As the world begins to realize the very real prospect of eliminating
malaria as a public health problem globally, the scientific community is acutely aware that novel and innovative new tools will be required if that lofty goal is to be accomplished. Moreover, the need for comprehensive, integrated products and interventions is being recognized in order for the critical 'final steps' toward elimination to be taken successfully. Failure to take these crucial last steps have dogged all past global disease elimination programmes, except for
smallpox. The success of
ivermectin in driving two of the most devastating and disfiguring
neglected tropical diseases (NTD) to the brink of elimination has been well documented. The
drug also bestows immeasurable non-target benefits, increasing the health and socioeconomic prospects of all communities where
mass drug administration (MDA) has been carried out.
Ivermectin kills a variety of parasites and insects, including the Anopheline vectors of
malaria parasites. In view of long-standing MDA programmes, increasing attention is now being paid to the potential offered by re-formulating and re-purposing
ivermectin to function as a feed-though mosquitocidal tool. This will provide a comprehensively beneficial weapon, for the
anti-malarial armamentarium, as well as for probably improving the impact on existing target diseases. Prospects currently look highly promising, especially as the
drug is already proven to be extremely safe for human use. However, for maximum impact, detailed analysis of various analogues of the unique
ivermectin, as well as the parent
avermectin compounds, will need to be undertaken. '
Ivermectin' comprises an imprecise mix of two compounds, both of which are potent
anthelmintics. Yet recently, it has been confirmed that only the minor of the two component compounds is molluscicidal. Further structure activity relationship studies may well identify the analogue, analogues or combination thereof best suited for use in a concerted initiative to simultaneously tackle
malaria and other NTD in poly-parasitized communities.