THE MULTILATERAL INITIATIVE ON MALARIA
(MIM)

after the meeting in The Hague , 8-9 July 1997

Thomas Nchinda and Barend Mons

The meeting in The Hague was meant to discuss the practical consequences of the recommendations made in Dakar and what was needed to realise co-ordinated investment into broad malaria research activities, such as proposed in the Letters of Interest. To that end the meeting brought together 60 participants from 17 countries (mostly donor countries) and international bodies, such as WHO, the EC, The World Bank and UNESCO .Most participants were senior administrators in their respective agencies.

Overall scope of the MIM

It became clear that the MIM has a double role to play in the international efforts to understand and control malaria:

  1. An immediate role :To facilitate Collaborative Efforts between scientists and control workers and therefore also between supporting agencies and thereby providing a context and a suitable environment for training and capacity building of young scientists from developing countries.
  2. A potential long-term goal: To serve as a Global Forum for malaria-related discussions and political awareness and a political context for co-ordinated action of traditionally separated bodies, such as research and development agencies.

The long-term goal is of much wider implication, involving all possible players as much as possible. This aspect was discussed mainly at day two of the meeting. Day 1 concentrated on the practical possibilities of national and international research agencies to work more closely together (related to a).

It was decided to attempt to achieve the MIM objectives initially within existing research funding mechanisms and to achieve the desired added value mainly through co-ordination and synergistic action. Especially in the field of Research Capacity Strengthening (RCS), immediate and common actions could be envisaged.

I. Collaboration between the research agencies (day 1)

1. Focus

(here captured under Research Capacity Strengthening -RCS- in the broadest sense)

2. Co-ordination.

a. Preparing a Compendium which succinctly describes mandates and procedures of each of the participating agencies and provide this to the scientific community at large. All agencies will contribute and WHO/TDR will collate this compendium and make it widely available through all appropriate mechanisms.

b. Designating a Focal Person for each agency to participate in the perceived Clearing House function of the MIM.

c. Continually and structurally plan activities of common interest and exchange transparent information via these focal points about recent new initiatives and funding decisions as soon as procedures allow wider communication.

  1. In case the operational phase reveals the need for additional mechanisms, specific working groups may develop proposals for adapted procedures acceptable for all participating agencies in close consultation.

 

3. Response to the Letters of Interest.

A positive feed back will be given to the scientific community at large regarding the inventory exercise of the call for letters of interest containing at least the following elements:

 

4. Communication and access issues.

II. The wider perspective (mainly day 2)

At the second day a broader picture was discussed, which stretched beyond what research agencies alone can do within their mandates. The organizers of the DAKAR conference had realised that important other sources of support to the malaria research and control community are needed for the MIM to have an impact beyond more efficient use of existing research resources.

Two main categories of players were identified:

Representative of these two groups joined the meeting and discussed with the research agencies. There was a strong feeling of consensus that the MIM could generate the long-awaited forum for structural collaboration between research agencies, development (government) agencies and industry, complemented where appropriate with other players such as NGO’s.

Briefly, the presentations in the morning revealed the following key points.

The Development Agencies have their focus more on downstream issues of research and on the control aspects of diseases. RCS and implementation projects as well as application-oriented and operational research are therefore more likely to fall in their area of interest. It became clear that there is an increasing awareness all around the globe that science is an important instrument for development. Therefore, we witness a growing interest from the side of the development agencies to co-ordinate their efforts with the research agencies. The research agencies in turn recognise more and more that supporting high quality and relevant research in Africa is not enough in the long term. There must be a context for growth of the research opportunities and the implementation of research results. It became very clear from the discussions, that this continuum can only be created if the research and the development agencies co-ordinate with the governments of the African States and develop a coherent research and implementation policy.

The industry representatives stressed that the private sector is very conscious of the enormous medical need for better tools in malaria control, but that two principle elements hamper industrial involvement. First of all, the demonstration of feasibility of novel candidates for drug and vaccine development is not easy. Academic products frequently still have a major risk of downstream failure. In-house discovery and development programmes bearing the full range of potential no-go decisions, are even more difficult to justify in the present industrial climate. Second, Although it is obvious that the potential market for new malaria tools will be enormous in size (virtually half of the world’s population) but not in financial volume. The core of the problem is therefore the risk/benefit ratio. Public Sector Research supporters and the Development Agencies as well as the African Governments can contribute to reduce the risk/benefit ratio in different ways; Evaluation of candidate drugs and vaccines up to the phase where they become attractive to industry should be taken up by the public sector, and the support to governments of endemic countries could finance the market. The latter aspect would be crucial if we talk about either a vaccine designed for use in Africa or drugs that have no use as a travellers prophylactic.

Such products can not be financed through tiered pricing like other vaccines via the UNICEF system. Consortia of Private and Public sector institutes should also be explored.

Outcome of the discussions

The participants first discussed the Research & Capability Strengthening aspects as formulated in Dakar:

In a plenary discussion these principles appeared to be acceptable to all concerned and during the afternoon session the following issues were discussed and proposed:

  1. MIM should concern itself with the Development of a Strategy to bring malaria higher on the political agenda.
  1. The entire range from basic research to control and development issues related to malaria should be viewed as a continuum and the role of each player in that process should be identified to facilitate co-ordination.
  1. Assuring a reasonable market in a context of cost-effectiveness can be a major contribution of Development Agencies to promote the involvement of Industry in the development of new and improved tools.

 

  1. Demonstration of feasibility to a much higher extent than up to now could be a valuable contribution of the public sector research to promote the industrial development of drugs, vaccines and diagnostics.
  1. The comparative advantage of the MIM vis a vis this big challenge should be spelled out clearly, to result in concerted efforts where scientifically feasible and to generate a significant increase in resources invested in malaria.

The following agencies have agreed to take part in the development of a consolidated approach towards this challenge (the major public role of MIM) , each within their own mandates.

CDC, EC+ contact several EU research councils, NIH, Malaria Foundation, MRC (UK), NLM, NWO , OAU, UNESCO, Wellcome Trust, WHO/TDR, World Bank, WRAIR.

These organisations will participate in the Clearing House function when appropriate (see also day 1 for research agencies)

6. The malaria Foundation was mandated with the PR issues for the MIM and will do so in close co-ordination with the other partners concerned with communication, such as the National Library of Medicine, SHARED, Satellife and the World Bank (see day 1).

‘Immediate Homework’ assigned on day 2

(partly additional to day 1) :

  1. Assessment of Scientific Needs (based on Letters of Intent and other sources): WHO/TDR
  2. Public Relations: Malaria Foundation & partners
  3. Macro-Economic + Marketing Analysis: World Bank
  4. Basic Research issues: NIH
  5. Initial Response to Letters of Interest: core group under auspices of WHO/TDR
  6. Internet Connections (NIH/NLM/USAID/WB/SHARED/GTZ)

 

Positive recent developments (apart from MIM itself)

 

 

Scientific Response to the Malaria Challenge in Africa

Managing the transition from one phase to the other requires close collaboration between agencies of different nature

time frame: 10 years (at least)

Step in Continuum

Aims/products

Partners

Location of operation

Support from:

Basic Research (laboratory based)

Leads for tool and strategy developments (example: Genome projects)

Public Sector

North and South

Research Agencies (B)

Application-Oriented Research

Vaccines, Drugs, Diagnostics and Strategies

  1. Public Sector
  2. Private Sector

North and South

African States (A) Research Agencies (B) Development Agencies (C)

Product Development

Vaccines, Drugs, Diagnostics, Insecticides, Nets, Traps etc.

1.Private Sector

2. Public Sector*

Mainly North, but increasingly South

Private Sector (D), Public Sector (B)

Field Evaluation**

Efficacy of Tools/Strategies

African Scientists, with logistical support from ‘Producer’

Mainly South

African states (A), Development Agencies (C), Research Agencies (B)

Industry (D)

Implementation

Control Strategies/improvements

Control managers/

governments

Mainly South

African States (A), Development Agencies (C) NGO’s (E)

Post-Marketing Research, evaluation and feed-back to Basic Research

Improvements, Detection of problems, cost-effectiveness

African Scientists/Control managers/Industry

Mainly South

Industry (D), NGO’s (E)

Development Agencies (C, Market assurance)

Co-ordination

optimal use of resources, and smooth transition from one phase to the next, especially when different players are involved

All/ mainly contact persons in participating agencies

South and North

All

(part of overhead)

Communication/PR/Political Awareness

Increased investment in malaria as the biggest killer in Africa

Malaria Foundation

& Partners (see text)

South and North

All

(part of overhead)

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Malaria Foundation International
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