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05 Sep 2018

Malaria World Congress sets precedent for greater collaboration between stakeholders in malaria elimination

From 1-5 July 2018, Melbourne hosted the inaugural Malaria World Congress, welcoming delegates from 66 countries. BMC Medicine spoke to four of these delegates on the importance of community-driven approaches, funding for malaria elimination and adapting interventions for specific local needs.

Sarah Charnaud, Julia Cutts, Angela Devine & Herbert Opi 

Despite malaria having been with us for millennia, prior to the Malaria World Congress there was no forum for all key stakeholders involved in elimination of the deadly disease to come together and share information. The presence of policy makers, national malaria control program personnel, scientists, clinicians, civil society and community organizations, funders, and regional organizations, made this meeting truly different.

Uniquely, the Congress featured four main pillars: Frontline and Intervention, Putting People at the Centre, Science, and Governance, ensuring engagement with a broad range of players. The Congress was a step to greater collaboration between laboratory and field scientists, implementers and community users.

Traditional scientific conferences are notoriously insular, with the abundance of jargon often preventing those from non-research backgrounds entering the discussion. For many basic scientists, this was the first time we had been exposed to the ideas of the end user: what do people living in malaria endemic regions want and need? How can we improve access to basic life-saving interventions? What happens when diagnostic tests and drugs fail? Throughout the conference, scientists were exposed to ideas that put people at the center.

A resounding message to come out of the Congress was that for too long, the voices of affected community members have been ignored or unheard by decision makers. However, capacity building and community-driven approaches to malaria control and elimination will be absolutely critical for success. To address this gap, a new civil society initiative, the Civil Society for Malaria Elimination (CS4ME) was formed immediately prior to the Congress, with the aim of bringing on board civil societies and other interest groups around the world in the fight against malaria.

The importance of partnerships in research was emphasized: Dr Moses Laman (PNG Institute of Medical Research) argued that research project ‘failures’ are often not technical, but due to inadequate partnership.

The Congress encouraged participants to consider malaria elimination in the broader context of global health, health security, health systems strengthening, the Sustainable Development Goals and Universal Health Carein some contexts where frontline healthcare workers solely provide malaria-related services, declining malaria incidence can translate to a decline in malaria testing, as communities no longer perceive malaria as a risk. However, testing rates may improve when additional health services are offered by healthcare workers, thus sustaining the momentum of malaria elimination measures.

Funding for malaria elimination was a major discussion point, with Dr Rima Shretta(APLMA and UCSF) and others highlighting the strong investment case to be made for malaria elimination. Analysis by think tank Policy Cures Research revealed that the US government and US-based Bill and Melinda Gates Foundation provide over half of all funding for malaria research and development, but several speakers called for greater financial commitment by the governments of malaria endemic countries themselves.

While there was a clear and urgent call for research and development of new tools, particularly in the context of drug and insecticide resistance, the rallying cry to optimize use of current tools was just as emphatic.

To eliminate malaria globally, it is critical that we adapt interventions to suit local needs and challenges. Dr Corine Karema (Swiss Tropical and Public Health Institute, Rwanda) highlighted how heterogeneity within a single country calls for varying responses and differences in allocation of resources for optimal outcomes. In the Asia Pacific, relapsing P. vivax and zoonotic P. knowlesi provide additional challenges and call for specific approaches. It was widely acknowledged that the “the last mile” to malaria elimination will be the most difficult.

An important and unique outcome from the Congress was the development of a Statement of Action identifying priority areas. The Statement reflected the optimism apparent throughout the Congress, largely driven by the enormous achievements to date, but also acknowledged that the status-quo is not enough to achieve malaria elimination.

Sir Richard Feachem (UCSF) argued convincingly that commitment matters, and we shouldn’t wait for the tools before we commit. If we commit, the tools will come. We must think of creative new ideas, listen but also act, and collaborate far more effectively to eliminate the disease. You can read the statement here.