Science special issue reports on Malaria

May 15 2010

This week's issue of Science features news articles focusing on recent progress on malaria control in Africa and discussing future challenges, including drug resistance. Summaries appear below:

"Africa is the key battlefield in the fight against malaria - and in recent years, there have been major successes," Science reports in a piece that attributes such successes to "the widespread introduction of insecticide-treated bed nets, indoor spraying, and a new generation of drugs called artemisinin-based combination therapies (ACTs)." However, as the article notes, "most of the successful countries were small and peaceful. More than half of all malaria cases occur in Nigeria, the Democratic Republic of the Congo, Sudan, Tanzania, and Uganda - and in some of those, the challenges are far greater."

The article includes a quote from Robert Newman, head of the WHO's Global Malaria Programme, and features a map of Africa, highlighting the countries who have made gains in the fight against malaria and those where challenges remain (Enserink, 5/14).

A separate piece examines how scientists are responding to the call to eradicate malaria: "Nobody believes that [malaria eradication is] possible in the next 10, 20, or even 30 years. But the call for eradication, combined with the plummeting malaria burden, are already reshaping the scientific agenda," Science notes. "Rather than preventing disease and death, there's a new focus on breaking the chain of transmission between host and parasite," according to the article.

The article details the recent work of "a group of 15 scientists, supported by the [Bill & Melinda] Gates Foundation" who over the past 15 months have "consulted hundreds of experts to hash out a new road map, called the Malaria Eradication Research Agenda (malERA)," expected to be unveiled "in the months ahead." The piece speculates on likely focal points of the research agenda, as gathered from interviews with malaria scientists and previous papers (Enserink, 5/14).

Another piece examines the rise of artemisinin resistance along the border between Thailand and Cambodia. "For the moment, the drugs still work in the area; they just take more time to do the job. But that is alarming enough, scientists say," Science reports. "If resistance gets worse and starts spreading out from here, the results could be catastrophic." The article examines how the Thai-Cambodian border has proven vulnerable to drug resistance in the past, efforts to minimize the risk of the situation and the challenges associated with malaria control in the region.

"Action is needed, and the Thai and Cambodian governments, WHO, and a range of donors have all stepped up their efforts; the ... Gates Foundation alone has contributed $22 million," Science writes. However, according to Nicholas White, "who's widely considered the dean of malaria research in Asia," what's lacking is a comprehensive strategy on how to tackle the issue of artemisinin resistance in the region. The article includes responses to such criticisms by Newman, who "said WHO has a plan but conceded that no publicly available version of it existed; he had WHO staff members write up a strategy and a progress report, however, which he sent to Science on 28 April" (Enserink, 5/14).

"If the current generation of artemisinin-based combination therapies (ACTs) should fail, does the world have a solid backup plan? The short answer: No," Science writes in a related piece that examines several drugs in different stages of development.

"New funding has lured academics and pharmaceutical companies back to the malaria field after a decades-long drought. But drug development is a slow process, and the only compounds far enough along in the pipeline to quickly replace current ACTs are variations on the artemisinin theme. Whether they will kill resistant parasites is a big question," the journal writes (Enserink, 5/14).

Other articles in the Science's special issue: a look at scientist's efforts to create transmission-blocking vaccines to prevent the spread of malaria (Vogel, 5/14); the debate over how to best target efforts to fight malaria (Roberts, 5/14); and the challenges of eliminating malaria in the island of Hispaniola, due to the high number of cases in Haiti (Roberts, 5/14).

Science Editorial Argues For U.S. To Boost Funding For Global Fund

Barry Bloom, a professor of public health at Harvard University and former dean of Harvard School of Public Health, reflects on the Obama administration's plan to "expand multilateral efforts to address the major health problems of developing countries" in a Science editorial.

"One of the triumphs of multilateral cooperation has been the Global Fund to Fight AIDS, Tuberculosis and Malaria, a program that has saved millions of lives in developing countries," Bloom notes. "That is why the $50 million reduction in funding for the Global Fund requested by the U.S. government for fiscal year 2011, in the face of increased requests for expanded coverage by those countries, would be a major setback."

After highlighting key ways the Global Fund has impacted health in recent years, Bloom concludes: "By announcing its intent to expand multilateral efforts, the United States has committed itself to maintain leadership in international development, which the White House states to be as critical to national security as defense and diplomacy. This commitment should include vigorous funding for global health, including the Global Fund" (5/14).