Innovations in the health system: Brazil adopts new tools in pursuit of P. vivax elimination

On September 10, 2023, the Brazilian Ministry of Health (MoH) and the Partnership for Vivax Elimination (PAVE), led by Medicines for Malaria Venture (MMV) and PATH, hosted a panel event at the largest Tropical Medicine Congress in Latin America, known as MedTrop. Panelists discussed how Brazil is leveraging its success with vivax malaria control to expedite a path to national malaria elimination, following the adoption of tafenoquine (TQ) with G6PD testing in the Unified Health System (SUS) earlier this year. Tafenoquine is the first new treatment to be developed for vivax malaria in over 70 years, and Brazil is the first malaria-endemic country to adopt it along with the STANDARD^TM G6PD test. The event was attended by more than 60 participants and featured malaria researchers, government representatives as well as funders and non-profit organizations.

Janice Culpepper, Senior Program Officer of the Malaria Program Strategy Team at the Bill & Melinda Gates Foundation, along with Claude Pirmez, researcher at Fiocruz; Nick Luter, Senior Market Dynamics Officer at PATH, and George Jagoe, Executive Vice President of Access and Product Management at MMV, welcomed and introduced the event. Janice, who participated virtually, emphasized the importance of joint actions for malaria elimination and presented the Gates Foundation’s strategy to reach this goal. Nick Luter and Elodie Jambert, Senior Director of Access and Product Management at MMV, introduced the multisectoral PAVE consortium and how it is supporting countries in achieving their elimination goals by working closely with National Malaria Programs, generating and disseminating high-quality evidence on P. vivax radical cure case management to inform policy decisions and guide implementation as well as advancing the development of quality-assured medicines and diagnostics for P. vivax.

In the second half of the panel, Dr. Marcus Lacerda, researcher at the Dr. Heitor Vieira Dourado Tropical Medicine Foundation (FMT-HVD), shared the TRuST study results including its implications for the rollout of the new treatment in the public health system. TRuST was the largest real-world study on the use of single dose tafenoquine and G6PD testing, conducted in Brazil in 2021 and 2022, and it was key in providing evidence that led to the treatment’s adoption by the Brazilian government. Lacerda explained that the study sought to identify the challenges of implementing the tools and to ensure that the treatment was given safely to the population: "Anything new generates feelings of strangeness and fear. TRuST showed that tafenoquine can be used safely and Brazil, with CONITEC’s approval, is already aiming to implement it on a large scale."

Cássio Peterka, from the Department of Communicable Diseases (DEDT) within Brazil's MoH, presented its plan to implement tafenoquine nationally: “By the first half of 2024, we want to implement tafenoquine in the municipalities of Calçoene (AP), Cruzeiro do Sul (AC), Manaus (AM) and Porto Velho (RO). In the second half of 2025, we want to have tafenoquine rolled out in all municipalities in Amazonas, Pará, Rondônia, Roraima, Tocantins, Mato Grosso, Amapá and Acre, including indigenous areas. For the first half of 2026, we will implement it in all states in the extra-Amazonian region”. Peterka also emphasized the importance of the partnership with PAVE and studies like TRuST to enable innovations in malaria treatment in Brazil.

Malaria researchers Dr. Cláudio Daniel-Ribeiro, from Fiocruz, and Silvia di Santi, from the University of São Paulo (USP) took part in a roundtable to discuss the impacts of the adoption of the new tools in Brazil on malaria elimination efforts. They pointed out the importance of allocating investments or innovations in the health system, such as the implementation of TQ and G6PD tests. "We need financial investment to eliminate malaria. We need to get out of the mindset of just control and move towards elimination. And that comes at a cost," said Daniel-Ribeiro.

Finally, Dr. Alda Maria da Cruz, director of DEDT at the MoH in Brazil, highlighted how innovation will contribute to the elimination of P. vivax malaria. The director stressed that there are still challenges for the full implementation of the new tools but believes that the country is on the right track: "We have this challenge of implementing tafenoquine together with the test, but we are on a good path and at a good time. We're going to need innovative measures to achieve this elimination goal."