Fansidar could have a new lease on life as a protective malaria drug 

A dramatic reduction in the impact of malaria is in prospect with a clinical drug trial to begin in Papua New Guinea early next year. Success in the trial would open the way to relief in the 10% of humanity infected with this debilitating and often fatal disease – over 500,000,000 people.

The Walter and Eliza Hall Institute of Medical Research is collaborating with the Papua New Guinea Institute of Medical Research (PNGIMR) and the University of Melbourne to confirm significant health benefits in the new application of an old malaria drug – at just 12 cents a dose. The project is supported by a AUD$3.7 million grant to PNGIMR from the Bill and Melinda Gates Foundation.

Fansidar is a 20-year-old malaria drug. As with many other such curative drugs, its effectiveness has declined over time with increased resistance by the malaria parasite. But initial clinical evidence suggests that Fansidar could have a new lease on life as a protective drug that strengthens a person's own immune system against malaria.

Early field experiments were conducted in the African country of Tanzania in the late 1990s. These suggested that giving just one Fansidar tablet to an apparently healthy child during their routine infant immunization visits dramatically reduced the impact of any subsequent malaria infection. Used in this way, Fansidar does not prevent malaria but seems to produce a massive 50% reduction in death, debilitation and complications of malaria, such as severe anaemia and raging fevers.

Joint project leader, Dr Louis Schofield from WEHI, says, "There seems to be a totally unexpected residual immunological effect when children are given this tablet as a preventative rather than as a post-infection treatment for malaria. While the drug itself dissipates in the bloodstream over a few days, it appears to enable the immune system to re-energize and more successfully combat any subsequent malarial infection. We suspect that many toddlers who seem reasonably healthy might actually have low level malarial infections that are eliminated by Fansidar, allowing the immune system to develop to its full potential."

WEHI's Dr James Beeson adds, "Most of the 2 million or so annual deaths from malaria and much of the severe illness involves children under five years of age. Pregnant women are also highly susceptible to the effects of malaria, but the good news is that they too appear to have much greater immune protection conferred by the preventative or 'presumptive' use of Fansidar. This looks like a case of teaching an old drug new tricks – or perhaps the old drug teaching us that it can perform tricks that we never suspected it could."

The four-year trial is being conducted in PNG for a number of reasons. First, PNG is a relatively confined area with a high concentration of all four types of global malaria – unlike Africa, where one type predominates. Second, outstanding field researchers with clinical trial capability from the PNGIMR can collaborate with world leading Australian experts in malaria from WEHI and the University of Melbourne. Third, the organizational and public health infrastructure already exists to dispense the tablets in a controlled way, since PNG's children routinely attend clinics to be vaccinated against a range of other diseases.

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