P. vivax radical cure in Latin America: regional coordination to advance malaria elimination

Representatives from Brazil, Peru and Colombia’s Ministries of Health met virtually on November 30 and December 1 with officials from the Pan American Health Organization (PAHO), the World Health Organization (WHO), Unitaid, the Bill & Melinda Gates Foundation, research institutions, and global and regional organizations to discuss ongoing efforts toward P. vivax malaria elimination. The event was hosted by the Partnership for Vivax Elimination (PAVE), an initiative led by PATH and Medicines for Malaria Venture (MMV), which facilitates access to new and existing malaria diagnostics and treatments for P. vivax elimination. 

The discussion comes at an important time as countries in Latin America have been actively engaged in innovative research to explore new strategies for malaria control and elimination, focused on improving the safety, efficacy and effectiveness of P. vivax radical cure. As new tools become available, researchers and governments in the region are collaborating to assess how they can best be applied in endemic contexts. 

After a meeting last year that helped align participants around a shared agenda, the 2021 Regional Meeting was another step towards advancing radical cure in the region. The meeting disseminated recently concluded radical cure research and reviewed the pipeline of ongoing activities in Brazil, Colombia, and Peru. This work will provide critical evidence for policy makers in the Americas and beyond. 

“This meeting is a fantastic initiative to join the efforts to eliminate malaria in our countries. Malaria is a barrier we have encountered, but the new tools we are working on will play a key role in its elimination. We are very happy to be part of this action and of this great group”, said Verónica Soto, from Peru’s Ministry of Health, during the meeting.

“Latin America has a remarkable opportunity to light the path for the global malaria community by radically transforming how we attack P. vivax in this hemisphere. The work that countries are doing here is fundamental for helping defeat vivax worldwide”, stated George Jagoe, Executive Vice President for Access and Product Development at MMV and member of PAVE’s Leadership Team.

According to WHO’s latest World Malaria Report, 141 million people in the Americas live in areas at risk of malaria. Brazil, Colombia and Venezuela account for 77% of all cases in the region, and P. vivax is dominant, representing 68% of malaria cases in the WHO region of the Americas. In 2020 there were estimated to be between 4.1 and 5.1 million cases of P. vivax malaria worldwide. This parasite can stay dormant in the liver, causing multiple relapses from a single mosquito bite, creating a challenge for malaria control efforts. The COVID-19 pandemic has impacted the malaria elimination in the Americas, reducing the detection of new cases and limiting access to treatment for malaria patients.

Despite challenges, Latin America is uniquely positioned to lead the world in malaria elimination. Malaria cases fell 58% from 2000 to 2020. Paraguay (2018), Argentina (2019) and El Salvador (2021) have been recognized by WHO as malaria-free. Many other countries in the region are scaling up their efforts to eliminate malaria with guidance from PAHO and support from other global and regional organizations. 

“The elimination targets in the Americas are set. The region is making progress towards elimination and a group of countries with less than 2,000 cases have the potential to eliminate malaria by 2025. There are great possibilities to strengthen regional coordination and the exchange of knowledge and experiences”, said Roberto Montoya, Regional Malaria Advisor at PAHO.

Recognizing the region’s potential to reach P. vivax elimination, participants from Brazil, Colombia and Peru discussed the effectiveness, safety, costs, risks and benefits of vivax treatment regimens, and showcased the roll-out of existing and new treatments for vivax malaria in real-life settings. These experiences and a related growing body of evidence will ultimately inform policy change for malaria elimination efforts, with potential for global implications. 

Participants also highlighted solutions to optimize radical cure in endemic settings by preventing malaria relapse with existing and newer tools: 

• Brazil will leverage results from an ongoing operational research study (TRuST) which seeks to understand the feasibility of providing radical cure treatment based on the results of G6PD testing to malaria patients in the municipalities of Manaus and Porto Velho. This study includes the first real world implementation of single-dose tafenoquine. 
• Peru will scale up its Malaria Zero Plan nationwide. This includes piloting new technologies in endemic areas and mainstreaming successfully piloted approaches, such as active search for new cases (active case-detection) and deepening the engagement of community health workers. Additionally, the country plans to implement an operational feasibility study of P. vivax malaria radical cure after G6PD testing. The study is funded by Unitaid.
• In Colombia, the Ministry of Health is launching new efforts to explore the best approaches to train health workers to conduct G6PD testing in endemic areas, to implement a clinical study for treating P. vivax with higher doses of primaquine, and to pilot a tool intended to help determine the most effective radical cure strategies according to health system context and epidemiological criteria. 

To conclude the meeting, PAHO’s Malaria Diagnostics and Supply Management Advisor, Maria Paz Adé, highlighted the importance of regional cooperation and multi-sectoral partnerships with Ministries of Health to optimize the deployment of new and existing tools for the diagnosis and treatment of malaria. She proposed the creation of a Regional Radical Cure Working Group to join efforts to increase access to radical cure for P. vivax in the Americas. This will be instrumental as the research pipeline continues to generate new evidence to inform elimination efforts in the region. 

“From the perspective of PAHO's mission, in addition to leading strategic efforts, it is important to cooperate with member states and other stakeholders involved in the malaria landscape. We are learning lessons by analyzing past experiences, previous initiatives and success cases. I believe that this Working Group can align efforts to leverage existing resources and avoid duplicating efforts”, stressed Dr. Adé.

About PAVE
The Partnership for Vivax Elimination (PAVE) is led by Medicines for Malaria Venture (MMV) and PATH. It facilitates access to new and existing malaria diagnostics and treatments for P. vivax elimination, supporting countries in adopting new and existing tools and approaches to achieve universal access to the best clinical practices for P. vivax case management. PAVE consolidates its project work from multiple funders and is aligned with country partners and the World Health Organization (WHO) to accelerate progress.