services of these countries in general and their malaria control programs in particular, as a higher priority than searching only for new tools, products, and methods of vector control, since the currently available tools are not effectively used for the very reasons mentioned above. However, this does not mean that the development of new tools is not necessary. Due to widespread problems of drug resistance, research efforts on drug discovery and development do require increased funding and commitment.
I participated in the three meetings of the IOM committee and expressed my concern during two of these meetings that too much emphasis was being placed on malaria research and too little on its prevention and control. The committee's final report reflects that imbalance. There are recommendations on all aspects of research, including risk factors for severe malaria, social and cultural aspects, pathogenesis of severe and complicated malaria, vaccine development, drug discovery, and development and vector studies to interrupt transmission. There are also recommendations for malaria control, such as improvement of treatment guidelines and improving communication, but these do not address the fundamental issues of building the capabilities of endemic countries for malaria control.
Apart from theoretical discussion and limited exchange of ideas among the committee members, there was no in-depth discussion or review of country malaria control programs in Africa and South America. From Asia, an officer of the malaria control program in Thailand gave a presentation on the status of malaria control in his country. According to the data he presented, the malaria control program in Thailand is having an impact using currently available tools (the mortality rate decreased from 200/10,000 in 1949 to 1.5/10,000 by 1987). In spite of problems of drug resistance in Thailand, it seems that the developed infrastructure, national commitment, and the size of external assistance to the Thai program have made a difference. It seems to me that the solution to malaria control should be primarily concentrated on correcting the present lack of resources and the nonresponsive, underdeveloped health care delivery systems that prevail in most malaria-endemic countries, and not only on searching for new strategies and tools. Investment in additional research to generate new tools and products for the future, while useful, will not by any means help to correct the precarious malaria situation that exists today.
It is also unrealistic to expect that the malaria situation will be improved through the establishment of an advisory panel in the United States, with a core of experts to advise donor agencies concerning allocation of funds for surveillance, impact assessment, operational research, support of senior malaria control managers, etc., unless fundamental action is taken to improve health infrastructure and to support control programs in a meaningful way.
I do not agree with the concept that there are four priority areas for malaria control, as if each area could stand by itself and from which donors