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What is MIM?

The Multilateral Initiative on Malaria (MIM) is an alliance of organisations & individuals concerned with malaria. It aims to maximise the impact of scientific research against malaria in Africa, through promoting capacity building & facilitating global collaboration & coordination..
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Overarching goal

The original overarching goal of MIM was "to strengthen and sustain, through collaborative research and training, the capability of malaria endemic countries in Africa to carry out research required to develop and improve tools for malaria control." However, co-ordination of research activities in isolation was recognised to be insufficient to ensure that research findings yield practical health benefits and the remit of the MIM has been broadened to encompass strengthening of the research-development interface.
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Broad Objectives

  • To raise international public awareness of the problem of malaria in order to mobilise necessary resources and action.
  • To promote global communication and co-operation between organizations and individuals concerned with malaria, with the aim of maximising the impact of resources and avoiding duplication of effort.
  • To develop sustainable malaria research capacity in Africa through international scientific partnerships. Further development of human resources and institutional capacity in Africa is essential to enhance the ability of African countries to address their own health problems. MIM aims to publicise existing training opportunities and further develop research capacity by facilitating effective scientific partnerships across Africa, and between African researchers and colleagues internationally.
  • To ensure research findings are applied to malaria treatment and control and to translate practical problems into manageable research questions. MIM aims to stimulate and facilitate dialogues among scientists, public health professionals, policy makers and industry.

Key features

  • An alliance of organisations and individuals concerned with malaria research and control, including donor organizations (governmental, non-governmental, international agencies and private foundations), scientists, health professionals, and industry.
  • A focal point for interaction and communication between organizations and individuals to raise awareness of ongoing activities and avoid duplication of effort.
  • A structured framework for enhancing co-operation between interested parties and facilitating activities that yield "added value"
  • Uses existing diverse mechanisms for funding prioritised activities where possible
  • Encourages specialisation of organisations in focused areas and the building of effective bridges between activities to promote integrated synergistic activities.
  • Catalyses concerted efforts to address specific identified scientific problems and needs to ensure full exploitation of scientific opportunities. This may involve collective or individual action by organisations or scientists to organise meetings or workshops, and establish new initiatives.
  • The Wellcome Trust is acting as the nominated co-ordinator of MIM activities during 1998, and has allocated staff and funds specifically for this purpose in recognition of the importance and responsibility of this role. [List of organisations involved in MIM].
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Other malaria initiatives

     

  • The Roll Back Malaria Initiative was announced in May 1998 by the new Director of WHO, Dr. Gro Harlem Brundlandt. RBM is a strategy for a new sector wide approach to combat malaria at the global, regional, country and local levels. This announcement was followed by support at the May 1998 G8 Meeting in Birmingham, UK (G8 leaders pledged support for international malaria initiative.)
  • The African Malaria Control Initiative (AFRO/WHO/World Bank), to be formally launched in 1999, is a 25-year plan that specifically targets malaria control in Africa. It is a multi-agency, multi-disciplinary, and multi-national initiative, based in Africa, which focuses on sustainability, strengthening capacity and capability at lower levels, and a bottom-up development of malaria control programmes
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Relationship with other initiatives

  • MIM originated in discussions between a number of organisations supporting malaria research. As such, the priority focus of MIM is to promote and facilitate communication and collaboration in the research community, and strengthen research capacity in Africa, while advancing critical areas of malaria research. A major objective of MIM, however, is to ensure that practical health benefits arise from research and close liaison with the control community and pharmaceutical industry is therefore critical. MIM is fully committed to integrating its activities with the major new malaria control initiatives (WHO/World Bank African Malaria Control Initiative, and Roll Back Malaria) to ensure that research findings are actively fed into these programmes and that research necessary to underpin policy decisions is carried out.
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Why was MIM established?

  • A limited repertoire of tools is available for treatment and control of malaria, but more effective application of these tools is required, together with the development of novel approaches to tackle the disease.
  • The complexity of the problem of malaria demands that short, medium and long-term research priorities continue to be actively addressed.
  • Recent technological and scientific developments have advanced our knowledge of the malaria parasite and mosquito, but the impact of these advances on the malaria burden faced by endemic countries has been low. MIM recognises the importance of developing collaboration and co-ordination not only within the scientific community, but also at the research/public health interface.
  • The fact that most laboratory malaria research is carried out in the USA and Europe, whilst control must be implemented in malarious regions, means that effective communication among scientific, medical and public health communities across these regions is critical to the effective translation of research findings into practical benefits.
  • Further development of human resources and institutional capacity in Africa is a fundamental requirement for establishing effective malaria control programmes.
  • With the worsening of the malaria situation world-wide, governments and donor organisations recognised the need to formulate a new multilateral response to the problem of malaria, including increased financial inputs. A range of different activities concerned with the problem of malaria in Africa is ongoing independently, but there is a need for a formal mechanism by which these activities can be orchestrated into a more cohesive global effort.
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Specific Immediate Objectives

 

The following specific priorities were identified for immediate action at the MIM meeting held in London in November 1997: [press release]

  • Enhance interaction between African scientists and the global research community by improving access to electronic communication facilities and the internet
  • Complete genome sequencing of malarial parasites and ensure that knowledge gained is applied to the discovery of vaccines and novel drugs
  • Support a malaria conference in Africa to bring together research and public health communities from across Africa on a regular basis
  • Create an inventory of African research capacity and infrastructure, to identify opportunities for further development (ongoing at Wellcome Trust and via the African Malaria Vaccine Testing Network (AMVTN)
  • Support a working group to explore ways of maximising interactions between researchers and development agencies, to orient research agendas to the practical needs of malaria endemic countries.

Progress on these priorities is identified in the following sections. Evolution of MIM

  • July 1995, April 1996, Washington. Meetings organised by Fogarty International Center, including representatives from the US National Institutes of Health (NIH), Institut Pasteur, Wellcome Trust, UK Medical Research Council (MRC), INSERM, ORSTOM, European Commission (EC) and African scientists, to discuss co-operation and collaboration in scientific efforts to address the health problems of the developing world. Malaria in Africa was selected as the initial focus.
  • January 1997, Dakar, Senegal. Over 150 malaria researchers and representatives of funding organisations gathered to identify the major scientific questions to be answered in order for the problem of malaria to be effectively addressed, and to discuss mechanisms for supporting the identified research priorities. [Malaria in Africa: Challenges for Co-operation Meeting report]

  • July 1997, The Hague. Representatives of donor organisations met for further discussions on the mechanisms for supporting malaria research priorities identified in Dakar. MIM was broadened to include representatives of industry and development agencies. [Meeting report]

  • November 1997, London. Funding agencies meeting to define more clearly specific priority areas impacting upon malaria that would benefit from concerted action and to identify the initial steps required to address these areas. [Meeting report]

    Progress since Dakar

 

The following list represents activities that have been established during 1997 and 1998 following the MIM meeting in Dakar. Some are investigator-driven initiatives while others represent proactive responses of particular donor organisations to address the research priorities identified in Dakar and other identified needs. The list includes activities stimulated directly as a result of the MIM, and also other activities developed within the current climate.
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Publicity and advocacy

  • Publicity and advocacy are required to increase awareness of the public health significance of malaria, to raise the status of malaria on political agendas, to mobilise resources and to stimulate action.
  • The Malaria Foundation International (MFI) has been nominated to handle public relations activities and communication issues relating to MIM. It has also been involved in generating publicity more broadly; e.g. for the Roll Back Malaria Initiative. These activities are in partnership with several other MIM participants including the UK Department for International Development (DFID), the US National Institutes of Health, the Burroughs Wellcome Fund (BWF), and the European Commission.

  • A MIM newsletter will be produced and circulated to all MIM members every two months and will provide up-to-date information on all the latest developments at MIM. The newsletter is intended to serve as a forum where all participants and other interested parties can share their news, views and information, particularly those without electronic access to the web pages.
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Electronic communication

  • Improved access of African scientists to electronic communication facilities and the Internet will enhance their interaction with the global scientific community and promote communication across Africa

  • Improved electronic communications in Africa National Institutes of Health (NIH) /US National Library of Medicine (NLM) are taking forward a strategic plan to improve access of African scientists to electronic communications facilities and the internet. Current activities focus on Mali, Kenya, Tanzania and Senegal, selected for the high quality of their malaria research. [Meeting report]

  • Malaria Foundation International is establishing a World-Wide Malaria Directory and the Malaria Research Network (MRN), which is an investigator-initiated interactive electronic forum, with chaired working groups, designed to enhance communication and networking in malaria research and control. MIM supporters include the NIH, BWF, and EC

  • The Malaria Network has been developed by WHO/CTD in collaboration with the World Bank to provide easily accessible support for malaria programme managers. The global network will function through an Internet web site and aims to provide information on operational issues in the management of malaria control programmes. It will collect and make accessible information relevant to malaria control activities in the field and will also function as a forum for discussion for participating managers and senior health workers both among themselves and with WHO/World Bank.

  • Scientists for Health and Research for Development (SHARED) is an EC sponsored interactive database of research relevant to diseases of developing countries.
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Antimalarial drugs

  • In view of the increasing levels of parasite resistance to antimalarial drugs currently in use, there is urgent need to optimise the use of existing drugs and to develop new antimalarial compounds.
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    Drug development.

    • A proposed plan for a public-private alliance for development of antimalarial drugs (with the goals of producing one registered product every five years and of becoming financially self-sustaining in the medium term) was not supported by industrial partners in November 1997. Discussions on an alternative format for the initiative are continuing.
    • Meeting between UK Government and pharmaceutical company executives (Glaxo Wellcome, SmithKline Beecham, Zeneca), 14th May 1998. Joint statement: "The British-based pharmaceutical industry strongly supports the Government’s initiative in seeking G8 backing for a renewed global strategy to combat malaria to be led by WHO. Products developed by British companies already play an important role in the prevention and treatment of malaria and our companies are committed in working in partnership with government, WHO and others to find ways of encouraging, and overcoming obstacles to, the development of new medicines, as well as promoting the use of preventive public health measures".
     

    Monitoring Antimalarial Drug Resistance and formulating drug policies

    • MIM Meeting on "Antimalarial drug resistance and policies for drug usage" 14-15th May 1998 [Report]
    • Confronting the challenge of antimalarial drug resistance in Africa Series of workshops organized by the US Centers for Disease Control CDC: 22nd-24th June 1998 - Planning meeting, Nairobi, Kenya. October 1998 Main workshop.
    • Development of software for reporting and analysis of data from antimalarial drug therapeutic efficacy studies (CDC/CTD/WHO/AFRO)
    • East African Network For Monitoring Antimalarial Therapy A regional network established in 1998, between Kenya, Tanzania and Uganda to monitor antimalarial drug resistance in the region
    • Towards a global surveillance network of anti-malarial drug-resistance (EC supported concerted action) has the objective of improving the monitoring of anti-malarial drug resistance and establishing a system for rapid dissemination of information in order to guide treatment and prophylaxis policies. The co-ordinator can be contacted at University of Rouen, France (philippe.brasseur@wanadoo.fr).
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Capacity building in Africa: training and infrastructure

  • African nations suffer from a shortage of health scientists and the further development of human resources and institutional capacity in Africa is essential for enhancing the ability of countries to address their own health problems.
  • MIM Task Force for Malaria Research Capability Strengthening in Africa (donors include NIAID, CTD/WHO, World Bank, TDR, Norway Government, Rockefeller Foundation, WHO/AFRO). Co-ordinated by TDR; formed directly in response to priorities identified at Dakar. The objective is to develop and strengthen core African research groups, promote technology transfer and local training through research activities involving partnerships between African and non-African groups. At the first meeting of the task Force in February 1998, fifteen full proposals (budget US$2.5 million) were recommended for funding. These covered several aspects of malaria research including; clinical and molecular basis of drug resistance, chemoprophylaxis in pregnancy, drug policy, epidemiology of immune response, epidemiology of parasite diversity, home-based malaria management, and vector biology. Additional support was recommended for 12 proposals for further improvements and collection of preliminary data. [MIM Task Force Grant Awards] A further call for proposals will be made late in 1998.

  • Inventory of Current Infrastructure and Malaria Research Capacity in Africa (Wellcome Trust/PRISM) represents a first step towards the identification of requirements for further development of human and infrastructure resources in Africa and training requirements.

  • Training Program in Medical Informatics. The Fogarty International Center and the National Library of Medicine of the National Institutes of Health have launched a new International Training Programme in Medical Informatics. The program will provide opportunities to advance research, including malaria through training in informatics and related disciplines.
  • International Training and Research in Emerging Infectious Diseases (ITREID) Program. This program, launched in 1997 and supported by the Fogarty International Center, working in close co-operation with NIAID, provides training to scientists and health professionals on emerging infectious diseases. Eight of the 13 awards under this program support malaria research. Awards are made to US institutions working in partnership with counterparts in developing countries.
  • International Collaborations in Infectious Diseases Research (ICIDR) and Actions for Building Capacity in support of ICIDR. NIAID and Fogarty International Center of the National Institutes of Health initiated this program in 1998 to offer opportunities for training in malaria research and other tropical diseases as part of the broader infectious disease research agenda
  • Computer Assisted Learning (Tropical Medicine Resource, Wellcome Trust) CD-ROM interactive tutorial on malaria launched April 1998.
  • Malaria Research and Reference Reagent Repository (NIAID) A request for proposals was issued and award of the repository contract is expected before the end of 1998. The full repository will improve access to research materials (including Plasmodium parasites and vector reagents) for malaria investigators worldwide.
  • Wellcome Trust Training Fellowships for researchers from developing countries. June 1998. These have been established to provide an opportunity for local, regional or international research training for junior postdoctoral basic scientists or medical graduates who are nationals of developing countries. The Wellcome Trust offers a range of schemes through the Tropical Medicine Programme that aims to specifically promote clinical and non-clinical research in the field of tropical medicine.
  • Human Immune Resistance to Malaria in Endemic Areas (NIAID) 1998. NIAID seek to expand, through clinical studies, the understanding of immunity to Plasmodium falciparum or Plasmodium vivax in humans.

  • TDR Malaria Research Priority areas in 1997/98 include Severe Malaria (SEVERE), Malaria and Health Sector Reform, Malaria Research Capability Strengthening in Africa.
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Annual MIM African Malaria Conference.

The MIM African Malaria Conference (AMC), which will be held 15-19 March 1999, in Durban South Africa, will be a MIM meeting to promote discussion and interaction between scientists and public health workers across Africa. The MIM AMC will extend the existing biennial Southern African Malaria Conference to create an all Africa conference. The last Southern African Malaria Conference, held in May 1997 in Maputo, Mozambique, was initiated and organised from within Africa, attracting over 200 delegates from 16 countries in Southern and Eastern Africa. The objective of bringing together malaria health personnel and research scientists coincides with the MIM priority of promoting integration of the research and development communities. The MIM AMC will include African delegates from both public health and research, together with a number of key malaria scientists from outside Africa. To maintain regional cohesion, the meeting might have embedded within it parallel sessions to discuss regional malaria control issues. Joint sessions will be organised to address critical, pan-African issues such as antimalarial drug resistance and malaria economics. The meeting will also provide an opportunity to track the progress of MIM initiatives.

The Conference is planned for 15-19 March 1999. In view of the location of the previous MIM meeting in West Africa, the 1999 Conference will be located in Durban, South Africa. (Meeting Information)
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Vaccines and immunology

  • A major impediment to vaccine discovery has been the insufficient funding and capacity for R&D scale process development, but following Dakar there has been an expansion of activities in this area.
  • European Malaria Vaccine Initiative, (EMVI, supported by the EC) will provide a framework for potential malaria vaccine candidates to be produced and taken through early trials.
  • Clinical Research and Trial Preparation Sites in Endemic Areas (NIAID) 1998. This initiative will establish field sites in malaria endemic regions which will provide fundamental information on transmission and pathogenesis, characterise parasite and patient populations in preparation for future clinical trials, and provide training to local scientists in research and clinical trial methodology. The initiative includes an option for expansion at individual sites to conduct safety, immunogenicity and efficacy testing of candidate vaccines and therapies, as they become available.
  • African Malaria Vaccine Testing Network (EC sponsored) to improve the capacity of African institutions and scientists to conduct malaria vaccine trials. Includes a training component. Established in 1995.
  • Collaboration on malaria vaccine development (NIAID); Research to determine in vitro correlates of protection for an MSP-1 based vaccine for future clinical trials, through a collaborative initiative between intramural and extramural investigators.
  • Product Research and Development. WHO/TDR has reorganised its Product Research and Development Unit to facilitate discovery and development of new drugs and vaccines for malaria and other diseases. Interaction with the private sector has been intensified. Two new committees were established, the Vaccine Discovery Research Committee and the Drug Discovery Research Committee, by merging the former disease-specific Steering Committees. Leading products will be developed by specific development teams, involving TDR’s pre-clinical and clinical coordinators.
  • The Primate Reference and Research Parasitology Consortium (EC supported). To develop an organisational and communication framework between European and Developing Country primate research centres within which improvements in the capabilities for research on health problems of developing countries and improvements in animal welfare can most effectively be realised. (The PRRPC can be contacted at thomas@relay.nl.net)
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Epidemiology

  • An understanding of malaria epidemiology underlies control programmes. Relationships between transmission, infection, disease and death; impact of environmental change on malaria, and malaria surveillance for guiding health services are all important aspects of malaria epidemiology requiring further investigation.
  • The development of PCR techniques has enabled researchers to investigate the molecular epidemiology and population genetics of malaria parasites and the interaction of host, parasite and vector genetic diversities on malaria epidemiology.
  • Molecular Epidemiology of Malaria Vaccine Antigen and Drug Resistance proposed workshop (CDC)
  • Interactions of Malaria and HIV/AIDS (CDC) - proposed future meeting
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Pathogenesis and clinical management of malaria

  • Understanding the mechanisms of malaria morbidity and mortality will provide opportunities for new methods of disease prevention and treatment. Africa wide capacity for pathogenesis research needs to be developed, with research in specific areas, such as malaria anaemia, parasite cytoadherence, stimulated. Clinical management and chemotherapy of malaria cases are research priorities, particularly in the face of developing antimalarial drug resistance.
  • Network for Study of Severe Malaria in African Children (supported by NIAID) - a collaborative network of clinical centres for the study of severe and complicated malaria in African children, capable of conducting multi-centre clinical trials and validating prognostic features identified in a single site. Initial participating centres include Malawi (NIAID Malaria Project and Wellcome Trust Centre), Kenya (KEMRI/Wellcome Unit), Ghana (Komofo-Anokye Teaching Hospital) and Gabon (Research Unit, Albert Schweitzer Hospital).

  • Malaria in Pregnancy 10-14 November 1997 workshop, Kenya (CDC/USAI

  • New Initiatives in Malaria Research (Burroughs Wellcome Fund) - 1997 initiative, to increase fundamental understanding of the biology and pathogenesis of malaria
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Genome sequencing of malarial parasites

  • Complete genome sequencing of malaria parasites will provide the basis for rational approaches to the design and development of vaccines and chemotherapeutic agents.
  • Plasmodium falciparum Genome Sequencing Project (Burroughs Wellcome Fund, NIAID, Wellcome Trust, USDoD). A consortium approach by funding agencies, sequencing centres and malariologists to achieve the complete sequencing of the entire genome of Plasmodium falciparum and to promote its use in developing new strategies to control malaria, including diagnostics, vaccines and drugs. [EBI NCBI TIGR Sanger Stanford]

  • Plasmodium vivax and Plasmodium berghei Gene Discovery Projects (NIAID) sequence acquisition (EST’s and GST’s) for another important human malaria parasite, as well as rodent malaria that serves as a model system.
  • Fifth Malaria Genome Sequencing Meeting, Hinxton, UK, 30th June- 1st July 1998. The agenda was expanded to include consideration of the mechanisms required to optimally exploit sequence information for identification of novel drugs and vaccines.

Investment in malaria research

Provisional funding figures indicate that thre has been a substantial increase in investment in malaria research. Over US$100 million was invested in malaria research in 1997, compared to approximately US$85 million in 1995. During this period, NIAID increased its expenditure by 50% and the Wellcome Trust doubled its expenditure. The overall level of funding still remains low relative to the burden of the disease.
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Promoting interaction between the research and control communities

MIM recognises the importance of developing collaboration and co-ordination not only within the scientific community, but also at the research/public health interface. Historically, a clear source of funding for research at the interface with control programmes and health care provision (e.g. large-scale intervention trials, home management of malaria) has been lacking. There is a need to change the perceptions of funding agencies to ensure that mechanisms are in place to allow for operational research to be supported. MIM is working to promote constructive interactions between the research and development communities, and to address the problem of funding for intervention trials, health services research and operational research.

MIM has selected the problem of antimalarial drug usage and policy development to explore in greater depth the mechanisms required to stimulate stronger links between laboratory and field research, promote wider dissemination of research results relevant to country programmes and ensure that research agendas are orientated to provide essential information to underpin policies.

The recent MIM antimalarial drug resistance and policies for drug usage meeting in Geneva brought together individuals from 20 organisations encompassing malaria control programmes, through policy formulation, clinical and epidemiological research, and basic laboratory research. The meeting provided a forum for examining on a broader basis options for enhancing the dovetailing of research and development activities.
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