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A need for coordination of projects, donors and various players

May 2, 2014 - 13:17 -- Clive Shiff

I feel that we should start a conversation about coordination. I attended Malaria Day here in Baltimore last week, and one still hears people speaking as if all we have to do is send more nets to Africa! Africa is swimming in nets, in fact there are NO plans that one hears of to REPLACE (key word) expended of torn nets in anything but an ad hoc manner. Yet Anopheles funestus (resistant to pyrethoids) is appearing all over Eastern and Southern Africa.

One could go on.. but anyone of us malariologists working in the field will know what I mean. I would like to se what others feel, as I think we should start to think of a global oversight to keep things on track.
Any ideas (I have some, but it would be nice to hear others first!)

Clive Shiff

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Comments

Clive Shiff's picture
Submitted by Clive Shiff on

I think that WHO should be resourced to re-establish its advisory role that it had in the mid-20th Century. There should be some respected organization with oversight. e.g. If ITN were distributed in 2009, the country programme should be asked to reveal when the next intervention will be carried out. OR, with the interest in the "seasonal malaria chemoprevention" (SMC) being adopted. is it wise to allow various NGO to try it because it seems so effective. WITHOUT careful assessment of the effect. If you think about it, this process is ideal for selecting drug resistant parasites, and secondly what will happen to children who had been protected for age 1-5, when they get to 6?
Should we be summoned by the journal Nature ( see Nature 14 November 2013) to be careful with this procedure?
We really have a problem internationally. What do you all think.. There is no other organization than WHO to adopt this. My suggestion is that all donor funders to malaria control should contribute at least 10% of donated funds to WHO so as to finance this oversight process.
That should throw a cat among the pigeons

Clive Shiff

Bart G.J. Knols's picture
Submitted by Bart G.J. Knols on

Dear Clive,

Difficult topic I'm afraid. Although I agree that there should be a mechanism for oversight, the question will be if this is ever going to be possible (again). There are an estimated 10.000 people worldwide working more or less fulltime on malaria, and many of them are die-hard advocates of their own 'best tool'. And so the vaccinologists will argue that insecticide resistance is killing vector control efforts, whereas the entomologists will argue that a vaccine has been promised for decades and that we still don't see one. 'Millions wasted that could have been used better' I often hear them say.

Those working on genetic control of mosquitoes will argue that bednets are useless, that people don't use them a lot of the time because they are too hot, and that there is plenty of pyrethroid resistance. There are die-hard believers in indoor residual spraying (that includes DDT), some that advocate old-style vertical larval control campaigns, and others that now re-invent mass drug administration to deplete the parasite reservoir in the population.

Many flavours, many choices. And scientists battling for their own turf. But where is the true integration of these efforts? Is anybody out there bringing it all together and making wise decisions on what approach will work best in setting A and another approach in setting B? I see very little (or should I say nothing) of that.

Historical successes have told us one thing: there is no one magic bullet when it gets to malaria. But making today's scientists acknowledge that is hard - there are mortgages to be paid, careers are being planned, and perhaps Nobel Prizes around the corner...so we keep on believing in our own bullet...at the expense of other (equally valuable but competitive) approaches. We are all fighting for funding after all...

I have sometimes referred to malaria as an 'industry', where being in the game may be more important than actually going out there and ending it in the real world...or am I missing something?

Clive Shiff's picture
Submitted by Clive Shiff on

Dear Bart,
thanks for the comments. You are quite correct when you relate to malaria research. It is an industry and with all the give and take, it has been remarkably productive. However almost every paper written, even on the most esoteric idea, the preface always mentions the people dying of malaria, so this is the justification (if not always the motivation!). There are two issues that need addressing. First, on the ground application of interventions - the work in the trenches. Presently this is done under the umbrella of a National Malaria Control Centre (NMCC) but in most nmcc's there is a strong donor presence, so the NMCC can only operate with the tacit approval of the donor (who pays,). Donors have the overall deference to the source of funds, so there are limitations on the way the funds can be used and this is not in the hands of the NMCC. Some interventions are encouraged without sufficient research such as the seasonal malaria chemoprevention currently being implemented in parts of Africa. We don't know how this will impact the health of the children when they come off prophylaxis. This needs some oversight. This oversight can only come from an international institution.

The second issue, lies with the research community. Each year we have great conferences that produce papers, discussion seminars etc. The ASTMH Annual conference is a good example. Who knows how many good ideas become "hot air" during these meetings. If the International Agency had the funds to employ scientific personnel to attend these meetings and review many of the research discussions, and report to an expert panel they may be able to channel some ideas into the "applied" world and put then into practice. Couldn't this oversight help? It needs to be dispassionate and objective so donors would not be appropriate. what about WHO?????

The second

Clive Shiff

Andrew Lover's picture
Submitted by Andrew Lover on

"Local malaria problems must be solved largely on the basis of local data. It is rarely safe to assume that the variables in one area will behave in the same way as they do in another area, however closely the two regions may seem to resemble each other in topography and climate. Large sums of money have been wasted in attempted malaria control when malariologists have forgotten this fundamental fact."

- Paul F. Russell, 1946.