Emerging and Neglected Infectious Diseases: Insights, Advances, and Challenges

What We Learnt From The DRC's Malaria Outbreak

In the remote village of Panzi, nestled deep within Kwango province in the Democratic Republic of Congo (DRC), a deadly outbreak has emerged. Between October 24 and December 5, 2024, the WHO reported 406 cases and 31 deaths linked to a mysterious disease that disproportionately impacted children. Patients presented with fever, headaches, cough, fatigue, and runny noses, but severe complications – such as difficulty breathing, acute anaemia, and malnutrition – proved fatal, with over 70 per cent of deaths occurring in children under the age of 15.

After weeks of investigation, health officials identified severe malaria as the cause of illness. Acute malnutrition due to food insecurity, inadequate diagnostics, and a fragile healthcare system with limited access to essential medications significantly contributed to the high mortality rate. These factors created a perfect storm of vulnerability, with delayed diagnoses and treatment compounding the severity of cases. Local health posts, already operating with minimal resources, were unable to meet the surge in demand, leaving many patients without the life-saving care they needed. The crisis underscores the urgent need for strengthening healthcare infrastructure and addressing underlying social determinants of health in the region.

The malaria outbreak in Panzi is more than an urgent humanitarian crisis – it is a stark reminder of the fragility of global health systems and the need to prepare for both emerging and known infectious diseases. The world must act swiftly, not only to address this immediate crisis but to strengthen health systems in DRC and other resource limited settings to prevent future outbreaks.

DRC has long battled infectious disease crises, from recurring Ebola outbreaks to cholera and measles, repeatedly straining its health system. Malaria kills approximately 600,000 people annually around the world, with 12 per cent of those deaths occurring in DRC. Given the prevalence of malaria in the country, there should be better systems in place to prevent, diagnose, and treat this deadly disease.

The prolonged failure to diagnose malaria reveals a deeper vulnerability: the lack of robust diagnostics and health infrastructure to quickly identify and contain threats. In areas where poverty, malnutrition, and limited access to life-saving tools like diagnostics, medicines, and vaccines persist, the risk of outbreaks rises sharply. While this undiagnosed illness was identified as malaria, a disease with known therapeutics and vaccines, these have not been readily available to those infected, highlighting systemic gaps that endanger not only the DRC but global health security.

The first step in managing any outbreak is determining its cause. While malaria has been identified as the primary culprit behind the mysterious outbreak, experts are investigating whether co-infections or additional factors are contributing to the high death toll. Ongoing testing and surveillance aim to clarify the full extent of the outbreak and rule out other potential causes. This continued uncertainty weeks after the outbreak was declared underscores the critical need for improved diagnostic tools and coordinated efforts to better understand the outbreak so life-saving interventions can be implemented.

Deploying point-of-care (POC) and rapid diagnostic tests (RDTs) – through strengthened local labs, mobile laboratories, and trained health workers – can transform outbreak response by delivering quick, on-site results for infections such as Covid-19, HIV, Influenza and malaria. These portable tools enable timely treatment, reduce reliance on distant labs, and improve access in underserved areas. Thus, availability of these tools is critical for early detection of diseases, linkage to appropriate healthcare, and outbreak control.

In the DRC, many clinics lack even basic tools like thermometers, let alone advanced diagnostics. Imagine a health worker in a one-room clinic with limited electricity, forced to rely on visual inspections to diagnose a child with fever and shortness of breath – symptoms that could indicate a range of illnesses. Without local diagnostic capabilities, samples must be transported over unpaved roads to distant urban laboratories, often taking days to arrive and delaying results by days or even weeks. In Panzi, the absence of essential diagnostic tools left health workers unable to identify and treat malaria, a common and treatable disease, resulting in numerous preventable deaths.

Equally critical to diagnostics is ensuring that sick patients have access to high-quality clinical care. In many parts of DRC, the lack of resources at rural healthcare facilities delays life-saving treatment. In Panzi, patients with high fevers and severe fatigue arrived at under-resourced health centres where health workers were forced to rely on guesswork. Basic medicines, including anti-malarials, intravenous fluids, and pain medications were either unavailable or in short supply, compounding the crisis.

Global health stakeholders – including governments, non-governmental organisations, and the private sector – must prioritise investments in affordable, accessible diagnostics and high-quality clinical care. Strengthening health systems is not only a technical necessity but a moral imperative and strategic investment in global health security. Fragile systems with limited diagnostics and inadequate treatment delay care, enabling outbreaks to spiral out of control, spread harm, and prolong suffering. Investing in essential medicines, diagnostics, and infrastructure is vital to treating known diseases and building resilience against emerging pathogens. In our interconnected world, localised outbreaks can quickly escalate into global crises, as demonstrated by Covid-19.

Investing in diagnostics, surveillance, data-sharing systems, and preparedness frameworks strengthens health systems to prevent, contain, and mitigate outbreaks. Surveillance involves real-time monitoring through community reporting, laboratory testing, and genomic sequencing to detect disease hotspots early. Data-sharing systems facilitate swift communication of findings among clinics, health ministries, and global organisations, enabling a coordinated response. Preparedness frameworks encompass emergency plans, stockpiles of medicines, mobile laboratories, and trained health workers ready to respond. Together, these systems enable swift detection and intervention, preventing outbreaks from escalating and saving lives.

The experience in DRC also highlights the need for equitable health interventions. The global response to the ongoing mpox emergency reveals similar failures: inequitable vaccine distribution and delayed action in the most affected regions, particularly in Africa, have exacerbated the crisis. While high-income countries secured vaccines swiftly during the global outbreak in 2022, African nations – where Clade I mpox was spreading and had a higher fatality rate – were left waiting for doses, leaving communities vulnerable. By the time vaccines and resources arrived, the outbreak had already spread to new regions and populations, straining fragile health systems and increasing mortality.

These disparities reflect systemic neglect, where life-saving tools are allocated based on economic power rather than need. To ensure equity, the international community must establish vaccine and treatment stockpiles, invest in regional manufacturing hubs, and expand financing tools like the Pandemic Fund to support resource limited countries. Transparent data-sharing and real-time needs assessments can further ensure resources are allocated fairly, protecting vulnerable populations and preventing local outbreaks from becoming global crises.

The outbreak in Panzi is a stark reminder that the cost of inaction is far too high. The undiagnosed malaria crisis in the DRC, which claimed countless lives over months, may seem distant to those beyond its borders, but it serves as a silent warning. In our interconnected world, no one is truly safe until everyone is.

Krutika Kuppalli, MD is an infectious diseases physician focused on global health, emerging pathogens, and outbreak response; Placide Mbala Kingebeni is an epidemiologist and associate professor of medicine at the University of Kinshasa, DRC

Protect yourself and your family by learning more about Global Health Security

Broaden your horizons with award-winning British journalism. Try The Telegraph free for 1 month with unlimited access to our award-winning website, exclusive app, money-saving offers and more.

Chimpanzees Have 'genetically Adapted' To Resist Deadly Disease In 'significant' Finding For Humans

A study suggests that chimps have evolved to resist the ravages of malaria in findings hailed as significant for humans (

Image: Getty Images)

Chimps have genetically adapted to avoid one of the biggest killer diseases plaguing humanity, scientists believe.

The endangered ape species - which are humans' closest genetic relative - appear to have evolved to resist malaria, a deadly disease spread through mosquitoes which kills hundreds of thousands around the world every year. The new study, carried out by a team at University College London (UCL) and published in the journal Science, used DNA from the primates through poo samples.

The research found evidence in their genes linked to malaria pathogens, finding evidence of mutation. The team analysed the exomes - the protein-coding part of the genome - from 828 wild chimpanzees, 388 of which were included in the final analysis, representing 30 different chimp populations from the four chimpanzee subspecies.

Chimps currently face severe threats from climate change, deforestation and poaching, with only 170-300,000 thought to be remaining on Earth. Most live in rainforests in West and Central Africa, but are known for their elusive nature. The species are some of our closest relatives, sharing 98% of their DNA with humans.

Scientists say the study's findings could shed further light about our own evolutionary history. Lead author Professor Aida Andres, a geneticist at UCL, said: "There are just a few hundred thousand chimpanzees alive, but they are found across very different landscapes from east Africa to the far west of the continent, including dense tropical rainforests and open areas of woodland and savannah.

Chimps are our closest genetic relatives, sharing 98% of their DNA with humans (

Image:

Kevin Langergraber / SWNS)

"This makes them quite unique, because except for humans, all other apes live exclusively in forests. We have shown that besides acquiring behavioural adaptations, different chimpanzee populations have evolved genetic differences to survive in their different local habitats.

"As chimpanzees are facing threats across their range, including environmental changes to the climate and displacement due to human pressures, it is important that their genetic diversity is conserved to maintain their resilience and ensure the long-term survival of this intelligent and fascinating species."

To avoid disturbing the chimps used for the study, rsearchers used faecal samples that were collected as part of the Pan African Programme: The Cultured Chimpanzee (PanAf). The samples were then analysed using state-of-the-art lab technology and computers. It's the largest genetic study of mammals to date.

Two genes discovered in the chimps' samples, which are also found in human DNA and are linked to adaptation and resistance to malaria and sickle cell anaemia in humans. The findings suggest that malaria is likely a "significant" disease for wild forest chimpanzees and that adaptation to the malaria parasite has happened, independently, through changes in the very same genes in chimps and humans.

Study first author Dr Harrison Ostridge, also of UCL, said: "The close genetic similarities between the great apes have resulted in diseases jumping from apes to humans, such as with malaria and HIV/AIDS, so studying wild chimpanzees is extremely useful to understand these and other shared infectious diseases in humans, and could help to develop new treatments or vaccines.

Malaria continues to be one of the biggest killers of children in parts of the world with hot and tropical climates. In 2023, the World Health Organization (WHO) estimates that 597,000 died from the illness, with 263million cases globally.

NIH Researchers Discover Novel Class Of Anti-Malaria Antibodies - New Antibodies Could Lead To Generation Of Interventions Against Malaria

New antibodies could lead to the next generation of interventions against malaria. 

January 5, 2025 – A novel class of antibodies that binds to a previously untargeted portion of the malaria parasite could lead to new prevention methods, according to a study from researchers at the National Institutes of Health (NIH) published today in Science. The most potent of the new antibodies was found to provide protection against malaria parasites in an animal model. The researchers say antibodies in this class are particularly promising because they bind to regions of the malaria parasite not included in current malaria vaccines, providing a potential new tool for fighting this dangerous disease.

(Pictured) Colorized scanning electron micrograph of red blood cell infected with malaria parasites (orange/red/yellow). The small bumps on the infected cell show how the parasite remodels its host cell by forming protrusions called 'knobs' on the surface, enabling it to avoid destruction and cause inflammation. Uninfected cells (teal) have smoother surfaces NIAID

Malaria is a life-threatening disease caused by Plasmodium parasites, which are spread through the bites of infected mosquitoes. Although malaria is not common in the United States, its global impact is devastating, with 263 million cases and 597,000 deaths estimated by the World Health Organization in 2023. Of the five species of Plasmodium that cause malaria, Plasmodium falciparum is the most common in African countries where the burden of malaria is largest and where young children account for the majority of malaria deaths. Safe and effective countermeasures are critical for reducing the immense burden of this disease.

In recent years, new interventions have been developed against malaria, including vaccines that currently are being rolled out for young children in regions where the disease is prevalent. Anti-malarial monoclonal antibodies (mAbs) are another promising new tool that have been shown to be safe and efficacious against infection with P. Falciparum in adults and children in early clinical trials. The anti-malarial mAbs evaluated in trials in malaria-endemic regions target the P. Falciparum sporozoite—the life stage of the parasite that is transmitted from mosquitoes to people. By binding to and neutralizing the sporozoite, the mAbs prevent sporozoites from infecting the liver, where they otherwise develop into blood-stage parasites that infect blood cells and cause disease and death.

The most promising anti-malarial mAbs tested in humans to date bind to a protein on the sporozoite surface called the circumsporozoite protein (PfCSP) at locations near to or containing amino acid repeats in a region called the central repeat region. This portion of PfCSP also is included in the two available malaria vaccines. The researchers in the current study aimed to find mAbs that target new sites on the sporozoite surface. 

Led by scientists at NIH's National Institute of Allergy and Infectious Diseases (NIAID), the research team used a novel approach to find new portions—or epitopes—on the sporozoite surface where antibodies bind. They isolated human mAbs produced in response to whole sporozoites, rather than to specific parts of the parasite, and then tested the mAbs to see if they could neutralize sporozoites in a mouse model of malaria. One mAb, named MAD21-101, was found to be the most potent, providing protection against P. Falciparum infection in mice.

This new mAb binds to an epitope on PfCSP outside of the central repeat region that is conserved—or similar—between different strains of P. Falciparum. Notably, the epitope, called pGlu-CSP, is exposed only after a specific step in the development of the sporozoite, but it is widely accessible on the sporozoite surface—a scenario that the researchers say could mean pGlu-CSP would be effective at eliciting a protective immune response if used in a vaccine. As pGlu-CSP is not included in currently used malaria vaccines, mAbs targeting this epitope are unlikely to interfere with the efficacy of these vaccines if the vaccines and mAbs are co-administered. According to the scientists, this could provide an advantage because this new class of antibodies may be suitable to prevent malaria in at-risk infants who have not yet received a malaria vaccine, but may receive one in the future. 

Findings from the study will inform future strategies for the prevention of malaria and may facilitate the development of new antibodies and vaccines against the disease, the researchers indicate. The scientists also note that more research is needed to examine the activity and effectiveness of the newly identified antibody class and epitope, according to their paper. The approach used in this study could also aid the development of a new generation of countermeasures against other pathogens, in addition to malaria.  

Article: C Dacon, R Moskovitz et al. Protective antibodies target cryptic epitope unmasked by cleavage of malaria sporozoite protein. Science DOI: 10.1126/science.Adr0510 (2025) .

NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.Nih.Gov.

NIH…Turning Discovery Into Health®

Source: NIH

---