Getting the right message across on malaria

Although research on malaria needs greater support, the fight against the disease will not be won in the laboratory but with tools in the field, many of which already exist. Improved techniques are needed to communicate this reality to decision-makers.

Next week, researchers from around the world will attend the biggest ever scientific conference on malaria, to be held in Cameroon’s capital Yaoundé. It is being organised by the Sweden-based Multilateral Initiative on Malaria (MIM) and the Biotechnology Centre of the University of Yaoundé.

Inevitably, much of the attention generated by the conference, both among the participants and in the media, is likely to focus on new possibilities for preventing and treating the disease.

With a malaria vaccine still elusive, everyone will want to hear about promising candidates. They will also want to hear about new anti-malarial drugs — particularly those based on artemisinin — to replace existing treatments to which parasites are becoming increasingly resistant.

In some ways, such focus on novel approaches is appropriate. After all, much of what will be said is likely to be familiar, both to malaria researchers and to those who support their efforts. 

And this novelty will, equally inevitably, be the main focus of media coverage. After all, ‘news’ is, by definition, that which is ‘new’, in science reporting as in any other field of journalism.

But there is a major threat lurking in all of this. Paying excessive attention to novelty in the prevention, diagnosis and treatment of malaria could be detrimental. Portraying malaria as a problem that will only be solved by new research could deflect attention from existing knowledge and techniques that have already been proven effective.

Needing both old and new

This is not an ‘either/or’ situation; science and health journalists covering the meeting must ensure that their coverage of new developments does not obscure the message that existing tools need to be used more efficiently. Biased coverage would send a distorted signal to aid donors and government officials alike.

No-one at the Yaoundé conference will be ignorant of the enormity of the malaria challenge. Each year, between 300 and 500 million people get sick with the disease, and it kills up to three million of them — mostly young children in sub-Saharan Africa. Africa loses about US$12 billion a year in lost economic capacity.

Nor will the participants be ignorant of the scientific difficulties in combating this disease. The parasite adopts different forms during its lifecycle. This means that vaccine researchers face massive difficulties in deciding which parasite proteins are likely to be the most vulnerable to attack (see Malaria vaccines: research problems and priorities).

Similarly, efforts to develop new artemisinin-based drugs to treat the diseases are hindered by the facts that artemisinin itself is in short supply, and that such ‘combination therapies’ are much more costly than existing drugs such as chloroquine.

More money for research

It is therefore encouraging that funding for malaria research, after declining over several decades, is once again on the increase. Particularly significant in this context has been the support from by the Bill and Melinda Gates Foundation, which last week announced US$258 million in grants for malaria research and development.

This money is far from sufficient to meet the full range of research needs in the field; in the same week as the grants were announced, the Malaria R&D Alliance, an international coalition of research groups, reported that global funding for malaria in 2004 was only US$323 — a fraction of the US$3 billion needed (see Malaria research ‘needs ten times more funding’).

Nevertheless, it should be enough to allow significant advances in three separate aspects of research — testing a new malaria vaccine, developing low-cost anti-malarial drugs and creating safe, effective and long-lasting insecticides.

Foundation officials, sensitive to previous criticisms of the institution’s tendency to focus on technical fixes rather than system-wide approaches (see for example, New vaccines are not the only answer to malaria), have stressed that research is only part of the solution.

Richard Klausner, executive director of the foundation’s Global Health Program, has written of the need “to deploy existing tools on a vastly greater scale”, while Bill Gates himself, in announcing the awards, emphasised the need not only for investment in research and development, but also expanded malaria control programmes.

Nevertheless, large sectors of the malaria community remain concerned that, when it comes to listening to messages, government decision-makers – and journalists for that matter – remain more attentive to new research prospects rather than the more prosaic task of ensuring that existing knowledge is used as widely and effectively as it could be.

Getting the message heard

Two articles in the new dossier that SciDev.Net is publishing this week (see www.scidev.net/malaria) provide details of this dilemma. Chris Curtis of the London School of Hygiene and Tropical Medicine, for example, shows how one of the most effective ways of preventing the spread of malaria lies in the community-wide provision of bednets rather than just focusing on vulnerable groups such as pregnant women and children (see Insecticide-treated bednets to prevent malaria). 

In a separate opinion piece, Jeffrey Sachs and colleagues from the UN Millennium Development Project argue that tools such as bednets should be given away for free — because no matter how cheaply they are sold, millions of rural Africans at risk of malaria still cannot afford to buy them (see The cost of making the poor pay).

It would be as naive to pretend that new approaches are not needed. And the exciting scientific possibilities that exist in malaria research need to be highlighted to ensure that the brightest scientific minds are attracted into this field of study.

But it remains important that all those engaged in the fight against the disease remember that no matter how groundbreaking new developments are, they will only make a significant impact if they are introduced into effective production and delivery systems.

And if these delivery systems are not distributing existing tools to those who need them, what hope is there for future vaccines or drugs?

Indeed, what is needed is the ‘systems of innovation’ approach that has been frequently described on this website. Such an approach requires an awareness that the fight against malaria will ultimately be successful only if is multi-faceted and multi-dimensional; it is not a fight that will be won and lost in the laboratory.

Getting this idea across through newspaper headlines is, itself, a major challenge. After all, ‘magic bullets’ have an immediate appeal to reporters and news editors alike in a way that bednet-financing strategies could never hope to achieve.

But spreading the message that many tools to fight malaria are already at our disposal — if only we would learn to use them more effectively — remains a goal to aspire to. It is also that, in the long run, could make a greater impact on the global fight against the disease.