New plan to defeat Malaria in Africa

Achieving victory over malaria in Africa, a disease that each year kills millions and imposes costs that cripple entire economies, requires a new internationally funded effort dedicated to training and supporting a critical mass of African malaria researchers, according to a new plan launched today by the Multilateral Initiative on Malaria (MIM) at the Fourth MIM Pan-African Malaria Conference in Yaoundé, Cameroon.

"While the work of scientists from outside Africa continues to be critical, the fact remains that African malaria researchers need to be involved in parallel if we are going to successfully implement new research findings and begin to reverse the situation in malaria endemic countries," said Andreas Heddini, secretariat coordinator for MIM.

MIM is an international organization dedicated solely to building a sustainable malaria research infrastructure in Africa. This year it will officially move its headquarters to Dar es Salaam, Tanzania, under the auspices of the African Malaria Network Trust (AMANET).

A 1999 MIM survey reported that there were only 752 trained malaria researchers in sub-Saharan Africa, the area of the continent that each year endures the brunt of the world's 500 million malaria infections and 2.7 million deaths. The number of scientists is growing, Heddini said, noting that there are 1,000 African malaria researchers attending this week's MIM conference in Yaoundé. But he said many more malaria experts are needed, and, to keep them in Africa, they must be supported by a system that can provide sustainable long-term funding and adequate facilities.

MIM is calling for a new initiative that would focus on competitively awarded long-term grants that would be dedicated to developing new "centers of excellence" in malaria endemic areas of Africa. These centers would serve as hubs for training new scientists and assembling interdisciplinary teams for conducting malaria research.

Training and capacity building would occur within the context of new investigator-driven research projects directed by African scientists and aimed at developing better tools for fighting malaria. These would include new drugs, vaccines, diagnostic tests, treatment strategies, and mosquito control techniques.

"We're not asking for a quick fix here but an investment that allows us to establish a research culture focused on malaria, one that begins attracting scientists at the undergraduate level," said Wen Kilama, Managing Trustee of the African Malaria Network Trust (AMANET), which is based in Dar es Salaam.

"We also know that creating a sustainable malaria research infrastructure in Africa does not involve simply training 'malaria researchers,'" he added. "Given the complex questions that must be answered to defeat malaria, when you talk about capacity you are talking about scientists with expertise in parasite biology, entomologists who can focus on insect control, and toxicologists who will understand the effect of drug compounds. You also need epidemiologists, biostatisticians and experts in bioethics, and you need the information technology and other resources that allow you to take the research directly to where the problem is."

As ambitious as it sounds, the good news, Kilama said, is that Africa would not be building a malaria network from scratch. Though insufficient in number, there is a core group of highly trained African experts working in malaria endemic areas, and, in just the last few years, their numbers have been growing. For example, Kilama said that when he returned three decades ago to Tanzania, there were only a couple of PhD's with a good understanding of malaria. "Now there are at least 20, and I think we have seen a tremendous increase in human resources focused on malaria across Africa," he said.

So a new initiative targeted at building capacity would be taking advantage of an existing momentum that has brought tangible progress to Africa-based malaria work. But Wilfred Mbacham, coordinator of the Fourth MIM Pan-African Malaria Conference, said unless there is a long-term commitment to their development, there is a danger that Africa's new cadre of malaria experts will go the way of many of their compatriots--to Europe and North America.

"That is always the dilemma with training African scientists," he said. "They become experts and are then encouraged to go work overseas. But if they see there is a future to develop professionally in their home countries, most will choose to stay."

Ogobara Doumbo, director of the Malaria Research and Training Center at the University of Bamako in Mali, said there are many areas where having trained African scientists leading malaria research teams can accelerate efforts to find new ways to fight the disease. For example, he said while there is an urgent need to conduct more clinical trials in malaria-affected areas, without extensive knowledge of local social and cultural conditions, it can be very difficult to recruit patients and obtain informed consent in an ethically sound matter.

"In our work in Mali we have developed our own procedures for obtaining informed consent that are quite different from what a scientist would do in the West," he said. "But without this approach, it would have been impossible to accomplish what have been very valuable clinical trials. And as we see more and more drugs and vaccines that need to be tested in African populations, the presence or absence of well-trained African scientists could become the critical factor in their success or failure."