What Went Wrong with IPTi?

On the first clinical trial the Intermittent Treatment of Malaria in infants (IPTi) showed a protective efficacy of approximately 60%, thus, comparable to the one of a vaccine

A few years ago, a large group of researchers from several biomedical centers around the world focused their efforts to demonstrating the safety and efficacy of the Intermittent Treatment of Malaria in infants (IPTi), a new preventative strategy consisting in the administration of a small quantity of an antimalarial (sulfadoxine-pyrimethamine – SP) to infants through the routine Expanded Program on Immunization. The increasing attention towards this promising prevention was the consequence of the overwhelming results of the first IPTi clinical trial conducted in Tanzania: IPTi showed a protective efficacy of approximately 60%, thus, comparable to the one of a vaccine.

Up to now, none of Sub-Saharan African countries have implemented IPTi

In 2003, in order to speed the translation of IPTi into policy, the IPTi consortium was created. In addition to researchers, the Consortium was constituted by a number of key stakeholders: its funder, the WHO, and UNICEF among others. In parallel, a Policy Platform was created at the WHO.

A number of clinical trials started in several areas of Sub-Saharan Africa and one in Papua New Guinea. Not only the efficacy of the intervention was evaluated, but also its acceptability and cost-effectiveness were. At least in Sub-Saharan Africa, the results of the clinical trials showed a lower level of efficacy compared to the one of Tanzania: the pooled analysis of six trials pointed to an efficacy of about 30%. Despite its limited efficacy, IPTi was a safe, acceptable and cost-effective intervention able to prevent a high number of malaria cases and was excellent in the context of a disease that is not yet vaccine preventable.

The course on Health Systems, Policies and Economics will discuss IPTi and other health challenges

Although the path towards translating IPTi into health policy was challenging, in 2009, the WHO recommended its implementation in Sub-Saharan Africa in areas of moderate to high transmission, where parasite resistance to SP was not high and under the condition that its implementation would not detract other malaria interventions, such as distribution of bed nets and indoor residual spraying.

Up to now, none of Sub-Saharan African countries have implemented IPTi.

What happened? What went wrong? Several hypotheses have been proposed:

Were there too many organizations with different aims in the Consortium? Were there too many personal ambitions prevailing on the achievement of a common aim? Were there conflicts of interest? All these factors may have had an impact. Despite being a strategy requiring extremely low level of incremental resources, there was probably a need to understand the health system’s problems and how to move from efficacy to effectiveness with this strategy in different settings; but one study only focused on this aspect.

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This discussion and other similar health challenges will be discussed during the short course on Health Systems, Policies and Economics . Enrolment is still open.