Is genomic research the panacea to malaria elimination?

Africa carries a disproportionately high share of the global malaria burden.

The World Health Organization (WHO) reported in 2021 that Africa was home to 95 per cent of the world’s estimated 247 million malaria cases, and 96 per cent of the 619,000 deaths.

With elimination of the disease now a focus of the national and international community, discovering novel ways to tackle the disease is the primary goal.

Genome sequencing and bioinformatics, the analysis of vast amounts of genomic data, holds the key to fighting malaria.

Genomics research across Africa faces several challenges, including funding, inadequately equipped facilities and insufficient capacity and staff expertise, among other barriers. 

However, progress has been made. According to the Africa Centres for Disease Control and Prevention (Africa CDC), genome (the complete set of genes passed by an organism) sequencing is on the rise in Africa.

Whereas before the COVID pandemic, only 7 of the 55 (13 per cent) African Union (AU) Member States had next-generation sequencing (NGS) capacity in their public health laboratories, by August 2022, 31 (56 per cent) Member States had strengthened their infrastructure and capacity, with the number projected to rise by six more (67 per cent) Member States.

A team at the Ghansah lab at the Noguchi Memorial Institute for Medical Research at the University of Ghana, is exploring the genome of the malaria parasite to detect mutations.

By studying the genes, researchers may see whether the anti-malarial drugs are working, whether drug resistant malaria parasites are emerging, and contribute information to help understand the impact of the vaccine being developed and implemented.

This would then enable researchers to make genomics a key component of national malaria elimination programmes.

A key mutation being studied is those linked to the malaria parasite’s resistance to artemisinin – the primary chemical compound in antimalarial drugs and partner drugs like lumefantrine, amodiaquine and piperaquine used in formulating the artemisinin-based combination therapies.

Artemisinin resistance has emerged in East Africa, specifically in Rwanda and Uganda, and it will eventually reach Ghana and potentially spread to other West African countries.

It is natural that when you introduce a new drug, the malaria parasite will respond by changing its genome. This adaptation is a matter of survival for them – and it begins drug resistance.

Scientific research is necessary to hasten identification of possible emerging resistant parasites, prevent the spread of such parasites and development of new drug combinations if malaria elimination is to become a reality.       

Because genomic research can be costly and resource intensive, the Ghansah lab is taking a unique approach to genomic research in Africa by pooling samples, involving the laboratory staff in health facilities across the country in sample collection and working on many genes at a time to reduce the costs involved in order to make these new research methods more affordable and accessible across the continent. 

In collaboration with Brown University, USA, the team is also driving a far-reaching training and research capacity building programme in malaria genomics and bioinformatics to help people understand genomics data. This partnership is supporting the building of pipelines for genomics data analysis.

 Using technology to develop new drugs 

Advances in genomics and bioinformatics drive faster, more cost-effective development of malaria vaccines and treatment.

This enables a lot of in-silico discovery, which is computationally looking at the parasite’s genome to identify potential drug or vaccine targets. Only when satisfying results are achieved computationally will the team go to the lab, reducing the time and cost involved in discovering a vaccine or drug for malaria treatment.    

Beyond parasite genomic data, the Ghansah lab collects field data including demographic information from participants that are linked to the genomics data.

The genomic and field data are used to develop a digital health data dashboard by the Noguchi team. This digital health data dashboard will present data concisely that will help Ghana’s National Malaria Elimination Programme (NMEP) to understand the impact of interventions, and change the interventions, if necessary.

This information and understanding will guide policy. The hope is that by the end of this year, NMEP will actively access this dashboard and include its own epidemiological and clinical data, merging the existing genetics, epidemiological and demographic data.

Involving public health officials and policymakers in genomic research 

This work informs and guides the adoption of genomics and bioinformatics data in malaria policy making and control interventions.

Genomics is not a simple biochemical test – it is a long-term process that researchers must continually explore.

It is important for policymakers to see the need for genomic research, fund it, and incorporate it into strategic public health planning and implementation.

African governments need to allocate more resources to genomic research and development on an ongoing basis, enabling cutting-edge malaria research to progress.

In line with this, this work includes an extensive training activity to demystify and simplify genomics for policy makers, field staff and scientists across Africa, conducting interactive workshops to introduce people to genomics and tailoring these workshops to ensure that participants from different walks of life get a good understanding of the basics of genomics and that they see the importance of it in malaria elimination.

Policy makers and health officials are starting to understand that genomics supports broader interventions, such as reducing mosquito populations in areas where drug-resistant malaria has been identified, thus reducing the spread of any resistant parasite.

This supports other measures to curb drug-resistant malaria and ensure that patients complete the treatment regimen.

Despite the satisfactory progress made in combating malaria to date, much more can be done to promote the value of genomic research in combating malaria.

Funding remains a challenge. This work is supported by international partners, which comes with limitations, including noncontinuous funding, and narrow research focus areas and scope.

It is imperative that more African governments contribute to ongoing funding to sustain this research that is critical in the fight against malaria and other neglected tropical diseases.

Africa is yet to reap the benefits of genomics research on public health outcomes across a range of disease areas, including malaria.

The WHO’s Science Council emphasises the need for more financial commitment and allocation, laboratory equipment, computational tools for data management and storage, and construction and maintenance of research facilities to enable the advancement of genomics research in low-middle-income countries.

Given the critical role of genomic sequencing in combating malaria, more domestic financing is needed to bridge these gaps and sustainably enable African researchers to progress in this field, ultimately eradicating drug-resistant malaria.

By Dr Anita Ghansah
The writer is a leading Genetic Epidemiologist and Senior Research Fellow at the Noguchi Memorial Institute for Medical Research at the University of Ghana.

Source: GNA