RESEARCH TOPICS

Data needs for Elimination and Stratification

Malaria transmission often varies widely within countries, which means that applying an intervention on a national scale can be an inefficient use of scarce resources. In order to ensure that interventions are deployed most effectively, countries need to be subdivided into areas that share common features relevant to malaria transmission: for example, they may be stratified by geography, if some regions within them have higher transmission than others, or according to population characteristics if certain groups of people are at greater risk of malaria. The MMC is supporting country programs in the process of stratification, so that they can prioritize particular regions and populations at particular points in time, and maximize the impact of malaria control interventions. The MMC is also working to identify the types of data needed to make sure that this is done as accurately as possible.

Emergence of Resistance

The emergence of resistance to antimalarials is a major consideration in efforts to control and eliminate malaria. Already, there is widespread resistance to some of the early medications used to treat malaria, and parasites resistant to the newest class of antimalarials – artemisinin-based combination therapies – have been observed in Southeast Asia. If this resistance spreads to sub-Saharan Africa, it will likely cause a drastic increase in burden of malaria due to ineffectiveness of treatment. The MMC is building models to better understand the emergence of resistance and determine the best strategy for avoiding this outcome.

Vector Control

Malaria transmission often persists even when countries achieve very high coverage of long-lasting insecticide-treated nets (LLINs), indoor residual spraying (IRS), and improved case management. The MMC is looking at the role that this residual transmission plays in preventing elimination, and working to determine whether or not elimination is possible using these existing technologies given contextual constraints. The MMC is also assessing the potential contribution that other interventions, such as mass drug administration (MDA) or novel forms of vector control, can play in helping countries to eliminate malaria once they have maximized the use of LLINs, IRS, and case management.

Resurgence

In contexts where malaria has subsided thanks to the deployment of interventions, continued control measures are necessary in order to prevent resurgence. The MMC’s work on resurgence is aimed at understanding which factors determine the likelihood and rate of resurgence, including the role played by reactive case detection (RCD), case management coverage, an area’s baseline transmission potential, importation of infections, a population’s immune status, and spatial considerations such as household density.

Diagnostics

Treatment of malaria starts with a diagnosis using one of the many diagnostic tools that currently exist or are under development. In collaboration with the Diagnostics Modelling Consoritum, led by Professor Azra Ghani, the MMC is conducting an analysis to determine when and where one new diagnostic tool currently under development – ultra-sensitive rapid diagnostic tests (uRDTs) – may be useful.

Cost-Effectiveness

Much of the MMC’s work has focused on identifying the optimal package of interventions, given a geography and its transmission dynamics. However, this does not address a key issue for policymakers, the cost and relative return of interventions. MMC member groups have begun to incorporate costs into existing models of malaria and conduct cost-effectiveness analyses. Ultimately, this will help to identify the most cost-effective path to elimination in a range of settings.