Malaria elimination also requires research

While universal coverage of existing malaria control tools is necessary to achieve 2010 and 2015 targets, moving beyond such scale-up toward elimination requires a thorough examination and reappraisal of these tools and the way they are applied. A special supplement to Malaria Journal addresses these concerns.

In his introductory editorial to the special supplement, Marcel Hommel warns that, “The move from control to elimination is actually a quantum leap. If it were once possible to state that all the tools for control were available and that no further research was required, it is doubtful whether elimination could be achieved with those same tools. There is now a need to define a new research agenda and to identify the differences between control and elimination.”  The ten review articles included show that this research agenda includes both basic and applied or operational research. A few highlights follow.

Galinski and Barnwell point out that, “Plasmodium vivax, which has long been neglected and mistakenly considered inconsequential, is now entering into the strategic debates taking place on malaria epidemiology and control, drug  resistance, pathogenesis and vaccines. Thus, contrary to the past, the malaria research community is becoming more aware and concerned about the widespread spectrum of illness and death caused by up to a couple of hundred million cases of vivax malaria each year. ”

Ann Mills and colleagues discuss the economic, financial and institutional challenges that face the renewed call for eradication and intensified control. They point out that some of the key issues requiring research include 1) allocative efficiency of malaria eradication, 2) costs and consequences of the various tools and mixes, 3) extension of coverage of interventions and service delivery approaches, 4) processes of formulating and implementing malaria control and eradication policies, and 5) research on financing issues. They are concerned about equity and decision making at both national and international levels.

Brabin et al. look at the role of monitoring and evaluation in malaria in pregnancy (MIP) control and conclude that, “Large-scale operational research is required to further evaluate the validity of currently proposed (MIP) indicators, and in order to clarify the breadth and scale of implementation to be deployed.” This is especially urgent because MIP interventions currently vary by the type and stability of malaria transmission, which itself may be changing due to large scale intervention to date.

Other reviews address malaria research issues surrounding global warming, vaccines, ACT deployment, the role of drugs in elimination, diagnostics, and integrated vector management.

Finally, the Executive Director of the Roll Back Malaria Partnership calls attention to the research agenda inherent in the newly adopted ‘Global Malaria Action Plan.’ As she explains …

Armed with the Plan’s globally agreed research agenda, partners and advocates can now bring more investment to malaria research and foster further dialogue and innovation. The Global Plan requires a long-term commitment: continued funding is essential in both country implementation and R&D to prevent a re-emergence of malaria. However, the investment is worthwhile.

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