International Centers of Excellence for Malaria Research

The past two decades have witnessed an extraordinary commitment to malaria control and elimination, which has been accompanied by a considerable reduction in global malaria morbidity and mortality. Although malaria research efforts have dramatically increased over this period, most clinical research projects still tend to be narrowly focused in scientific scope, and are conducted in a limited catchment area with a relatively homogeneous “at risk” population. In 2010, the National Institute of Allergy and Infectious Diseases established 10 International Centers of Excellence for Malaria Research (ICEMR) to support multidisciplinary research in diverse epidemiologic settings which span representative malaria-endemic regions around the world. Table 1 describes the locations of field sites and research focuses of each ICEMR. Research projects were designed to capture and track changes in the complex interactions between the human host, malaria parasite, and mosquito vector in different eco-epidemiologic settings. Unlike typical monitoring and evaluation programs, the ICEMRs are mandated both to adopt an integrated approach to malaria research, and to apply molecular epidemiology and genomics to study transmission and disease in the context of dynamically changing in disease prevalence and incidence (Table 1). Following the initial establishment of the ICEMRs, Acta Tropica published a special supplement issue focusing on the ICEMRs, titled “Tackling the Malaria ‘End Game’: Regional Needs and Challenges for Successful Malaria Elimination.” This supplement described each of the Centers, their research projects, and their scientific scope. The articles described how individual Centers planned to implement multidisciplinary research approaches in the context of local and regional control efforts to provide evidencebased findings which inform the future course of malaria control and elimination efforts. Taking advantage of the network structure of the ICEMRs, which encourages and facilitates collaboration between centers, the ICEMRs have shared protocols and technologies and have worked to harmonize outcome and predictor variable definitions. In this issue, the ICEMRs jointly present early findings organized by on broad themes rather than by results specific to individual centers. This approach highlights the value of a broadly focused program and the generalizability of the findings from the ICEMR network. In this research supplement, the ICEMRs attempt to provide a comprehensive view of the interplay between control interventions and epidemiology, vector ecology, parasite diversity, insecticide and drug resistance, pathogenesis, diagnostic performance, molecular epidemiology, biosignatures of transmission and immunity, and urban malaria across different settings. The impact of human migration, man-made ecological modifications, and climate and vector behavior on malaria transmission is extremely complex to study and quantify. The multidisciplinary nature of the ICEMR program enables each center to study these interactions in a specific, well-defined setting, and to subsequently compare findings across centers for consistency and variability. Table 2 provides an overview of the transmission settings in which the ICEMRs are located as well as study questions and approaches. Although the incidence of malaria continues to decline in many parts of the world, some sites have experienced little or no change, and a few locations have seen incidence rise. The most pressing scientific questions will differ depending on the transmission setting. For example, when transmission is low, how is it sustained and what control and surveillance measures will be most effective at driving rates toward elimination? Where transmission levels remain high despite interventions, what are the factors or knowledge gaps that impede impact? Where malaria has recently dropped to low levels, what are the early warning signs of an impending epidemic? In addition to insecticide-impregnated bed nets and indoor residual spraying of insecticides, a number of novel control and prevention strategies have been proposed in recent years. Seasonal malaria chemoprophylaxis, mass drug administration, school-based treatment programs, targeted parasite elimination, and outdoor vector control are examples of a few approaches being tried in different settings. In addition to the direct impact these interventions might have on disease and infection rates, it is critical to study their effects on the immune status of the population, the genetic diversity of circulating parasite strains, the evolutionary response of emerging and surviving strains, as well as impacts on the mix of vector species and their vectorial capacity. All of these factors will ideally be taken into account to maximize the likelihood of achieving malaria elimination as quickly as possible. As a network of multidisciplinary research centers in diverse epidemiological settings, the ICEMRs are poised to provide insightful research findings that will inform the design and implementation of optimal malaria control and elimination programs.