Malaria is not something we usually celebrate. It is something we overcome. Day in and day out, too many of us struggle against its insidious threat to our children. As scientists studying ways to defeat malaria, we witness the toll all too often.

However, on this World Malaria Day, while reflecting on the burden of the disease, we should pause to celebrate the strides made in the fight against it.

Globally, deaths from malaria apparently declined from around 1 million in 2000 to under 800,000 in 2009. How have we gotten this far? The world committed to expanding use of insecticide treated bed nets, artemisinin-based combination therapies, and indoor residual spraying. We should further expand the use of these measures as the burden of the disease is still too high.  But even this may not be enough.

We know from past experience that resistance to malaria drugs and insecticides can rapidly emerge and dramatically compromise our ability to control the disease. Looking forward, we’ll need advances in existing malaria control measures as well as new weapons to fight malaria. This requires investments in research and the capacity to conduct it.

Recently, the push for new malaria prevention tools and the drive to strengthen clinical research capacity in Africa came together in the quest to develop an effective malaria vaccine. Vaccines are one of the best public health interventions available, yet a vaccine against malaria remained elusive. Today, a promising vaccine candidate has advanced farther in clinical trials than any before it.

In January 2011, enrollment of 15,460 infants and young children at 11 trial sites in seven African countries was completed for the Phase 3 clinical trial of the RTS,S malaria vaccine candidate. RTS,S is being developed by GlaxoSmithKline Biologicals,  the PATH Malaria Vaccine Initiative (MVI) and African research centers. This study, slated for completion in 2014, will inform scientific and policy decisions on the potential use of the vaccine in 2015 and beyond. If approved and recommended for use, RTS,S could complement existing malaria control interventions and potentially save hundreds of thousands of lives. 

As with current malaria control measures, getting a vaccine candidate to this stage has required extensive research—and to conduct such research, we needed to provide our scientists with the means to achieve their mission.

In Bagamoyo, Tanzania, for example, we were able to conduct the malaria vaccine trial through the use of a new, well-equipped research facility, a renovated pediatric ward, and enhanced telecommunications, thanks to support from MVI and the INDEPTH-Malaria Clinical Trials Alliance.  The facilities will now be used to test other types of malaria and TB vaccines and drugs. Confidence has grown that we can conduct research at a level never thought possible before, and this has led to a higher level of engagement by African scientists in finding solutions to African health problems.

Across the continent, in the small town of Nanoro, Burkina Faso, a fully equipped research center was built on the grounds of the San Camillo District Hospital. Although Nanoro had been identified as a sentinel site for malaria drug resistance surveillance, research was severely limited by a lack of electricity and  adequate infrastructure to support a permanent team. Investment for the vaccine trial encouraged the government to extend the electric grid to the site and town. The center grew from two projects and 10 staff in 2009, to 20 grants providing professional employment for 150 clinical and support staff today.

Such strengthening of research capacity bodes well for the battle against malaria and other health challenges facing the continent. The infrastructure will leave a lasting legacy that extends past the lab and academic circles. Providing scientists and medical staff with quality facilities and equipment helps retain highly trained personnel, which contributes significantly to the quality of health services at the national level.

At the community level, the impact of the clinical trial is even more evident. In Bagamoyo, improvement in the quality of care has resulted in more children being brought to the health facility when they are sick, greatly enhancing the overall wellbeing of the community’s children.
In Nanoro, running electricity to the trial site has yielded direct benefits in health and general welfare. 

The hospital can now run the refrigerators necessary for vaccine storage, but also diagnostic and surgical equipment. The water supply has been improved thanks to reliable electric pumps. And schools and students--perhaps the next generation of researchers--now extend their study hours past nightfall.  

From West to East Africa, and points in between, we see African scientists, health staff, policymakers and local communities working hard to implement today’s control measures and develop new tools for tomorrow. If we persevere, we may someday truly celebrate World Malaria Day as a commemoration of the eradication of the disease. 
 
By Tinto Halidou (Principal Investigator, Nanoro, Burkina Faso) and Salim Abdulla (Director, Ifakara Health Center)