It truly is a time to celebrate. Malaria deaths have dropped by one-fifth during the past decade. A total of 43 countries -- 11 of them in Africa -- have seen malaria cases or deaths fall by 50 percent, reversing the previous decade's trend and saving more than one million lives. Malaria has even been declared eliminated from Morocco, Turkmenistan, and United Arab Emirates -- the first countries to achieve this major milestone in two decades.

 

The World Health Organization (WHO) and Roll Back Malaria's report Roll Back Malaria: A Decade of Partnership and Results, released earlier this month, outlines these achievements and attributes much of success to the $5 billion in aid allocated to widespread malaria treatment and prevention measures. This includes the distribution and use of insecticide-treated bed nets, which have been delivered to nearly 80 percent of the at-risk communities in sub-Saharan Africa.

 

"The last decade has been a turning point for the global community working towards malaria elimination," says Roland Gosling, head of the Malaria Elimination Initiative at the University of California, San Francisco. "However, major strides must still be made to capitalize on the gains we've made in order to put an end to this deadly disease."

 

According to Gosling, key hurdles remain to achieving the ambitious goals -- including ending malaria deaths by 2015 -- laid out by Roll Back Malaria and the WHO. Many people who are at risk of malaria still lack sufficient access to treatment and prevention options. The emergence of malaria parasites that are resistant to insecticides is threatening the effectiveness of bed nets, and malaria treatments are being rendered ineffective by the rise of drug-resistant parasites.

 

Another major barrier is the ability of health care workers in the most remote and resource-poor communities to accurately diagnose the different causes of fever, especially among children. Children brought to clinics often present with general symptoms, including fevers that could be caused by a wide range of diseases -- from malaria to pneumonia, HIV/AIDS, and others. Health care workers in low-resource settings are often unable to isolate the root cause of illness and have difficulty making an accurate diagnosis to determine the appropriate treatment needed to save a child's life.

 

The scale-up in funding during the past decade has fuelled the introduction of rapid diagnostic tests for malaria, which has helped the fight against the disease in many regions, the Roll Back Malaria report notes. But compliance with a negative test result appears to be a problem. Numerous studies have shown that many cases of non-malaria fever are treated as malaria.

 

In order to continue to successfully reduce malaria deaths over the next decade, not only will diagnostics need to be made more widely available, but new diagnostic tools that can differentiate the cases of fever -- especially among children in the developing world -- will need to be produced, Gosling says. 

 

Directly addressing these threats to progress will require increased political attention within endemic countries, as well as the continued investment in malaria diagnosis, prevention, and treatment, Roll Back Malaria states. Following this roadmap will ensure that this past decade's important achievements are not only maintained but built upon to welcome an era of zero deaths from malaria.

Drug discovery, which requires years of spending, clinical trials, and often trial and error experimentation, is rarely -- if ever -- used as a prime example of efficiency in our sustainability-focused culture. But six years ago, Atul Butte, associate professor of systems medicine in pediatrics at Stanford University School of Medicine, set out to establish a novel method for drug discovery. Using Butte's new approach, old, already approved drugs can be made new by applying them to different diseases. Butte and his Stanford colleagues have sifted through virtual reams of data and have identified potential new treatments for lung cancer and Crohn's disease using drugs that have already been produced. Their findings were published in two articles in Science Translational Medicine last month.

 

BIO Ventures for Global Health spoke with Butte about how he created this method of drug discovery and how it might be applied to a variety of diseases, including neglected tropical diseases that impact the world's poorest people.

 

In the world of drug discovery, it seems that companies and researchers are always in a race to find the next new blockbuster drug, vaccine, or diagnostic.  What got you interested in examining already approved drugs and finding new ways to apply them?

About ten years ago, scientific journals began requiring authors using high-tech data-measuring techniques to deposit their raw data into international repositories. I realized that almost nobody actually uses these troves of data, and so about six years ago, I received a grant to examine every human disease included in these databases. We started by studying data for about 100 diseases, and we began noticing similarities between diseases. In fact, we saw molecular similarities between diseases for which there are many existing therapies and diseases for which there are no or very few therapies, often called orphan diseases. Naturally, that got us excited and thinking about how we could start repositioning some of those drugs to help patients with orphan diseases.

 

With such a robust amount of data, how were you able to sift through it all to find key correlations between diseases and drugs?

The disease side turned out to be the trickiest part. A lot of investigators and labs study diseases by conducting molecular measurements on samples from patients with a specific disease. But we only used experimental data that included both normal, healthy samples and diseased samples. That allowed us to standardize the disease measurements against the healthy samples. Once we found data sets that fit those criteria, we could begin to match the data on diseases with those data on the drugs.

 

How do you know when you've found a drug might be effective against a disease?

Bruce Goldman, a science writer at Stanford, came up with the best analogy for this. It's like an online dating service where the driving dogma is that opposites attract. So, if in a disease we saw that this gene goes up and this gene goes down, and a drug does exactly the opposite, then maybe that drug would be a good candidate for this particular disease.

 

From an economic perspective, it seems that this approach would be less costly and more efficient than starting from scratch.

I do think that our method can help us discover new uses for existing drugs without spending as much money. But I acknowledge that most of the costs in drug discovery come from the need for human clinical trials, which we have not yet undertaken with our lung cancer and Crohn's disease and ulcerative colitis compounds. So there are still expenses to be incurred. But I think that our approach to drug discovery, using publicly available data, can lead to more cost-efficient drug discovery.

 

Do you plan on testing any drugs against neglected tropical diseases such as malaria, tuberculosis, or dengue fever?

There are certain drugs that are continually discovered to have antibacterial or antiviral effects that people didn't know about, and I think we might be able to make more predictions with regards to diseases that respond to such drugs. Tuberculosis is a great example where the pathogen itself causes damage but so does our host response; there might be ways to predict drugs that could play a role against tuberculosis or other similar neglected diseases as well.