Malaria meeting charts rocky path ahead

Scheveningen, the Netherlands

US proposals to establish a common, centrally managed fund for malaria research were firmly rejected at an international meeting in Scheveningen last week. But a positive outcome of the meeting was a decision on the next steps to take in combating malaria.

The high-level meeting was a follow-up to an international meeting on malaria research held in Dakar, Senegal, in January, where the world's research agencies, charities and major donors met for the first time to explore ways forward (see Nature 386, 535; 1997). The movement has since been named the Multilateral Initiative on Malaria (MIM).

The meeting resulted in a clarification of MIM's raison d’être , with a shift in focus away from relatively narrow issues of research management towards the wider strategic goals of obtaining an increase in funds for malaria research, and pushing the disease up the international political agenda. This shift was reflected in the decision to replace MIM's ill-defined collegial structure with a more formal organization and to set up a series of working parties.

The degree of attention now being focused on malaria was reflected in the calibre of the participants at the meeting. The US delegation alone included Harold Varmus, the director of the National Institutes of Health (NIH) and Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases.

Coordination, not pooling

Also present were Fotis Kafatos, director of the European Molecular Biology Laboratory in Heidelberg, George Radda, director of the UK Medical Research Council, Robert Howells of Britain's Wellcome Trust, and senior officials from the World Bank, the European Commission (EC), the World Health Organization (WHO) and the Organization for African Unity. Major pharmaceutical companies were also represented for the first time.

The US proposal came under intense criticism from all sides, with opponents calling it premature and unworkable. An alternative proposal was equally rejected, which, while creating a common application and review process, would still have allowed individual agencies to decide whether to fund projects approved by a common review body. Mark de Bruycker, an EC official, pointed out that, as the commission is legally obliged to peer-review all research proposals, it would be unable to take part in such as scheme.

Echoing comments by other agencies, he argued that coordination could be achieved more simply by agreeing on specific priorities, and then inviting researchers to apply for funding for these through existing agencies. Howells agreed that “pooling resources is not desirable”. Others argued that malaria should be considered as part of the overall collaboration between agencies on issues of health in developing countries, and that setting it apart would weaken inter-agency collaboration. But Varmus dismissed such positions as defending “business as usual, with a little more enthusiasm”.

Letters of interest

Many at the meeting, while encouraged by Varmus's prominent lead in promoting malaria research, were concerned that US hyperactivity could upset established working relationships between the agencies involved in malaria research. Indeed, apprehension at US calls for radical change was fuelled by the fact that its interest in health issues in Africa is relatively recent, whereas Europe — the United Kingdom and France in particular — has a long tradition of supporting research on the continent.

”I can understand Varmus's impatience, but at the same time he must respect the fact that actually Europe has delivered here and the US has not,” said one senior official from a European funding agency.

The root of the row was a perhaps over-zealous decision at the Dakar meeting to issue a call for ‘letters of interest’ in malaria research. The organizers originally intended this only to yield a rough idea of the needs of researchers. But many scientists interpreted it as a formal call for proposals that would be followed up by funding.

The meeting found itself in the embarrassing position of having 138 letters of interest requiring new funding of millions of dollars, whereas MIM had not even begun to address the fundamental problem of how to win an increase in funds.

In putting the cart before the horse in this way, the organizers triggered what many agreed was a premature debate over how any research programmes should be managed, which took the meeting to the brink of a fiasco. At the same time, the mini-crisis prompted a rethink of MIM's purpose. Several delegates reminded the meeting that MIM's efforts would come to nothing unless it focused on the fundamental issue of boosting the paltry funds now available for malaria research (see Nature 386 535; 1997).

“Talking about research networks is not going to put malaria on the global agenda,” said C. Ok Pannenborg, a senior official at the World Bank. One funding agency official said that if funders were to invest they would need to hear consensus on such strategic questions as where most money should go — in vaccines, drugs or basic research — and whether more field sites should be set up in Africa, and, if so, how many.

As a result, a core organizing committee, which includes the Wellcome Trust, NIH, France's Institut Pasteur, the EC and the Organization for African Unity, has been created to address such issues.

Winning funds for research

The outcome of the meeting was ultimately “extremely positive”, said a funding agency official, because it “put the discussion on the next level up”, enabling MIM to start ‘politicizing’ malaria and getting more resources. Howell added: “There is now a much clearer picture that MIM is there to attract funding for malaria research.”

A series of working groups was also set up, with WHO's tropical research division accepting responsibility for preparing a compendium of the mandates, procedures and research carried out by the various agencies, with a view to facilitating collaborative research proposals. NIH is to report on the major basic research challenges, while the World Bank will prepare a macroeconomic analysis of malaria-related issues.

Responsibility for public relations, which emerged as a priority, was allocated to the Malaria Foundation, an independent charity based in Washington. It will also develop a plan for improving Internet access in Africa, working with the US National Library of Medicine, the EC and the World Bank.

This approach was endorsed by Pannenborg, who argued that MIM must realize that progress in fighting malaria can be achieved only by “a long-term concerted effort by a powerful group of players”, but with the various agencies working “in parallel”.

Meanwhile, the very existence of an influential lobby for malaria research is already paying dividends, according to one official. “Everything that was going on here [at The Hague] helps us to find ways to get money into malaria,” he said after the meeting. “It empowers me to say to my colleagues, as I did, that ‘I think something very good seems to be happening here’; I wouldn't do that if I thought this was no good”.

D. BUTLER

Varmus: plans for a centrally managed fund for malaria research failed to win universal support.