Robert Newman, Former Director, Global Malaria Programme, World Health Organization
The Worldwide Antimalarial Resistance Network (WWARN) is collaborating with the WHO Global Malaria Programme (GMP) on an initial 3-year project to improve data transfer and information exchange, and to develop tools to facilitate the monitoring of antimalarial drug efficacy and drug resistance.
Dr Robert D Newman
1. What will WWARN contribute to the fight against malaria?
WWARN offers a comprehensive approach for aligning the many aspects of antimalarial drug resistance research. The WWARN database has the potential to link all four components for assessing drug efficacy and resistance (clinical, in vitro, pharmacological, molecular markers) together. When it is functional and completed, this database will have the capacity to provide information for the validation of new tools to improve the existing methods of surveillance. In addition, WWARN's collaborations with many research institutes which are active in the areas of emerging artemisinin resistance make WWARN an ideal platform for coordinating new research on molecular markers of artemisinin resistance.
2. Why is it so important that WHO and WWARN work together?
Resistance to artemisinin is an urgent public health problem that requires a dedicated and coordinated response. WHO and WWARN have complementary capacities that can serve to benefit malaria endemic countries. WHO's mandate is defined by six core functions, including monitoring the health situation and assessing trends, and setting norms and standards. WWARN can complement and support WHO's core functions by collating the evidence on new determinants and predictors of drug resistance. Through its convened independent experts, WHO can review this evidence, which can contribute to the development of new protocols and new approaches for the study and surveillance of resistance to antimalarial medicines.
3. Data sharing will be key to the success of the project: how will we encourage people to contribute?
WHO currently collects mainly clinical data, not only from antimalarial drug efficacy studies coordinated by National Malaria Control Programmes but also from research institutes and other partners. These data are shared with WHO to guide national health authorities in the process of updating malaria treatment policies. The work of WWARN in the development and validation of new research and surveillance tools, requires access to comprehensive individual patient data, comprising the four components I spoke about earlier - clinical, in vitro, pharmacology and molecular markers of antimalarial drug resistance. Ideally all these outcomes would be available for the same patient. For this, WWARN focuses its collaborative work with research institutes that conduct these specialized studies. Ultimately, it is critical that appropriately protected data from all sources are made publically available in a common format to improve our understanding of antimalarial drug resistance and accelerate our response capacity to this threat. To ensure that this happens, WHO and WWARN need to work together to strengthen trust and collaboration between researchers and control programmes.
4. Looking ahead what do you think are our main challenges?
We cannot be complacent about the gains we have made in malaria control, as our progress is fragile. Our most acute challenge is to contain artemisinin resistance and prevent its spread. Thinking more broadly about antimalarial drug resistance, more investments are needed at country level to ensure the regular surveillance of antimalarial drug efficacy. This was emphasized in the recent Global Report on Drug Resistance (2000-2010) and highlighted in the Global Plan for Artemisinin Resistance Containment, which showed that currently, only one third of malaria endemic countries are conducting adequate monitoring of antimalarial drug resistance. We also need to work with endemic countries to ensure that young researchers and malaria control staff receive the support and mentorship they need to be the leaders of tomorrow in the fight against antimalarial drug resistance. Finally, we all need to continue working together to achieve the health-related Millennium Development Goals by 2015, and to achieve our long term goal of a world free of malaria.