Malaria research agenda stresses the need for innovation and integration

Health workers demonstrate bednets, Courtesty of Sven Torffin, WHO World Malaria Day 2017

New research agenda for malaria elimination and global eradication 'malERA' stresses the need for innovation and integrated approaches.

Imperial Network of Excellence in Malaria, Liverpool School of Tropical Medicine and London School of Hygiene & Tropical Medicine Malaria Centre researchers contribute to “malERA Refresh” consultative process of over 180 experts seeking to accelerate progress to a world free from malaria.

More than 180 scientists, malaria programme leaders and policymakers from around the world including leading researchers from the Network of Excellence in Malaria at Imperial College London, Liverpool School of Tropical Medicine (LSTM), and the London School of Hygiene & Tropical Medicine (LSHTM) Malaria Centre recently came together through a consultative process to update the research agenda for malaria elimination and eradication, first published in 2011.  The outcome is a series of seven papers entitled ‘malERA Refresh’ (malaria eradication research agenda) published today as a special collection in the journal PLOS Medicine. The aim of the exercise, coordinated by the Malaria Eradication Scientific Alliance (MESA) led by Barcelona Institute for Global Health (ISGlobal), was to define a forward-looking research and development agenda that will accelerate progress towards malaria elimination and global eradication.]

The World Health Organisation (WHO) vision is a world free of malaria. Achieving this would present enormous benefits in terms of health, equity and economy. The WHO has set ambitious goals for reducing the burden of malaria, and 21 countries have been identified as having the potential to eliminate local transmission of malaria by 2020. However, there is no easy path to achieving a malaria-free world and there is a real need for innovation. The malERA Refresh sets out a research agenda to meet the challenges, achieve these goals and, in the long-term eradicate it globally.

“The value of malERA Refresh is that it focuses on problems that need to be solved, not only the technologies that could be developed” states MESA chair Dr. Regina Rabinovich (ISGlobal and Harvard T.H. Chan School of Public Health). “Transforming the mindset from implementation to problem solving is an essential task for the next generation of scientists and program implementers,” she adds.

Key messages in the introductory paper of the malERA Refresh collection include:

• Since 2011 significant progress has been made in research and development, including support for large-scale testing of the first approved vaccine (RTS,S), non-pyrethroid insecticides in the pipeline, new genetic technologies to block parasite transmission by mosquitoes, and identification of markets of drug resistant parasites
• Progress has been balanced by significant challenges, such as the expansion of insecticide and drug resistance, knowledge gaps particularly when working in low disease transmission settings, and tools to prevent disease reintroduction.
• Despite knowing more about the transmission biology and epidemiology of Plasmodium vivax malaria, the most common malaria outside Africa, we still lack tools to tackle it. In addition, the continuous evolution of malaria parasites and vectors brings new challenges. An example is the reported rise of Plasmodium knowlesi infections in South-East Asia, as well as changes in mosquito biting and resting habits.

Solutions to these problems require three types of innovation: 1) iterative innovation (for example, new medicines); 2) transformative innovation of tools and strategies to reduce or halt parasite transmission (for example, gene drive technologies); and 3) integrated approaches tailored to local contexts and local variations in disease transmission dynamics.

To update the agenda, six panels with experts from different disciplines and countries engaged in a collaborative process to address progress made and main challenges across the following areas: basic science and technologies; insecticide and drug resistance; characterising the reservoir and measuring transmission; diagnostics, drugs, vaccines and vector control; combination interventions and modelling; and health systems and policy research.

Imperial Network of Excellence in Malaria, LSTM and LSHTM Malaria Centre researchers were involved in all six MalERA panels and Professor Jake Baum, Imperial Network lead stressed that the MESA call to action effectively highlights the vital need for innovation and integrated approaches in tackling malaria, matching the aims of the new Malaria Network to achieve cross-disciplinary discussion, debate and research in wide-ranging fields including economics, chemistry, vaccinology, bioengineering, modelling and basic parasite or vector biology.

Dr Tom Churcher, Senior Lecturer in the Malaria Modelling Research Group at Imperial contributed to the Insecticide and Drug Resistance panel chaired by Professor Janet Hemingway, Director, LSTM. This panel sought to review the current knowledge base and identify research priorities addressing resistance to drugs and insecticides. 

Professor Hemingway stressed that “vector control has made an enormous contribution to the recent reductions in malaria transmission. The new formulations and products that are now being introduced will sustain and enhance these gains, as long as they are introduced in combination with sensible resistance management plans”. Dr Churcher agreed and added that “checking that these interventions are still working as they should do is really difficult in areas with poor health systems and this is an area of research we need to get much better at to ensure the disease is targeted in the best way”.

Professor Chris Drakeley, Director of LSHTM Malaria Centre, who chaired the Characterising the Reservoir and Measuring Transmission Panel commented that “it is quite clear now that there are many more low-level malaria infections than we previously thought, the question for elimination is do these infections contribute to transmission, and, if yes, by how much.” Professor Drakeley went on to explain that “technology and general scientific advances are presenting multiple opportunities to improve the measurement of malaria transmission, the challenge is to integrate these in ways that are useful to country programmes.”

Coinciding with the launch of the 2017 WHO World Malaria Report; with its emphasis on a cross-roads moment due to stalled progress, where renewed leadership and investment on malaria is needed to help revitalise and accelerate global progress made since 2000; the malERA Refresh collection is considered a complement to the WHO ‘Global Technical Strategy for Malaria’ (GTS) and the Roll Back Malaria ‘Action and Investment to defeat Malaria’ (AIM). Pedro Alonso, Director of the WHO Global Malaria Programme, underlined the importance of the updated agenda as a key pathfinder for the Global Observatory on Health R&D and added: "Robust research is critical for the WHO to build evidence-based policies and guidelines.”  

To access the PLoS Med publications, please visit PLoS Med malERA Refresh.