An article on LinkedIn from Trevor Mundel, President of Global Health at Gates Foundation announced phase III trial for ganaplacide-lumefantrine (GanLum), a new non-artemisinin malaria treatment being developed by Swiss Pharma Giant, Novartis. The posting linked to web post from NPR. ‘New malaria drug could be a life-saver as the standard drug shows signs of weakness’ by Jonathon Lambert has preliminary results of a study which  enrolled over 16,000 adults and children over 2 years old with malaria across a dozen countries in Africa. Half took GanLum over the course of three days and half got the current artemisinin-based standard of care.

The team found both drugs were about equally effective, with GanLum coming out slightly on top. Both drugs had similar levels of side effects, including nausea and diarrhoea. But the GanLum group did experience more vomiting.

Hardly, a game changer. The reason given for its development is that there are fears that artemisinin based drugs might lose their effectiveness. Lumefantrine features in the treatment as it does in one of the most commonly used treatments today, the artemisinin based artemether-lumefantrine.

I sought more information and found the Phase II trial on clinicaltrials website, ID NCT04546633. ‘Ganaplacide (KAF156) plus lumefantrine solid dispersion formulation combination for uncomplicated Plasmodium falciparum malaria: an open-label, multicentre, parallel-group, randomised, controlled, phase 2 trial’ by Ogotu et al was published in the Lancet in 2023. The study for which 1220 patients were screened funded by Novartis and Medicines for Malaria Venture found little difference between it and control, also artemether-lumefantrine.

The article does state that GanLum won’t replace artemisinin remedies any time soon.

I suspect the real motivation for its development is to have a product upon which the patent royalties have not expired. Wikipedia informs that Ganaplacide is protected by the granted United States Patent 9,469,645. This is now owned by Novartis International Pharmaceutical Ltd., Bermuda.

Why else would Novartis be motivated to fund studies?

In MalariaWorld this week a study from Madagascar examines early bio-efficacy loss of ITNs. In ‘Early Bio-Efficacy Loss of Nets Mass Distributed for Malaria Vector Control in Madagascar in 2018: Implications for Malaria Prevention’, Nepomichene et al assess the bio-efficacy of DawaPlus® 2.0 and PermaNet® 2.0 ITNs upon arrival and at 12, 24, and 36 months after distribution.

On arrival, mosquito mortality rates observed when exposed to DawaPlus 2.0 (86.4%) and PermaNet 2.0 nets (83.6%) exceeded the WHO’s threshold of 80.0%. However, at 12, 24, and 36 months after distribution, mosquito mortality rates were <56% for all districts. With the exception new DawaPlus 2.0, the deltamethrin residue on ITNs was also lower than the expected ranges of 80 mg/m² ± 25% for DawaPlus 2.0 and 55 mg/m² ± 25% for PermaNet 2.0. Regardless of ITN age, the concentration of deltamethrin was <66 mg/m² for DawaPlus 2.0 and <36 mg/m² for PermaNet 2.0 ITNs. According to the manufacturers (Tana Netting, Bangkok, Thailand and Vestergaard–Frandsen, Lausanne, Switzerland), ITNs are effective for 36 months. Therefore, mass distribution campaigns are organized every 3 years. However, the DawaPlus 2.0 and PermaNet 2.0 ITNs exhibited a loss of bio-efficacy within 1 year of distribution.

The logic behind the use of insecticide treated nets is that a mosquito that lands on the net will die and not be able to bite another person. This is assumed to improve the effectiveness of nets at preventing malaria. However, this has never been effectively shown. It is not even clear that net programs are effective at reducing the occurrence of malaria. In their discussion the authors state that Madagascar, reported malaria cases increased from 965,000 in 2018 and 992,000 in 2019, shortly after mass ITN distribution, and to 1,950,000 in 2020 and then to 2,344,000 in 2021. This does not suggest that they are effective at preventing malaria.

I sleep inside a mosquito net because I don’t like the discomfort of mosquito bites. It is not insecticide treated. From a health perspective I am concerned about the exposure to insecticides from such nets. It is clear from this study that the insecticide does not stay on the nets so could easily be absorbed by people using them.

And, of course, nets can only prevent malaria if it is indeed spread by mosquitos. I do not believe that this hypothesis has been proven.

A case-control study in MalariaWorld this week found association between malaria and undernutrition. ‘Associations between undernutrition and malaria infection: a case–control study from Rwanda’ by Uwimana et al found significant association between malaria and vitamin E and iron deficiency. There was a significant association in the occurrence of malaria with sub-optimal lipid consumption.

The case study with a total of 1025 participants in Western, Southern, Northern, Eastern provinces and Kigali of Rwanda, which are classified as malaria-endemic with stable transmission was carried out from November 2021 until December 2023. 658 were included in the analysis. Children under 3 years old were excluded due to underrepresentation. After analysis of reported dietary habits to detect under reporters and over reporters using the Goldberg index, 337 participants were excluded. 34% of the 658 tested positive for malaria.

The diet of the study population was predominantly composed of starchy foods, 56.7% of total intake. Fats contributed a moderate 16%, while vegetables and legumes made up 9.4% and 9.3%, respectively. Animal-source proteins were consumed at notably low levels: dairy products at 2.5%, and meat, poultry, fish, and eggs collectively at just 1.1%. 58.2% of participants reported caloric intake below 90% of the daily recommended intake.

There was an association between overall nutrition and malaria (measured with rapid diagnostic tests, RDT) but not statistically significant. Low intake of fats was associated with increased malaria. In general, the diet of the participants was sub-optimum with 58.2% consuming less than 90% of recommended calories, and low consumption of animal proteins.

There were some anomalies in the micronutrient consumption studies. In particular, the consumption of selenium was positively associated with malaria. Also, recall bias related to nutrition intake cannot be excluded and could lead to potential risk of error from participants in reporting their dietary habits.

The authors conclude that addressing micronutrient deficiencies may be a valuable strategy in malaria control efforts. Improving nutrition status, with an emphasis on food composition and a balanced diet, could further strengthen immunity for the control of infectious diseases including malaria. Therefore, integration or close collaboration between national programmes for nutrition and infectious diseases control are highly recommended.

A study listed in MalariaWorld this week found that adherence to a ‘fat and vitamin A’ dietary pattern was inversely associated with the chance of clinical malaria. ‘Associations Between Climate- Sensitive Nutrients, Clinical Malaria, and Anaemia Among Young Children in Rural Burkina Faso: An Analysis of Baseline Data From a Cluster- Randomised Controlled Trial’ by Kurniawan et al in Tropical Medicine & International Health, examined the effect of  ‘fat and vitamin A’ and  ‘fibre and micronutrient’ dietary patterns on the incidence of malaria and anaemia in children aged 6–23 months in Nouna, Burkina Faso.

No significant effects were found on the occurrence of anaemia or of the ‘fibre and micronutrient’ dietary pattern. While the diets of all children in the study relied on carbohydrate based foods for the majority of calories, those on the ‘vitamin A and fat’ pattern were more frequent consumers of yellow and orange fleshed fruits and vegetables and animal-based foods, such as red meat and eggs.

There is evidence that the occurrence of malaria disappears as the wealth and diet of a country improves. This study of a high-risk population in Burkina Faso gives some statistical evidence of how this could be so.

The lead article in MalariaWorld this week is ‘Rapid diagnostics test can detect asymptomatic malaria cases’ by Patel and Duncan of Imperial College, London. The article claims that the new test called Dragonfly is so sensitive it can detect 95% of cases where the numbers of parasites were too low to be detected by looking at blood under a microscope. It is well accepted that microscopy by an expert technician is the ‘gold standard’ for malaria plasmodium detection. However, this article says that PCR testing is the gold standard!

Kary Mullis, the discoverer of PCR (Polymerase chain reaction) said: “Anyone can test positive for practically anything with a PCR test, if you run it long enough with PCR if you do it well, you can find almost anything in anybody. It doesn’t tell you that you’re sick.” We all remember how PCR tests run for very long cycles detected many COVID-19 cases during the pandemic. Clearly PCR and Dragonfly are supposedly detecting plasmodia that are not detectable by the gold standard, microscopy.

The article title claims that asymptomatic cases (i.e. people who are not ill) can be detected. Presumable they can then be put on a dose of artesunate or another treatment generating more revenue. The benefit of detecting asymptomatic cases is supposed to be that by treating asymptomatic cases before they have symptoms, there will be less opportunity for a mosquito to become infected by biting them. However, if plasmodia levels are so low they can only be detected with super-sensitive methods, it seems unlikely a mosquito sucking a tiny aliquot of blood will be infected by such a person, even if the mosquito transmission hypothesis were true.

The other benefit of Dragonfly is that it will be even cheaper to run tests on many people even those without symptoms. Dr Jesus Rodriguez-Manzano of the Department of Infectious Disease stated “The technology delivered through this work represents a game changer for malaria control efforts.” If malaria were indeed a parasitic illness caused by plasmodia being spread by mosquito bites, this might be true. However, the evidence supporting this hypothesis is very flimsy. Seeking the truth is very difficult for researchers such as Rodriguez-Manzano. To again quote Upton Sinclair, ‘It is difficult to get a man to understand something when his salary depends upon his not understanding it.’

This is a ‘bleeding obvious’ statement. It is well acknowledged that malaria is a disease of poverty addressed in this column on June 13,  May 9, April 18, February 1, October 6 2024 and June 29 2024.  Malaria disappeared from Europe, North America and much of Asia as living standards improved.

And, of course, money is the fuel that keeps the malaria research and treatment business going, which is probably the motivation behind some articles in MalariaWorld this week. One article from PAHO, Pan American Health Organization, which is WHO in Americas region is ‘Best Buys to accelerate disease elimination in the Americas’.

PAHO has developed Best Buys, evidence-based technical briefs that summarize, in a single page, the most cost-effective and high-impact interventions recommended for each disease or condition. The attractive website has a wheel and you can click for any individual disease or all.

What does it say about malaria? The ‘Best Buys’ just seem to be business as usual. Is this approach solving malaria?

1. Expand access to early diagnosis and treatment:
   1. Ensure universal access to diagnosis for suspected cases using rapid diagnostic tests (RDTs) or microscopy
   1. Provide timely, barrier-free diagnosis and treatment in all endemic-area health services 
   1. Engage communities in testing with RDTs for early diagnosis and treatment
   1. Adopt strategies to improve radical cure efficacy or effectiveness for Plasmodium vivax uncomplicated cases
2. Prevent transmission:
   1. Distribute long-lasting insecticidal nets free of charge in endemic areas
3. Consolidate malaria-free micro-territories:
   1. Use microplanning to expand access to services and consolidate malaria-free areas
   1. Innovate in supervision and logistics using information and communication technologies 
   1. Accelerate elimination at the subnational level and pursue subnational verification of elimination
4. Strengthen surveillance to eliminate and prevent re-establishment:
   1. Maintain strong surveillance systems to detect and treat imported cases in all malaria-free countries
   1. Use data and information to guide local-level decision making and action

 The second MalariaWorld article is a blog post by Duma Gideon Boko, President of Botswana and Chair of the African Leaders Malaria Alliance (ALMA), titled ‘Why ending malaria depends on bold financing and global leadership’ in Health Policy Watch. The core principle of the article is that more international funding is needed to pay for mosquito nets, treatments and diagnostic tests. Somehow economists calculate that each dollar ‘invested’ in malaria yields four in economic activity.

Africa will solve malaria the same way the rest of the world did, by lifting everyone out of poverty. Malaria disappears when nutrition, water and sanitation improve. However, this is unlikely to happen as long as African leaders such as Boko continue to emphasise appeals for money from the former colonial powers to pay for nets, drugs and tests. As for African leaders, for every Traore there are at least 10 Bokos.

The lead article in MalariaWorld this week begins “An act of health justice”: Guinea’s children receive the malaria vaccine”. The article links to a posting by the Bill and Melinda Gates vaccine promoter GAVI that describes the national launch of Guinea’s malaria vaccination programme with Prime Minister Amadou Oury Bah and National Transition Council president Dansa Kourouma and Minister for the Promotion of Women, Children and Vulnerable People Charlotte Daffé. To warm applause, the Prime Minister and Kourouma each administer one of the very first doses (see picture).

The article contains the usual discussion items about the scourge of malaria – “In 2023 alone, Guinea recorded nearly 4.43 million cases of malaria, according to WHO’s 2024 World Malaria Report”. It describes the roll-out and promotion but contains no information about the safety or efficacy of the vaccines. Indeed, the article does not even say which vaccine is being administered in Guinea.

I found this information in an August 2025 posting on the GAVI website “Guinea introduces malaria vaccine into routine immunization”. This article has more details about the program. The RTS, S malaria vaccine is being administered. The recommended vaccination schedule in Guinea is 1st dose from 5 months; 2nd dose at 6 months (or a minimum of 4 weeks after the first dose); 3rd dose at 7 months (or a minimum of 4 weeks after the second dose); 4th dose at least 6 months after the third dose for children who come late.

RTS,S/AS01 (Mosquirix by GlaxoSmithKline) was first introduced in 2019 in Ghana, Kenya, and Malawi. In common with the more recently introduced R21/Matrix-M (developed by Oxford University and the Serum Institute of India) it is being rolled out by GAVI in different African nations. Neither were tested against a true placebo. Both were tested for safety and efficacy against a rabies vaccine (Rabipur manufactured by GSK, Marburg, Germany and owned by Bavarian Nordic, Hellerup, Denmark was used in RTS,S study). Nonetheless, these dubious medications are being rolled out in many African nations by GAVI with the support and even participation of the governments of these countries.

Clearly, GAVI have no interest in testing vaccines against true placebos, as is now required for vaccines by US Health Secretary, Robert F Kennedy Jr. I wonder why? And to describe the roll-out as ‘justice’ is at least a little disingenuous.

What type of illness is malaria? What are the symptoms? We hear catastrophic tales about this illness and usually about the worst, possibly fatal, examples.

However, soon after arriving in Kenya I encountered a real life example and wrote about it in February. This week another case in the same family reinforced my idea that malaria in countries where it is considered endemic is very similar to COVID19 in much of the world 2020-2022. A label for generic illness if there is a positive result in a potentially dubious test.

In western countries during COVID ‘pandemic’ if anyone had illness symptoms, cough, fever, stomach upset etc., they were encouraged to get tested either with PCR (polymerase chain reaction) or a Lateral Flow Test. If the test were positive they were considered a case and were usually required to quarantine to prevent spread. If symptoms were more serious they might be treated with an anti-viral drug such as remdesivir or a generic medication sold for another condition. Now most people no longer believe and recognise the pointlessness of all that.

In the recent ‘malaria’ case a young girl had a fever and upset stomach the day after her birthday party in which she ate much children’s party food. I was travelling on business in the far east so was not there. But I did suggest that she be given fluids and monitored at home while her body purged the junk she had eaten.

However, her mother first gave her paracetamol (acetaminophen. So toxic sale is often restricted to make suicide more difficult) to treat the fever and her condition worsened. She was worried and brought her to the same private hospital featured in my February tale. I expect the girl was tested with the same sensitive RDT (rapid diagnostic test) for malaria plasmodia and tested positive. Then she was given the first of three 12-hourly artesunate injections as well as dispersible Artefan tablets (Artemether-Lumefantrine). She went home but her condition worsened and she ended up back in hospital for two nights.

I suspect that she was mildly poisoned by the many artificial ingredients of the party food. Fever is one of the body’s means of purging. But then she was given more mild poisons, paracetamol, and then artesunate and artemether-lumefantrine which lengthened her period of illness.

But it will be recorded as another case of malaria. The test and drug treatment would not occur in a country in which malaria is not present. But if the same circumstances had occurred in 2020 and COVID test were positive, it would have been a COVID case. The belief in malaria is strong in endemic countries as was the belief in COVID worldwide in 2020. Cases will continue as long as people believe and the hospitals continue to make money providing treatments such as this.

This week MalariaWorld features a podcast on Spotify called ‘The tyranny of Defeat, Distraction and Dependency’ by Silas Majambere from his series ‘Malaria Poverty and Politics’. Majambere is described as a Public Health Entomologist who spent 20 years of his career studying and fighting mosquitos that transmit malaria. He discusses the 3Ds of the podcast title.

Defeat – Majambere describes a meeting with a well-dressed young woman in small town in Gambia while he was examining mosquito larvae in a pothole. He asked her what she was doing about the problem of mosquito larvae in potholes that would grow up to be malaria vectors. She said it was the responsibility of others, the authorities, but admitted they were doing little about it. She was accepting defeat to do anything about the problem.

But perhaps a better D is Disbelief. If deep down people really believed that malaria is spread by mosquitos, they would do more about it? I previously highlighted research that found than 53.23% of Chinese expatriate workers in South Sudan believed that attention to food and drinking water hygiene could prevent malaria. Those who have lived with the disease their whole life would have an even better impression of what can help.

In the first podcast in the series, Majambere talks about how shocked his Global North donors are when they see mosquito nets they paid for used as fencing of chicken farms or for fishing. The recipients clearly believe that these are better uses for the nets than the purpose for which they were provided.

Distraction – Majambere discussed all the meetings and plans of malaria researchers. I don’t disagree with him about distractions but I might have a different idea of what the distractions are preventing proper elimination of the causes of malaria. That great distraction of Burkina Faso’s termination of Target Malaria’s gene drive mosquitos continues this week in MalariaWorld with an article in the other great organ of the Scientific Establishment, Nature magazine. Other distractions are perhaps vaccines, IPT programmes, fish that eat larvae, etc.

Dependency – Majambere is spot on with this and he himself is no better example. I am sure his education at Liverpool School of Tropical Medicine and 20-year career as a bug hunter was dependent on money from Global North philanthropists. And also dependent on his belief that malaria is a parasitic illness transmitted by bites from female Anopheles mosquitos. Burkina Faso has shown that African nations do not need to be dependent on Global North financial schemes.

Majembere recognises the importance of poverty on occurrence of malaria. But as a bug-hunter links it to inadequacy of housing and sanitation that increases mosquitos rather than to inadequate nutrition or poor-quality water.

I have a 6-Sigma black belt. I am well trained at systematically identifying the causes of problems before implementing solutions. When applied to malaria the evidence that it is a parasitic illness spread by mosquitos is far from convincing.

The shutdown of the Bill Gates funded Target Malaria’s genetically modified mosquito experiments in Burkina Faso on 18 August continues to cause a major buzz in the malaria business. But the language used by a ‘Science’ article highlighted in MalariaWorld this week seems to take the angst of the neo-colonial promoters of  harmful experimental technologies in Africa to a new level (I previously discussed this topic on 16 August and 29 August.)

The article by Kai Kupperschmidt of 03 September that also appeared in the print edition of Science (Vol 389, Issue 6764) is entitled ‘After ‘humiliating’ raid, Burkina Faso halts ‘gene drive’ project to fight malaria’ with sub-heading ‘Disinformation campaign may have triggered “brutal” shutdown of mosquito lab’. In a week in which Charlie Kirk was brutally murdered in Utah and Israel carried out a brutal attack on negotiators in Qatar, this use of the word brutal to describe these events seems somewhat excessive.

According to the article Target Malaria’s partner scientists were “treated like criminals, with their offices and laboratories sealed and marked as crime scenes.” “Everyone was searched, including their vehicles, on the grounds that researchers might be carrying mosquitos in their pockets.” Four days later, the government suspended all of Target Malaria’s activities in Burkina Faso indefinitely. The scientists killed the mosquitos still living in their insectary, and the government sent a team to spray insecticides in Souroukoudingan to kill the mosquitos released there.

Unpleasant, no doubt, but hardly brutal.

And last week MalariaWorld featured a blog article by Mark Benedict entitled ‘Burkina Faso’s Government Smashes its Trustworthiness Over Transgenic Mosquitoes’. According to Benedict ‘Is it a big loss for Burkina Faso? The largest. The reversal sends a signal to donors and collaborators that government assurances and approvals cannot be relied on to permit projects to reach completion.’ The entire tone of the article is that it is Burkina Faso’s loss that the neo-colonial promoters of harmful experimental technologies in Africa will not be plying their trade there.

Unfortunately for now, many other African countries are led by leaders with less integrity than Ibrahim Traore who will happily take a few dollars to allow their countries to be used for such experiments no matter what the potential effect on their people or environment. For instance, an article in MalariaWorld describes Target Malaria’s meeting in Uganda.

Malaria can be solved in Africa as it was in Europe, North America and most of Asia with improvements to nutrition and sanitation. This can be achieved by improving the overall economies of the nations. But instead, westerners provide harmful experiments and chemical treatments of people and the environment based on the dubious, if widely believed, hypothesis that malaria is a parasitic illness spread by mosquitos.