The world\u2019s largest meeting on malaria, the 5th Multilateral Initiative on Malaria (MIM) Pan-African Malaria Conference, convenes in Nairobi, Kenya, on Nov 1\u20136.1 Since the last MIM meeting in 2005, the malaria landscape has transformed dramatically. Scientific progress and support from the highest levels of government galvanised the field, and the global community has begun to coalesce around the most ambitious goal possible\u2014eradication. <\/p>\n
Today, malaria-control efforts, particularly in Africa, have extraordinary visibility and unprecedented financial support from governments and philanthropic foundations. In Round 8 of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), approved grants for malaria exceed those for AIDS and tuberculosis combined.2 African governments are playing a larger role in efforts to eliminate malaria deaths, and creative partnerships with political and celebrity champions have accelerated the distribution of millions of insecticide treated bednets. In all, increased control efforts, including uptake of artemisinin-based combination therapies (ACTs), have led to a 50% decline in malaria cases and deaths in 29 countries since 2000, including
\nin seven countries in Africa.3<\/p>\n
Behind these successes, however, lies a worrying reality: the spread of drug and insecticide resistance threatens to unravel the progress. Malaria strains resistant to the cheapest and most commonly used drugs already exist in almost every endemic country. Now, irrational use and continued over-reliance on artemisinin monotherapies are undermining the gold standard for malaria treatment, ACTs. Last year, a study showed significantly longer parasite-clearance times in patients taking ACTs along the Thai\u2013Cambodian border.4 With no new classes of drugs in late-stage development, resistance to ACTs could render ineffective many of the endoperoxide drug candidates being developed as synthetic alternatives to artemisinin.5 <\/p>\n
Insecticide resistance is also spreading. Long-lasting insecticidal bednets and indoor residual spraying have saved millions of lives, but we are victims of our success. Expanding access to insecticides, combined with agricultural spraying practices, is putting evolutionary pressure on mosquitoes to develop resistance. In east Africa and other areas, two species of mosquito
\nhave already been found to be resistant to commonly used insecticides, including permethrin and DDT.6 Worse, there are no new classes of insecticides in late stage development. The Global Malaria Eradication Programme of the 1950s and 1960s failed in part because of resistance. We must learn from the past, and focus on research that accelerates development of new tools and supports effective use of existing ones. <\/p>\n
Evidence-based mechanisms are needed to improve access to effective treatments and displace
\nmonotherapies. Today, only 3% of children under the age of 5 years receive ACTs, partly because 40\u201360% of patients are treated in the private sector where ACTs remain prohibitively expensive.7 The Aff ordable Medicines Facility for Malaria (AMFm) is an innovative approach to reduce ACT costs. To support the AMFm and other efforts, the ACTwatch project is collecting data on market
\npenetration for ACTs and building recommendations on how to increase access to and affordability of ACTs.8 <\/p>\n
At the same time, operational research is crucial to determine which methods and policies can improve availability of existing interventions. Recent studies show that trained community volunteers can deliver antimalarial treatments successfully.9,10 Lessons learned today will speed access to new tools as they become available. <\/p>\n
We also need better diagnostics. The lack of accurate diagnostic tools leads to overprescribing of antimalarials by as much as 90% in some resource-poor settings, potentially contributing to resistance.11 An ongoing study of various rapid diagnostic tests is shedding light on their effectiveness in different settings, but more research is needed.12<\/p>\n
New or improved tools remain our best hope for eradication. The world may be 5 years away from a partly effective malaria vaccine with the potential to save hundreds of thousands of lives. The most advanced vaccine candidate, RTS,S, is now in phase 3 clinical trials in seven African countries.13 It is time to start discussing financing and delivery even as we invest in next generation vaccine candidates, including transmission blocking and whole-organism vaccines. <\/p>\n
At the founding of MIM just over a decade ago, essential malaria research in Africa was minimal. Malaria research initiatives, many of which are led by Africans, are now working with MIM and strengthening Africa\u2019s ability to spearhead the development of new tools and approaches for malaria control. But while African researchers celebrate recent progress, we remain all too aware of the disease\u2019s resilience and continued toll. Substantial political and financial support is needed, along with a critical mass of scientists working on malaria in sub-Saharan Africa, to maintain and implement an effective malaria research agenda.14 How many lives will be saved by what we learn at this Conference? With 2200 malaria deaths in Africa every day, we cannot afford to let up on our crucial mission. <\/p>\n
1. Rugemalila J, Ogundahunsi O, Stedman T, Kilama W. Multilateral initiative
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\n2 Global Fund to Fight AIDS, Tuberculosis and Malaria. Funding decisions.
\nNovember, 2008. http:\/\/www.theglobalfund.org\/en\/fundingdecisions
\n(accessed Outubro 7, 2009).
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\n5 Wells T. A question of quality: interview with Chris Hentschel, President &
\nCEO of MMV. October, 2008. http:\/\/www.mmv.org\/IMG\/pdf\/FINAL_
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\nUganda 2007\u2014an overview of the supply side. Novembro 6, 2008. http:\/\/www.
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\n9 Sudhakar M, Alem Y, Tegegn A, Woldie M. Acceptability of rapid diagnostic
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\nvolunteers for uncomplicated malaria in under 5 years\u2019 children, Home
\nManagement of Malaria (HMM) strategy in Jimma town, Ethiopia\u2014
\npreliminary results. 5th MIM Pan-African Malaria Conference, Nairobi,
\nKenya; Nov 2\u20136, 2009. http:\/\/www.mimalaria.org\/eng\/docs\/pdfs\/events\/
\nMIM2009Abstracts.pdf (accessed Outubro 7, 2009).
\n10 Ajayi I, Browne E, Garshong B, et al. Feasibility and acceptability of
\nartemisinin-based combination therapy for the home management of
\nmalaria in four African states. Malar J 2008; 7: 6.
\n11 Amexo M, Tolhurst R, Barnish G, Bates I. Malaria misdiagnosis: eff ects on
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\n12 WHO, FIND, CDC, TDR. Malaria rapid diagnostic test performance\u2014
\nresults of WHO product testing of malaria RDTs: round 1 (2008). 2008.
\nhttp:\/\/apps.who.int\/tdr\/svc\/publications\/tdr-research-publications\/rdtperformance
\n(accessed Outubro 7, 2009).
\n13 GSK Biologicals, PATH MVI. Fact sheet: phase 3 trial of RTS,S. http:\/\/www.
\nmalariavaccine.org\/fact-sheets.php (accessed Outubro 8, 2009).
\n14 Nantulya F, Kengeya-Kayondo J, Ogundahunsi O. Research themes and
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\nMalaria. Am J Trop Med Hyg 2007; 77: 303\u2013313.<\/em><\/p>","protected":false},"template":"","related_countries":[],"related_projects":[],"news_category":[],"health-area":[],"capabilities-and-cross-cutting":[],"class_list":["post-3755","news","type-news","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.psi.org\/pt\/wp-json\/wp\/v2\/news\/3755","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.psi.org\/pt\/wp-json\/wp\/v2\/news"}],"about":[{"href":"https:\/\/www.psi.org\/pt\/wp-json\/wp\/v2\/types\/news"}],"wp:attachment":[{"href":"https:\/\/www.psi.org\/pt\/wp-json\/wp\/v2\/media?parent=3755"}],"wp:term":[{"taxonomy":"related_countries","embeddable":true,"href":"https:\/\/www.psi.org\/pt\/wp-json\/wp\/v2\/related_countries?post=3755"},{"taxonomy":"related_projects","embeddable":true,"href":"https:\/\/www.psi.org\/pt\/wp-json\/wp\/v2\/related_projects?post=3755"},{"taxonomy":"news_category","embeddable":true,"href":"https:\/\/www.psi.org\/pt\/wp-json\/wp\/v2\/news_category?post=3755"},{"taxonomy":"health-area","embeddable":true,"href":"https:\/\/www.psi.org\/pt\/wp-json\/wp\/v2\/health-area?post=3755"},{"taxonomy":"capabilities-and-cross-cutting","embeddable":true,"href":"https:\/\/www.psi.org\/pt\/wp-json\/wp\/v2\/capabilities-and-cross-cutting?post=3755"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}