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| Professor Fred Newton Binka,executive director of INDEPTH Network |
In 2002, Nature published a study that sparked debate on a neglected disease. The report on older and more recent malaria maps showed that half a billion people in mainly poor areas of the world became sick with malaria the same year. Estimates were 50 per cent higher than those released by the World Health Organization (WHO).
Malaria, an infection characterized by fever, shivering, chills, malaise, headache and sweats, kills about a million people every year - 90 percent of them in Africa, 70 percent of whom are children under the age of five.
The irony is that though the disease, caused by any of four different species of parasite passed on via the bite of an infected mosquito, can be fatal, illness and death from malaria are largely preventable.
Eradication of malaria
Here in the United States malaria has been eradicated for almost 60 years. A national program, reported to have been started in 1947, conducted over 4,650,000 house spray applications. The same year, 15,000 malaria cases were reported. By 1950, the number of cases had dropped to 2,000. A year later, malaria was considered eradicated from the U.S.
In Mexico City May 1955, the eighth World Health Assembly adopted a global eradication campaign based on widespread house spraying with insecticides such as DDT against mosquitoes; use of anti malarial drugs to treat malaria and eliminate the parasite in humans.
By 1967, malaria was eradicated from nations with temperate climates and seasonal malaria transmission. Large areas of tropical Asia and Latin America were also freed from the risk of infection.
Some countries such as India and Sri Lanka had sharp reductions in the number of cases, followed by increases to quite substantial levels after eradication efforts ceased.
Other nations - Indonesia, Afghanistan, Haiti, and Nicaragua had negligible progress. The campaign was launched in only three countries of tropical Africa, and most of sub-Saharan Africa was excluded completely.
The emergence of drug resistance, widespread resistance to available insecticides, wars, and massive population movements, difficulties in obtaining sustained funding from donor countries, and lack of community participation made maintenance of the effort untenable. Completion of the eradication campaign was eventually abandoned to one of control.
Accelerated implementation of malaria control
In 1992, malaria control was re-established as a global health priority by a conference of health ministers held in Amsterdam. Scientific interest in the disease and its control, political commitment to reducing the burden of malaria, and the financial resources for malaria research and control began to increase rapidly.
The project for Accelerated Implementation of Malaria Control (1997-1998) represented an unprecedented contribution to the fight against malaria in Africa south of the Sahara, in terms of both technical support and funds. The funding provided for the project over the two years was estimated to have been more than 12 times the contributions made by WHO during the previous decade.
A more virulent disease
The Africa Malaria Report released in 2003 detailed what the world knew about malaria in Africa. It had become a more virulent disease than in the 1960s. Malaria was costing Africa more than $12 billion annually, and the disease slowed economic growth in African countries by 1.3 percent annually. Sub-Saharan Africa's GDP was 32 percent lower than it would have been had malaria been eradicated in 1960.
With no single cure for malaria on the horizon, and an effective vaccine considered years away, new analyses had confirmed that malaria was a principal cause of at least one-fifth of all young child deaths in Africa, and that no country in Africa south of the Sahara for which data was available showed a substantial decline.
On June 30, 2005, President Bush announced the President's Malaria Initiative (PMI), a U.S. government program designed to cut malaria deaths in half in sub-Saharan Africa. The president pledged to increase U.S. funding of malaria prevention by more than $1.2 billion over 5 years. He also called on foundations as well as private, public, and voluntary organizations to complement U.S. commitment by providing additional funding.
In Angola, Tanzania, and Uganda - the first three countries targeted by PMI - access is being expanded to include insecticide treated nets and indoor residual spraying with approved insecticides; drugs made available through public and private sector outlets and supported by information and education campaigns to improve care seeking and access to children, pregnant women, and other vulnerable groups at risk for malaria infections.
In 2007, PMI will target four additional African countries, and in 2008, at least eight more. The initiative is intended to eventually cover more than 175 million people in up to 15 African countries most affected by malaria.
Rolling Back Malaria
This year, on April 25, the day when many parts of the world stop to take stock of the progress toward the goal of halving the burden of malaria by 2010, INDEPTH Network –a collaboration of 37 African and Asian research sites based in 19 countries - announced the establishment of the Malaria Clinical Trials Alliance (MCTA).
Bolstered by a US$17-million grant from the Bill & Melinda Gates Foundation, MCTA will conduct clinical trials of new drugs and vaccines to fight malaria, provide assistance to research centers in Mozambique, Tanzania, Malawi, Gabon, Nigeria, Ghana, Gambia, Kenya and Senegal and help INDEPTH strengthen global research and development activities targeting malaria.
Professor Fred Binka, executive director of INDEPTH Network says "MCTA is an autonomous body established at INDEPTH as a result of the grant. It is a great opportunity for INDEPTH to work with other partners to develop a critical mass of self-sustaining research centers in Africa through the development of new drugs and vaccines to fight malaria.”
Since 2002, when INDEPTH Network was formally constituted with support from the Rockefeller Foundation, Sida/SAREC, World Bank and Wellcome Trust, INDEPTH has driven the agenda of creating a platform to network and strengthen individuals and self-sustaining sites in Africa and Asia.
INDEPTH's work includes improving methods used in malaria research, strengthening best practices in each site, and building capacity to be able to set both the research agenda and undertake research that is relevant to the current health problems in the developing world.
“Malaria has killed so many African children,” Professor Binka says “ and the burden of malaria is so unacceptable, that control of the disease needs to be attacked from several angles.
"For those who become ill, we need effective drugs to cure both the mild and severe forms of the disease, before it kills. … So far, we have been able to develop and deploy effective drugs. The journey to develop a vaccine has been long, but it is within our sight. An effective vaccine would further improve the effectiveness of our control methods, but would not completely stop the need for effective drugs. Hence we need to drive the agenda to develop drugs and vaccines with much vigor."
Driving the agenda
An African-led institution, the MCTA aims to strengthen clinical trial capacity, share results of real, on-the-ground trial activities and codify best practices. It will enable African institutions and scholars to participate fully in the development of new tools for addressing malaria and in conducting interventions against malaria. It will also create a long-term partnership between African and Northern institutions.
Initially, MCTA will work in partnership with two other Gates Foundation grantees: the PATH Malaria Vaccine Initiative and the Medicines for Malaria Venture to train personnel; and improve facilities and infrastructure to ensure successful execution of clinical trials in Mozambique, Gabon, Tanzania, Nigeria, Malawi, Ghana, Gambia, Kenya and Senegal, where trial sites have been identified for participation or are already participating in clinical trials.
"In the long term," Binka adds, "the objective is to identify, support, strengthen, mentor, and network trial sites to facilitate their self-sustainability, ensuring trial sites remain functional after the end of a trial and thus increasing the number of sites in Africa which will be ready to conduct trials for malaria vaccine and drug interventions.
"MCTA will also facilitate collaboration among trial sites, including sharing of data, expertise, and best practices. Specifically, this work will include: refurbishing trial sites to ensure adequate facilities for laboratory work, data management, space for seeing trial participants and administering vaccines and drugs; providing equipment for biochemistry work, data management, and storing of blood samples; facilitating good clinical practices and ethics training for trial staff; harmonizing research methods, data management, procedures across trial sites, and supporting the development of leadership skills of young investigators."
Before the launch of the MCTA, Professor Binka - first recipient of the Rudolf Geigy Award in 2001 for excellence in science and for dedication and outstanding contribution to malaria control and health development in Africa - says most countries in Africa had tackled malaria by establishing sentinel monitoring sites to document the sensitivity of the malaria parasite to existing first line drugs used in these countries.
" More and more research sites are getting engaged in the testing of new drugs and new drug combinations, " adds Binka. “ These include drugs like artemether lumefantrin, amodiaquine artesunate and labdap etc. A few other sites are involved in new drug formulations and we expect our sites to contribute towards the development of one or twenty new molecules under development especially by Medicines for Malaria Ventures.
"What MCTA will do is to make sure that there is an African contribution and development of African expertise to new tools and interventions. The Network has been and will continue to provide technical assistance to malaria control programs in the African Region. Alliance members are engaged in operational research to assist in development of effective malaria tools and monitoring of outcomes. Network sites are increasingly becoming centers of excellence in the training of the next generation of African research scientists.” Professor Binka concludes.
For more information
An International Network of field sites with continuous Demographic
Evaluation of Populations and Their Health in developing countries
http://www.indepth-network.net/
Eradication of Malaria in the United States (1947-1951) and Eradication Efforts Worldwide: Success and Failure (1955-1978)
U.S. Department of Health and Human Services Centers for Disease Control and Prevention
http://www.cdc.gov/malaria/history/index.htm
