Global research needed to address a disease without borders

In recognition of World Malaria Day, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has released two documents that describe a set of actions-national as well as international-that lay the scientific foundation for continued public health advances in the struggle against malaria. The NIAID Strategic Plan for Malaria Research: Efforts to Accelerate Control and Eradication of Malaria through Biomedical Research (view the PDF here) presents a long-term vision that links progress in malaria control to evolving research needs and priorities. The NIAID Research Agenda for Malaria (view the document here) identifies specific gaps and opportunities in the research portfolio, defines research priorities and lays out a series of research objectives and activities that address these needs and priorities.

The theme of this inaugural World Malaria Day, A Disease Without Borders, reflects the worldwide impact of malaria and underscores the increased need for global collaboration. More than 40% of the world's population, living in more than 100 countries, is at risk of contracting malaria. Although malaria exacts its greatest toll in sub-Saharan Africa, the disease also affects people in many parts of Asia, Latin America and the Middle East.

A major killer

The World Health Organisation (WHO) estimates that 300 million to 500 million cases of clinical malaria worldwide occur each year, killing 1.3 million people, most of whom live in developing nations. The vast majority of deaths occur in children under the age of five and in pregnant women in sub-Saharan Africa. Malaria also impedes economic growth and development in affected countries.

Programs such as the President's Malaria Initiative, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and many national malaria control programs are reducing the numbers of people who become sick or die from malaria. Nonetheless, we must increase and sustain malaria control efforts, especially if we are ever to achieve our mission to eradicate the disease throughout the world.

History has taught us that malaria is remarkably resilient, resurging because of the emergence of drug-resistant parasites and insecticide-resistant mosquitoes. New approaches and strategies will be required to sustain the successes of control programs over the long term.

Fortunately, scientists have made remarkable progress in understanding malaria parasite and mosquito biology and in translating these findings into tools to prevent and treat disease. For example, a promising candidate malaria vaccine known as RTS,S has been shown to offer partial protection against malaria in studies among children and infants in Mozambique.

Identifying the genes

A more recent clinical trial conducted in 40 adult volunteers in Mali demonstrated that a second candidate malaria vaccine based on the malaria protein AMA-1 is safe and elicits a strong immune response. Based on these results, a trial of this candidate vaccine was recently launched in 400 Malian children. Other candidate malaria vaccines are in early stages of clinical testing. Another recent effort, to sequence 54 variants of the most deadly malaria parasite, Plasmodium falciparum, revealed nearly 50,000 genetic variations.

This knowledge may help researchers understand how the organism evolves and may reveal potential drug and vaccine targets. Other investigators have already taken advantage of genome sequence data to identify which genes are expressed in human malaria and are correlating this information with disease manifestations as another way to identify drug and vaccine targets.

As part of our broad effort in global health research, NIAID supports basic, translational and clinical research to develop the tools needed to prevent, treat and control malaria. The control, elimination and ultimate eradication of malaria will require a long-term, sustained effort that will necessitate strengthening the many partnerships that already exist as well as forming new collaborations.

Building capacity in Africa

Through our partners in the Multilateral Initiative on Malaria, we are building a critical, sustainable malaria research capacity in Africa. This initiative seeks to increase and enhance research on malaria worldwide by facilitating multinational research cooperation, and by supporting the career development and research efforts of scientists working in malaria-endemic areas. NIAID also has developed and supports the Malaria Research and Reference Reagent Resource Centre to provide research reagents, materials and protocols to facilitate the work of malaria researchers worldwide.

We recognise the efforts of the researchers, healthcare workers, communities and organisations dedicated to identifying and developing effective tools and interventions to treat, prevent and control - and eventually eliminate and possibly eradicate - malaria globally.

NIAID has worked collaboratively for many years with numerous partners, including Fogarty international Centre, the National Library of Medicine, the US Agency for International Development, the US Department of Defence, the Centres for Disease Control and Prevention, the World Health Organisation, the European Commission, the European-Developing Countries Clinical Trials Partnership, the European Malaria Vaccine Initiative, the Wellcome Trust, the Bill & Melinda Gates Foundation, the Malaria Vaccine Initiative and the Medicines for Malaria Venture.

The goals of these research partnerships in malaria are ambitious, and the challenges correspondingly formidable; however, the objectives are worthy of our greatest efforts and scientific minds. Together, the global community will continue to transform scientific advances into highly effective interventions against the ancient scourge of malaria, and eventually defeat this global disease.

What is NIAID?

NIAID is a component of the National Institutes of Health. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on basic immunology, transplantation and immune-related disorders, including autoimmune diseases, asthma and allergies.

The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centres and is a component of the US Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases.

Visit NIAID's malaria Web site (http://www3.niaid.nih.gov/topics/Malaria/default.htm) for more information.