Funding for malaria research and development has quadrupled in the past 16 years - new drugs, diagnostics and insecticides have been developed and a vaccine is in the final stage of testing - but the constantly adapting malaria parasite means the pipeline of new products and technologies needs to keep flowing.
A new report, "Staying the Course? Malaria Research and Development in a Time of Economic Uncertainty", analyses the progress that unprecedented levels of funding has achieved in recent years and warns that the future of the global fight against malaria depends on better coordination among a larger number of donors and ensuring that the money is more evenly spread.
Currently, the lion's share of research and development (R&D) funds goes to developing new drugs (38 percent), vaccines (28 percent) and basic research (23 percent), while research into diagnostic tests receives a paltry 1 percent of funding, and product development for controlling malaria-carrying mosquitoes (vector control) just 4 percent.
Partly this is because developing and testing new drugs and vaccines is much more costly than developing diagnostics and vector control products, but David Bell, head of the malaria diagnostics programme at the non-profit Foundation for Innovative New Diagnostics (FIND), believes it also reflects donor preferences.
"It's easy to sell the idea of a drug or vaccine because it saves lives. A diagnostic test also saves lives by stopping a child being given the wrong drug and ensuring they receive the right drug... but it's harder to sell that to donors," he told IRIN on the phone from Geneva.
Bell described his field as "grossly underfunded". This has slowed the development of new diagnostic tools and made it difficult to ensure the quality of existing tests for detecting malaria - in sub-Saharan Africa, where the use of diagnostic tests is not widespread, patients presenting with a fever are often misdiagnosed with malaria and treated for the wrong disease.
The report, published by the global health non-profit, PATH, and the Roll Back Malaria Partnership, estimates that funding for diagnostic tests needs to quadruple and remain at US$50 million per year for the next four years.
Some of the most pressing needs are for the development of rapid tests for less common types of malaria; a way to screen pregnant women with low levels of malaria parasites that can still harm a foetus; and more sensitive tools for detecting a potential resurgence of the disease in areas with low prevalence.
"The problem in areas where mortality [from malaria] is very low because interventions have worked, is that people lose interest and there's a danger we'll see a rebound in malaria, so we need to have these new tools to manage that," said Bell.
Vector control neglected
Spraying insecticides and treated bed nets have yielded impressive results in reducing the malaria burden in many parts of the world, but vector control has been neglected in recent years - just when resistance to the one class of insecticides licensed for use with bed nets, pyrethroids, has become widespread.
"There are very few locations [in Africa] where there isn't [pyrethroid] resistance," said Janet Hemmingway, CEO of the non-profit research group, Innovative Vector Control Consortium (IVCC). "If resistance is sufficiently strong, a treated bed net is of no more use than an untreated one."
Developing a new active ingredient is a seven-year process because of the need for long-term toxicology reports, but IVCC is looking at several agricultural insecticides to determine whether they could be "re-purposed" for malaria control.
"We know there's nothing ideal, but there could be something that would hold the fort for a few years while we get some new active [ingredients] through [the process]," said Hemmingway.
IVCC is also developing a simple point-of-use test to determine whether a net has been treated properly, and another for monitoring insecticide resistance in mosquitoes - but even with a five-year, $50 million grant from the Bill & Melinda Gates Foundation, and a further $28 million from other donors, they still face a $100 million funding shortfall.
More donors needed
Total funding for malaria R&D reached $612 million by 2009, up from $121 million in 1993, but nearly three-quarters of that amount was provided by nine organizations, most of them public and philanthropic, and just two organizations - the Gates Foundation and the US National Institutes of Health (NIH) - accounted for half of all funding, and most of the increase in funding in recent years.
|Malaria vaccine could have extra benefits|
|Most paediatric fevers not caused by malaria|
|Control vs elimination - the great malaria debate|
|New malaria drug better but not cheaper, yet|
According to the report, funding for malaria R&D only needs to increase by 2 percent per year to meet the goals agreed by the international malaria community in the 2008 Global Malaria Action Plan (GMAP). After 2016, earlier investments should start paying off and funders can begin to scale back their contributions. However, this best-case scenario depends on donors coordinating with each other to ensure funds are distributed more evenly.
The Roll Back Malaria Partnership hopes to achieve this during two donor meetings later in 2011. "We need to ensure the main donors are aware of the poor distribution of funds," said executive director Awa Marie Coll-Seck.
"We're hoping new donors will come along - it's important to diversify," she said, insisting that the goal of eradicating malaria from the world, set out in the GMAP, was still within reach.
"All the elements are in the pipeline - a vaccine, insecticides, diagnostics. The more results we see, the more we think it is possible," Coll-Seck told IRIN. "But the malaria parasite is always changing and adapting; you need to always be developing new tools to stay ahead of it."