The deferred promise of radical cure: pharmaceutical conjugations of malaria in the global health era

Abstract

This paper explores the changing political economy of malaria drug discovery by tracing the career over the last four decades of a single molecule, tafenoquine. First identified as a promising antimalarial by the US Army in the 1970s, tafenoquine has recently been approved by the Food and Drug Administration for the radical cure of vivax malaria–the first product to receive marketing authorization for this indication in more than 65 years. The new drug is the result of a collaboration between the pharmaceutical company GlaxoSmithKline and the not-for-profit organization Medicines for Malaria Venture, with the financial support of the Bill and Melinda Gates Foundation. The successful development of tafenoquine, the paper argues, signals an important transition within the global health era: from the chemotherapeutic humanitarianism that characterized pharmaceutical efforts against malaria in the early 2000s, towards a period of drug discovery driven by the promise of global disease eradication. The paper uses the example of tafenoquine to advance a more general argument about the multiple and evolving pharmaceutical conjugations of malaria–the articulation of competing visions of the disease around the capabilities (and limitations) of particular molecules.