In the historic setting of the Palace of Westminster, last Tuesday, January 20th, representatives from the Barcelona Institute for Global Health (ISGlobal), participated in the All Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG) meeting to discuss collaborative initiatives in malaria research. Last year, the UK Government pledged to increase funding for the fight against malaria up to £500 million every year, a goal the APPMG hopes to see achieved in 2015.
Introducing her talk, Regina Rabinovich, director of the ISGlobal Malaria Elimination Initiative, reflected on the huge progress made over the last decade. The scaling up of effective tools, including long lasting insecticide treated bed nets (LLINs), rapid diagnostic tests (RDTs) and artemisinin-based combination treatments (ACTs) has resulted in impressive gains in lives saved. But none of these tools remain impressive in the face of resistance; continued investment in R&D is an essential component of the path forward. Rabinovich contemplated the false dichotomy between malaria control and elimination. She shared research findings that show that elimination is a surprisingly stable state, whereas becoming lax with continued control efforts and allowing funding to drop have shown to cause disastrous resurgences in malaria.
The community agreed that science and evidence are needed to drive our efforts towards malaria goals, both driving down deaths and driving out infection. The Malaria Eradication Research Agenda (malERA) articulated some of the research questions an eradication effort would have to address, and since malERA we've seen great progress made. Kate Whitfield, from ISGlobal, demonstrated how the 'MESA Track' database developed by the Malaria Eradication Scientific Alliance has begun to capture some of the ongoing research, helping to monitor progress in research ahead of publication and identify where gaps persist.
Resistance, both insecticide and drug, are of primary concern. Rabinovich warned that waiting to see public health impact of insecticide resistance would be too late. The group discussed that with promising novel candidates in the pipeline developed by industry partners and the Innovative Vector Control Consortium, we need to create the right environment and social contracts to get the products to the market as quickly as we can.
Discussion led by Andrea Stewart, from the Worldwide Artemisinin Resistance Network, centred on the power of pooling data from multiple clinical trials from all over the world to analyse safety, efficacy and quality of ACTs. WWARN provides a platform and toolkit for researchers and other partners to share and analyse their combined data. On the other hand, David Schellenberg, from the London School Hygiene and Tropical Medicine, presented some of the main findings generated by the ACT Consortium that show that using RDT diagnostics led to better use of ACTs by patients with malaria. However, striking the balance between sufficient access to malaria treatment and targeting the treatment to people with real malaria still has to be tackled, as current RDTs sometimes show false negatives. Research results also suggested that different retail prices of diagnostics compared to drugs can have an impact on uptake.