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HEALTH: From malaria research results to policy

lead photo
LONDON, 23 May 2012 (IRIN) - No matter how compelling, medical research
has historically not guaranteed swift regulatory approval, but
researchers are finding ways
resentations.html> to speed up translation of their conclusions into

In the fight against malaria, it took years of consistent medical
insecticide-treated bed nets to gain the World Health Organization's
(WHO) recommendation in 2007. Governments will generally not implement
an intervention without the WHO stamp of approval.

"After the evidence was collected, it took another decade for effective
use of this intervention," said Fred Binka, dean of the school of
public health at the University of Ghana and former board member of
WHO's Roll Back Malaria Initiative.

"The problem was, who was to drive this evidence forward, when was it
enough, and how do you move to policy?" Poor communication between
researchers could also lead to confusion, difficulty and stalled policy
recommendations, Binka noted.

But they are learning how to get approval in less time. After six years
of experiments, talks began between WHO and researchers testing
seasonal malaria chemoprevention

(SMC) in areas of sub-Saharan Africa where the disease is endemic. The
WHO recommendation came in March 2012, just one year after the final
trial results were published

About eight out of every 10 healthy children living in endemic areas
who are given four doses of anti-malarial drugs during
high-transmission periods do not contract malaria. SMC treatment was
previously called intermittent preventative treatment against malaria
in children.

To speed the approval process, researchers consulted with WHO
policy-makers while trials were still in the planning stages, SMC trial
coordinator Diadier Diallo told IRIN.

Similarly, scientists working on a malaria vaccine
extra-benefits> are optimistic that they will receive a WHO
recommendation soon after trial results
df> are reported in 2014. The RTS,S vaccine encourages the production
of antibodies and T-cells - part of the immune system - which weaken
the malaria parasite and reduce its ability to reproduce in the liver.

"All evidence points towards a potential licence for the RTS,S vaccine
in 2014 or 2015, with implementation in 2015," said Brian Greenwood, a
professor at the London School of Hygiene & Tropical Medicine (LSHTM)
and head of the Malaria Capacity Development Consortium, which is
hosted by the university to boost malaria research strength in Africa.

Photo: The Global Fund/John Rae
Tried and true, though not tested
When tests are completed, RTS,S
will have cost its makers an estimated $220 million since 2007.

Parachute approach

Not all methods to control malaria, among other diseases, have taken
the "gold standard" approach of scientific trials, said Immo
Kleinschmidt, a researcher in the Tropical Epidemiology Group at LSHTM.
Rather, common sense and communities have often promoted their use.

"It's been proposed to adopt a 'parachute approach' to evidence-based
trials, based on the simple observation that parachutes have never been
evaluated through trials yet we don't doubt their effectiveness," said

In this approach communities become testing grounds, where - like
parachutes - if malaria control methods are properly functioning and
effectively used, they will reduce infection and/or the risk of it.

For instance, in 2006 WHO used mostly historical data rather than
findings from large trials to promote indoor residual spraying
html> . But such instances are the exception. Community studies alone
rarely provide the needed assurance to roll out new malaria
interventions, said Kleinschmidt, who agreed that large experiments are
always the ideal, but said tests may not work out as planned.

"We should strive to produce evidence of the highest quality, but often
we have to resort to designs that don't necessarily meet the standard,
because the real world is inevitably more messy than the ivory tower."


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