Consultative Groups

Drugs

Used in conjunction with other tools, safe and effective antimalarial drugs will be a central pillar of all stages of the eradication process. As progress is made toward eradication, the goals of drug treatment and prevention strategies will change. These shifting goals will require drugs and drug combinations with different characteristics at different times and in different places. If it emerges and spreads, resistance to the artemisinins and other key drugs will threaten the whole malaria eradication enterprise. Now and at all stages of eradication, ensuring a steadily flowing pipeline of new drugs with the desired characteristics will be critical. Several key areas for drug improvement are needed, including effective and safer drugs to attack the liver stages of malaria, particularly for vivax malaria (hynozoites); drugs that block transmission by targeting the sexual stages of the parasite (gametocytes) that are transmitted to the mosquito; and drugs that block transmission by completely curing infection before gametocytes form. Pharmacokinetic and pharmacodynamic properties of antimalarial drugs and drug combinations will need to be optimized to improve adherence, safety and efficacy and to prevent emergence and spread of resistance. In coordination with other MalERA theme groups, novel strategies need to be developed for identifying and treating infected individuals as malaria incidence falls.

Health Systems, Operational Research, and Diagnostics

Developing an R&D agenda for malaria eradication not only entails the challenges to discover and develop new tools for diagnosis, surveillance, treatment and prevention, but to understand the key determinants of health systems. Health systems will have to provide the basis and framework to achieve and sustain elimination and eradication. Efforts must also focus on how existing and future tools can be strategically combined for maximum synergistic effectiveness when integrated into different health and social systems prevailing in different endemic areas. This further implies the need for effective and integrated surveillance strategies to monitor progress and the dynamics of malaria transmission in a world with rapidly increasing dynamics across environment, climate, migration, and transnational cooperation. A systemic approach also includes reflections about capacity-building and operational research issues for the whole R&D process from discovery to public health application and for health systems management.

Integration Strategies

Malaria has proven to be a resistant and adaptable disease that requires a multi-pronged approach with integrated strategies. Innovative solutions will only arise from synchronizing the ideas of people from diverse backgrounds, and for this to operate functionally, a system that rewards participants who share their information should be developed. This could include open source collaborations, use of the Internet to create social networks and facilitate collaboration, using funding more efficiently, and balancing collaboration with competition. Non-malaria experts in related fields will actively be engaged to encourage innovative thinking and the identification of non-traditional tools for malaria control.

Modeling

It is broadly accepted that there will be no single existing or new intervention to move from control to elimination and eventually eradication, but that integrated control strategies well tailored to a given epidemiological setting are required. When faced with the challenge to design and predict the impact of different intervention strategies for different endemic areas, the modeling of malaria epidemiology and the transmission dynamics can play a key role for the design of possible new tools and strategies, the combination of interventions and the design and adjustment of global strategies. Modeling entails much shorter time-spans than the development of effective strategies through trial and error in the field. Key questions on modeling entail (i) exploring which research questions modeling can and should address to complement the global strategy of malaria elimination, and (ii) defining the needs at the level of development of modeling at the conceptual and technical level.

Monitoring and Evaluation, and Surveillance

Improved and new tools and stratgies for monitoring, evaluation, and surveillance are needed to track of program intervention coverage, impact on cases and transmission, and progress towards elimination/eradication. New survey tools may help to measure transmission more simply and directly, thus enabling detection of 'hot spots' requiring additional resource allocation. Surveillance definitions must be standardized, and surveillance methodology and supporting technologies, such as information systems and data management must be developed to accurately track cases in real-time to target program response and limit outbreaks. In addition to case surveillance, improved and new tools may also be needed to track resistance to antimalarial drugs, vector control activities, and potentially, vaccines.

Vaccines

Vaccines that can protect against malaria and block transmission of malaria parasites can play a significant role in achieving the goal of malaria eradication. Following investment in basic and translational malaria research over the past three decades a number of malaria vaccine candidates are now in clinical development. While these first generation malaria vaccines may provide partial protection, they are unlikely to provide high levels of sustained protection. Vaccine development needs to address P. falciparum and P. vivax in different transmission settings and in potentially specific populations (e.g. pregnant women and children). There is an urgent need to review and rethink approaches to malaria vaccine development with the goal of developing vaccines with significant long-term efficacy. Moreover, if malaria vaccines are to contribute to the goal of eradication, vaccines that reduce malaria transmission must receive more attention. A multi-faceted strategy is needed to develop effective vaccines, which can only be achieved through collaboration.

Vector Control

Better and more varied vector control is needed, as well as more effective use of current products. It is also important to assess how to create a "pull" factor, which will attract people to those products that promote vector control. In addition, better ways to monitor vector behavior are required, as such information will inform what products actually do when used, how to target vectors other than indoor-biting mosquitoes and what products need to be developed to target other vectors. At a higher level, consideration should be given to targeting novel aspects of vector behavior in the development of new control tools, and that likely will require greater study of vector biology.

Young Investigators

To achieve eradication, we will need to develop new tools and make even better use of existing ones; to identify gaps in our knowledge of parasite, vector, and human biology; to recruit required expertise and tools from other fields; to identify barriers to moving basic research into concrete action toward eradication of malaria, and to identify career development challenges and opportunities facing young investigators working in malaria. A group of researchers early in their careers has been created to deep discuss all these topics and more, and to provide inputs that will become part of the larger white paper that will outline a comprehensive R&D agenda for malaria eradication.