April 25, 2015
Statement of B.F. (Lee) Hall, M.D., Ph.D., and Anthony S. Fauci, M.D., National Institute of Allergy and Infectious Diseases National Institutes of Health
On World Malaria Day 2015, the National Institutes of Health (NIH) reaffirms its longstanding commitment to reducing the global burden of this devastating and persistent disease.
Progress has been made in the fight to control and eliminate malaria. Since 2000, global malaria mortality rates have decreased by 47 percent, according to the World Health Organization (WHO). Nevertheless, an estimated 3.2 billion people worldwide are still at risk of becoming infected with the malaria parasite. And the mosquito-borne disease continues to kill far too many people. In 2013, about 584,000 people died of malaria, mostly African children. More must be done to implement proven malaria control programs and to develop new tools to treat, prevent and eliminate disease.
For the past two years, the World Malaria Day theme has been, "Invest in the Future. Defeat Malaria." That theme continues today. The National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH, continues to conduct and support biomedical research to better understand malaria and develop interventions to defeat the disease. The broad NIAID malaria program includes research to better understand the biology of malaria parasites; studies to identify and develop tools for diagnosis, treatment and prevention of malaria; and projects to enhance the research infrastructure in malaria-endemic countries. Fostering global cooperation in these efforts, including dialogue between laboratory-based and field-based researchers, is a key objective in NIAID's goal to reduce the incidence of and ultimately eradicate malaria.
Major elements of NIAID's malaria research agenda are carried out at the International Centers of Excellence for Malaria Research (ICEMR), a global network of centers with clinical research infrastructure in malaria-endemic regions. Each center is exploring the changing epidemiology and transmission of malaria and the new challenges presented by resistance to artemisinin, the main drug used to treat malaria. NIAID also supports research on drug resistance beyond the ICEMR program. For example, NIAID scientists helped identify a genetic marker of resistance as well as the mechanism of resistance, which will help scientists track the spread of resistance. In addition, a recent study conducted by NIAID scientists and international researchers showed that artemisinin resistance among malaria-causing Plasmodium falciparum (P. falciparum) parasites is now widespread in Southeast Asia, requiring longer courses of treatment.
New tools are in development to monitor and contain the spread of artemisinin-resistant parasites, including a barcode developed by NIAID researchers that can be used to track the geographic origin of parasites. Although artemisinin resistance is widespread in Southeast Asia, we are encouraged by a large-scale surveillance study conducted by NIAID-supported researchers that did not find artemisinin resistance mutations in circulating African parasites. Further study is underway to monitor and detect resistance in these parasites in an effort to slow its spread.
The emergence and spread of drug-resistant parasites underscores the critical need for new and effective antimalarial drugs. NIAID currently is providing product development support for 18 antimicrobial drug concepts and participating in multi-organization partnerships to accelerate research and development of new interventions. In addition to drug treatment, NIAID-supported scientists are also investigating ways to improve clinical management of malaria patients. A recent study in African children of the pathogenesis of cerebral malaria, a severe and frequently fatal form of malaria, found that increased intracranial pressure may be contributing to fatal outcomes. These findings suggest that interventions that decrease brain swelling may reduce mortality.
A safe and effective malaria vaccine is crucial to the effort to control malaria globally, especially in areas of low transmission that remain prone to future outbreaks. NIAID supports a broad portfolio of malaria vaccine research, ranging from basic to clinical research, employing a variety of technological platforms. For example, NIAID researchers and grantees recently identified PfSEA-1, an antigen that impeded parasite replication, offering a target for future malaria vaccines. NIAID scientists also improved an older malaria vaccine by adding an additional parasite protein. The resulting complex, called AMA1-RON2, protected mice from a lethal form of mouse malaria and could potentially be tested in the next generation of human malaria vaccines.
Many other preclinical and clinical vaccine studies are underway, including tests of investigational vaccines designed to block malaria-causing parasites as they enter and develop in the mosquito or as they are transmitted to humans via mosquito bite. For example, one investigational malaria vaccine, called PfSPZ, uses weakened malaria parasites that are delivered intravenously. In 2013, the experimental vaccine was found to be safe and protective in a small clinical trial. Further testing of the vaccine is underway.
In addition to vaccines, NIAID is supporting research to find alternatives to mosquito control. Resistance to at least one insecticide used for malaria control has been detected in 64 countries. To combat this, NIAID is supporting research on bait traps and alternatives to the commonly used repellent N,N-Diethyl-meta-toluamide (DEET).
The fight against malaria-a preventable and treatable disease-requires constant vigilance and coordination among researchers and healthcare providers around the world. On World Malaria Day, we join our partners in reaffirming our commitment to this fight by pursuing the biomedical research needed to control and ultimately eradicate this disease.
Lee Hall, M.D., Ph.D., is chief of the Parasitology and International Programs Branch in the NIAID Division of Microbiology and Infectious Diseases. Anthony S. Fauci, M.D., is Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.