Malaria researchers must join forces to present a clear and detailed call for the resources they need, say Ian Boulton and Steve Ward.
The antimalarial drug community needs to develop joint action plans to help funding agencies make the best use of the available resources in the coming years.
The challenge is to eliminate malaria in the next 50 years, rather than merely control it. This will require new tools, including drugs to replace those that have succumbed to the development of resistance.
In the current poor economic climate, donor fatigue and financial pressures mean that the current level of funding for research and development (R&D) may not be sustained. It is therefore important that those involved in antimalarial drug R&D come together to send clear messages to funders on R&D priorities, with details of what exactly is needed.
But the antimalarial drug R&D community is currently fragmented and uncoordinated. This risks wasteful duplication of efforts in some areas, with others being neglected.
A coherent strategy
One ongoing attempt to develop a detailed, coherent strategy is the CRIMALDDI Consortium, a European Union-funded collaboration between Medicines for Malaria Venture (MMV), the WHO Special Programme for Research and Training in Tropical Diseases (TDR), and research groups in Europe and Africa.
The consortium has started to bring together malaria researchers and experts from related fields outside malaria to develop research priorities in a coordinated fashion. The external expertise enables lateral thinking and outside-the-box ideas to be considered.
Five key priority areas that could prevent rapid progress in antimalarial drug development in the next 5–10 years have been identified. The focus on enabling technologies (such as culture and screening systems) is one major barrier to rapid progress.
Malaria has undergone a resurgence of interest in the past 10–15 years, as the development of new tools, such as artemisinin-containing therapies (ACTs), has raised the possibility that the disease could be eradicated.
This has led to a huge increase in funding, including drug R&D support, and the setting up of various funding organisations such as MMV. It has also resulted in the creation of mechanisms such as the Affordable Medicines Facility – malaria (AMFm), which enables effective but expensive drugs to reach those most in need.
Malaria-related deaths are falling
The wider use of ACTs and vector control methods, along with better diagnosis of malaria, means that cases of malaria and resultant deaths are falling in many countries.
But malaria funding is likely to peak in 2011–12 for a variety of reasons, including the success of Roll Back Malaria's Global Malaria Action Plan, which is reducing the incidence of malaria infections, especially in Sub-Saharan Africa.
Given progress using current methods, such as bednets, antimalarial drugs and diagnostics, which show that many fevers previously treated as malaria are caused by other infections, it is inevitable that malaria will be seen as a declining problem needing less money, with less urgency to develop new drugs.
But history suggests we cease drug development at our peril. There was a similar hiatus in anti-tuberculosis drug research after the adoption of DOTS (directly observed treatment, short course), the standard treatment for TB that was introduced in 1992, but the emergence of resistance is now causing problems.
Information must be used wisely
Several organisations have recently started to make public the results of their high-throughput screening programmes (see Glaxo to share malaria drug data). A huge amount of information is now available, but it is not clear what mechanisms are in place to ensure this information is used wisely and that wasteful duplication is avoided.
Similarly, the absence of key enabling technologies is hampering work in important areas. For example, the lack of workable culture systems for liver stages of the disease, particularly for malaria caused by Plasmodium vivax, is a major block to the discovery of fresh treatments to clear parasites from the liver.
This will be a major challenge for elimination programmes in the Asia–Pacific and Latin American regions. But technology development is not always seen as a priority for funding bodies and has not been given the attention it deserves.
A clear, detailed, prioritised and well articulated strategy is something that funding agencies find difficult to resist. Vague proposals may lead them to spread their resources too thinly. A more focused R&D agenda was effective in tackling HIV and is needed for malaria.
The malaria community must come together in a more structured way to set out the priorities for research and identify the roadblocks. Only then can it obtain the resources it needs for new drugs to be developed quickly and efficiently.
CRIMALDDI is an attempt to make this happen.
Ian Boulton is project coordinator for CRIMALDDI and a consultant specialising in malaria and neglected tropical diseases. He was previously one of the leaders of the GSK Diseases of the Developing World Initiative.
Steve Ward is deputy director of the Liverpool School of Tropical Medicine and scientific coordinator of the CRIMALDDI Consortium.