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
[back to top]
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.
[back to top]
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.
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
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
of organisations in focused areas and the building of effective bridges
between activities to promote integrated synergistic activities.
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.
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
[back to top]
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.
[back to top]
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
- 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
[back to top]
specific priorities were identified for immediate action at the MIM
meeting held in London in November 1997: [press
- 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)
these priorities is identified in the following sections. Evolution of
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
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]
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
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.
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.
[back to top]
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.
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
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.
[back to top]
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.
- 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 Governments
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".
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,
[back to top]
building in Africa: training and infrastructure
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.
Task Force Grant Awards] A further call for proposals will
be made late in 1998.
of Current Infrastructure and Malaria Research Capacity in Africa
Trust/PRISM) represents a first step towards the identification
of requirements for further development of human and infrastructure
resources in Africa and training requirements.
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
Assisted Learning (Tropical Medicine Resource, Wellcome Trust)
CD-ROM interactive tutorial on malaria launched April 1998.
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
- 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.
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
- TDR Malaria Research Priority
areas in 1997/98 include Severe Malaria (SEVERE), Malaria and Health
Sector Reform, Malaria Research Capability Strengthening in Africa.
[back to top]
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.
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)
[back to top]
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.
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.
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.
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.
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.
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 TDRs pre-clinical and clinical
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 firstname.lastname@example.org)
[back to top]
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
[back to top]
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
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
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.
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
Plasmodium vivax and
Plasmodium berghei Gene Discovery Projects (NIAID) sequence
acquisition (ESTs and GSTs) for another important human
malaria parasite, as well as rodent malaria that serves as a model
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
in malaria research
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.
[back to top]
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.
[back to top]