A research agenda for malaria eradication
Dr Margaret Chan
Director-General of the World Health Organization
Fellow members of the Leadership Council, distinguished scientists, colleagues in public health, ladies and gentlemen,
It is a great honour to address such a distinguished group at the end of this Zenith Week. As I have been told, this was a truly celestial event, where some of the brightest stars in basic research, product development, and the art and science of malaria exchanged views for a lofty cause.
I wonder if there are many meetings as forward-looking, ambitious, and yet scientifically rigorous as this one. Congratulations on a job well done.
The global momentum that has been built, so quickly, to tackle malaria is extraordinary. In a very short time, the world has gone from trying to hold malaria at bay, to aiming for its eradication.
As last year’s World malaria report tells us: development for health is working. With determination, resources, and good strategies, it is indeed possible to substantially increase coverage with existing interventions. And when this happens, the malaria burden falls dramatically. This is already extremely encouraging.
We know where the next immediate challenge lies. We need to move, with equal determination and assurance of success, into the heartland of malaria, where the disease is most rampant. Worldwide, around 50% of all malaria deaths occur in just five countries: Nigeria, Democratic Republic of the Congo, Uganda, Sudan, and Tanzania. Success in this heartland will be another milestone in building confidence that malaria can be defeated, once and for all.
This meeting has addressed yet another level – the celestial level – of ambition. That is, the ultimate defeat of a disease that has been the single biggest killer of people for tens of thousands of years. And you have mapped out a research agenda for doing so.
High ambitions fuel momentum, and they can also spark innovation. But the ambitions must be feasible and we must have solid evidence that they are doable. We must have good reason to believe that new and better tools are a realistic part of the future. And we must have a good grip on the magnitude of the task as we think about the ideal tools that will be needed, especially in resource-constrained settings.
We know we are in it for the long haul, and that steadfast determination will be as important as the discovery and development of new tools.
In terms of the long haul, it will be important to ensure that the research that emerges from malERA provides a platform for the engagement of young scientists from endemic countries. The engagement and mentoring of these scientists will be critical to the long-term success not only of the research agenda, but also of the eradication goal.
I was especially pleased to hear that there was a session dedicated to capacity building and training the next generation of scientists in endemic countries.
Because malaria has such a devastating economic impact, its control receives high political priority in endemic countries. A research agenda also needs buy-in from political leaders, such as those represented in the African Leaders Malaria Alliance.
The work done this week, supported by the seven consultative groups, is a solid step forward. It is also an important signal that the goal of malaria eradication is being taken very seriously by the scientific community. You are doing so in a rigorous, well-structured way that has looked at the historical past as well as towards the future. High ambitions gain substantial credibility as a result.
You have looked at research questions and knowledge gaps and you have generated a wide range of new ideas. In particular, you have opted for a multipronged approach that includes health systems, operational research, and monitoring and evaluation in addition to the basic and applied sciences.
You have taken a close and critical look at the prospects for vaccine development. You have considered the evolving needs for vector control. You have shown how a variety of mathematical models and analytical techniques can be used to assess the technical, operational, and financial feasibility of eradication, decide what combinations of tools and what level of coverage will bring the biggest payback, and avoid some mistakes of the past.
You have stressed the need for flexible strategies that can respond, as control progresses, to complex changes in the dynamic relationship between people, mosquitoes, and parasites.
You have set out your “gold standards” for diagnostics, and defined a “gold medal” ideal drug that provides radical cure and prophylaxis in a single encounter. But you have also made it very clear that no silver bullet will ever be able to defeat malaria. As noted in the documentation prepared for this meeting, no single technical breakthrough in any single area will be sufficient to eradicate a disease as complex and tenacious as malaria.
Even a highly effective vaccine will need to be supported by the simultaneous use of drugs, vector control, good monitoring and evaluation, and well-performing health systems.
Your achievements in so short a time are most impressive. They will no doubt guide researchers and funding agencies as the momentum to defeat malaria builds. As so many of your documents note, the move towards eradication needs a carefully planned, phased approach. Right now, we need to continue to build confidence on the ground.
The further spread of resistance to artemisinins makes progress fragile. We must be forceful in our call for a halt to the marketing and use of monotherapies. We need to increase the use of diagnostic tests as another way to prevent the misuse of these drugs.
Finally, as we look beyond the conclusions of this exciting Zenith Week, I want to assure you that WHO and TDR stand ready. We are ready to collaborate with all of you in executing this ambitious research agenda.
And we are ready to translate the evidence that emerges from this research into up-to-date technical policies and guidance as countries move forward in their determined fight to eliminate and eventually eradicate this ancient foe.
As I conclude, let me say thank you for putting so much smart science in the service of humanity. For me, seeing creative, cutting-edge science applied to a disease that mainly affects the poor is almost as uplifting as the decision to aim for eradication.