the cost of the drugs. “There is no doubt about affordability. Typically, a patient needs Sh130 for treatment,” he says.

According to Fitchet, the prevalence of malaria has remained flat – “neither increasing nor decreasing” – since around 2012. “Our work is far from over. We need to develop new drugs that are suitable for special populations before the parasites develop resistance to what we have today,” he says.