Meeting of the Multilateral Initiative on Malaria
held at the Wellcome Trust, Park Square West, London, UK
November 10th and 11th 1997
The objective of the meeting was to take forward the Multilateral Initiative on Malaria (MIM) which was conceptualised during previous meetings in Dakar (Senegal) in January 1997 and the Hague in July 1997. The MIM is a global collaborative effort by funding agencies, industry and research scientists to address the major and increasing problem of malaria in Africa. Despite past efforts at eradication, malaria still represents an enormous public health burden, with an estimated 40% of the world's population at risk of infection, and an annual mortality of 1.5 to 2.7 million (WHO, 1996). Of the estimated 300-500 million clinical cases each year, 90% occur in Africa.
Developing research capacity in Africa, increasing international co-operation and communication at all levels, and ensuring that research findings are actually applied to malaria treatment and control are central objectives of the MIM initiative. By promoting co-ordination between the range of agencies and individuals concerned with malaria, the MIM aims to maximise impact of global activities against malaria. The initiative arose out of preliminary discussions between a number of organisations supporting malaria research activities. The outlook was subsequently broadened with the recognition that the full benefit of research could not be realised without the close involvement of the communities responsible for implementation of public health activities and for the commercial development of tools for malaria control and treatment.
The fifty participants at the two day meeting held at the Wellcome Trust on November 10/11 1997 were mainly representatives of governmental, non-governmental and international agencies supporting malaria research or control activities, together with a number of senior malaria researchers. These participants were clearly committed to the principles of a concerted effort against malaria. The primary role of the meeting was to build upon progress made at earlier meetings, by defining more clearly the specific priority areas impacting upon the problem of malaria in Africa, that would benefit from concerted action by funding agencies, and by identifying the initial steps required to address these areas.
At the previous meeting in the Hague it had become evident that the differing remits and funding mechanisms of the range of organisations sponsoring malaria research presented substantial barriers to the establishment of a common fund for MIM-related activities. It was therefore acknowledged that any joint activities must allow individual agencies to operate within the constraints of their particular mandates. As a consequence, the MIM has taken the form of a loose alliance of organisations and individuals concerned with malaria research and control activities, as opposed to a defined body with a formalised administrative structure. It has been agreed that, as far as possible, activities prioritised by MIM should be supported through existing mechanisms offered by the range of participating organisations, in order to avoid unnecessary creation of new levels of administration and to fully utilise the diversity of established funding mechanisms. However, where required, concerted action will be taken by MIM agencies to establish new initiatives to fulfil specific identified needs. For example, the new scheme for Malaria Research Capability Strengthening in Africa was established through the WHO Special Programme for Research and Training in Tropical Diseases with funding from a variety of sources.
Current malaria research activities and new initiatives established since Dakar were summarised at the meeting in London; this information being an essential basis for integrating ongoing activities, minimising duplication of effort and optimising further investment of resources. From this summary it was clearly evident that international funding for malaria research had increased significantly over the past year: various agencies had established new initiatives in response to research priorities identified in Dakar, and in addition, scientists had successfully obtained funding through normal mechanisms for research projects developed since Dakar. Although substantial progress had been made, the meeting identified a number of specific additional short, medium and long term obstacles to achieving a lasting impact on malaria that are not adequately covered by existing mechanisms or levels of funding. There was agreement by all participants that the following immediate action should be taken to address a number of priority areas:
1. Establish an effective process for communication and advocacy on the public health importance of malaria, an area to be developed through the Malaria Foundation.
2. Complete the sequencing of the genomes of malarial parasites and ensure that the resulting knowledge is applied to the discovery of new drugs and vaccines.
3. Improve the access of African scientists to electronic communication facilities and the Internet in order to enhance their interaction with the global scientific community and to promote communication across the African continent; this programme to be advanced through the National Institutes of Health and National Library of Medicine of the USA.
4. Support an annual African malaria conference to bring together African public health and research workers. This meeting would serve to promote interactions between different regions of Africa and also between scientific and public health communities.
5. Create an inventory of the infrastructure and research capacity which exists within African malaria research centres as a first step towards identifying the requirements for further development of the technical and human resources for malaria research within Africa.
6. Support a working group to explore ways of maximising constructive interactions between the research and development communities in order to establish a more effective mechanism for translating research results into practice and to orientate research agendas to the on-the- ground needs in malaria endemic countries. This group would examine ways to optimise the use of available methods for control and treatment of malaria in endemic countries, including options for supporting intervention trials, and scientific and economic evaluation of the impact of interventions in communities.
7. Create a working group to address issues relating to the emergence of antimalarial drug resistance in Africa, including surveillance of parasite resistance; this working group to be established in collaboration with the World Health Organisation.
8. Create a group to work with the World Health Organisation and related organisations in setting targets for reduction in the morbidity and mortality associated with malaria; these targets being an important component in raising the profile of malaria on political agendas and generating a strongly co-ordinated response to the problem.
The above list was not intended to exclude other specific priorities, but represented areas that required immediate concerted action by sponsoring organisations. It was agreed that agencies participating in MIM should nominate representatives to act as a contact group that would further progress the general aims of MIM, while sub-groups of these agencies should take forward the separate initiatives identified above, according to their individual mandates and expertises. The Wellcome Trust accepted the nomination to serve an overall co-ordinating role for MIM-related activities for the first year.
The Multilateral Initiative on Malaria (MIM) is a newly developed forum for researchers, governmental and non-governmental agencies concerned about malaria. Its role is to facilitate a globally coordinated response to malaria in Africa where 90% of cases occur. Following previous meetings at Dakar and the Hague, a 2-day meeting of the funding agencies involved in the MIM met at the Wellcome Trust in London on 10 and 11 November 1997. There was a strong commitment by all participants to the principles of a concerted effort to tackle the major and growing problem of malaria. The meeting noted that a number of new initiatives directly relevant to MIM had been established since Dakar. Additional important short, medium and long term obstacles to achieving a lasting impact on malaria were identified, and the following priorities were agreed at this meeting for immediate action:
- To establish an effective process for communication and advocacy on the public health importance of malaria, an area to be developed through the Malaria Foundation.
- To sequence the malaria genome and ensure that the knowledge arising from the genome is applied to the discovery of new drugs and vaccines. This will enforce existing collaborations between the global research and funding community.
- To enhance the interaction between African scientists and their access to the global scientific community via the Internet; this programme is being advanced through theNational Institutes of Health and National Libraries of Medicineof the USA.
- To support a working group to explore ways of maximising creative interaction between the communities involved in malaria research and malaria control in order to optimise the use of available methods for control and treatment of malaria, including the scientific and economic evaluation of intervention trials.
- To provide support for an annual African malaria conference to bring together African public health and research workers.
- To create an inventory of the infrastructure which exists within African malaria research centres to assess the capacity for activities relating to research and control with the objective of maximising and improving the technical and human resource within centres.
- To create a working group to address issues relating to policy on the use of antimalarial drugs and on mechanisms for surveillance of resistance of those drugs within Africa, this working group to be established in collaboration with the World Health Organisation.
- To create a group to work with the World Health Organisation and related organisations in setting targets for reduction in the morbidity and mortality associated with malaria.
- To establish an MIM Contact Group to coordinate the further progress of these separate initiatives and the general aims of MIM. The Wellcome Trust will serve this coordinating role for the first year.