The Multilateral Initiative on Malaria: An Alliance to Enhance African Malaria Research
Fogarty International Center, National Institutes of Health
The Multilateral Initiative on Malaria (MIM) is an alliance of international partnerships supporting four functional components that address the malaria research priorities and scientific capacity strengthening needs identified during a ground breaking conference in Dakar, Senegal in 1997. Each component has its own leadership, seeks its own funding partners and advisors and organizes its own activities. The MIM Secretariat coordinates the components, facilitates communication and organizes the Pan-African Malaria Conference while rotating among partners (Welcome Trust (1998-1999), National Institutes of Health/Fogarty International Center (NIH/FIC), (1999-2002), Karolinska Institute (2003-2005), African Malaria Network Trust (AMANET)(2005-present)). MIM/TDR, based at the World Health Organization (WHO), provides grants to African malaria researchers. MIM/Com, based at National Institutes of Health/National Library of Medicine (NIH/NLM) provides Internet connectivity to African malaria research sites (based at NIH/NLM). The Malaria Research and Reference Reagent Resources Center (MR4) is supported by the National Institutes of Health/ National Institute of Allergy and Infectious Diseases (NIH/NIAID) contract. Despite what might be characterized as a controlled chaos approach to partnership over ten years, the MIM components have accomplished a great deal to strengthen malaria research capacity across Africa. The history of MIM reveals a complex approach to partnership and highlights the challenges to tackling the enormous problem of malaria in Africa.
The Dakar meeting is described as watershed moment at a time when it was recognized that global malaria research funding was severely underfunded and no new antimalarial drugs, vaccines, or public health use insecticides were being developing despite the enormous burden of disease in Africa and the rapid spread of drug and insecticide resistance. It was possibly the first time that leading malaria researchers from the United States, Europe, and Africa and the leadership of the world’s major research agencies, foundations and donors sat around the same table to explore ways to strengthen and coordinate the research needed to develop improved tools for malaria control. The participants agreed on the need to build sustainable research capacity in Africa and the immediate priority to provide African malaria scientists access to the Internet. However, plans to sustain an organization to accomplish these goals were unresolved.
In July 1997, representatives of the funding organizations and pharmaceutical companies to meet in the Hague to discuss practical mechanisms for supporting the research and capacity strengthening priorities identified in Dakar. Participants rejected the U.S. proposal to create a “common pot” of funds contributed by all partner funding agencies or bankrolled by the pharmaceutical companies. They also discarded an alternative to accept common applications with joint peer review of proposals but accepted individual agency selection of recommended proposals to fund. The core MIM agency partners reassembled in London in November 1997 to organize the initiative as the current four component effort in which each agency agreed to take responsibility for a specific part of the program.
From the beginning, MIM faced the continuing challenge of creating itself while fostering the work of African malaria scientists according to the principles established at Dakar. Each of the MIM components achieved a cumulative set of successes while struggling with fundraising. Each component developed its own funding partnerships and approaches to supporting its activities. The rotation of the secretariat was meant to allow different partner organizations to contribute new energy and new approaches based on their strengths through MIM administration.
In 2002, an independent review panel found that a remarkable number of the objectives designed at Dakar had been realized through the work of the MIM components. The reviewers pointed to core business functions and governance which needed strengthening (specifically, the lack of a strategic plan to guide the organization in working with its multitude of partners over the last 5 years (3 ministries of foreign affairs, 12 research funding agencies, 4 United Nations agencies, 6 national development agencies and 4 private companies). MIM was urged to position itself relative to other initiatives such as the Roll Back Malaria Partnership (RBM,) the Global Fund, and the various malaria programs supported by the Bill and Melinda
Gates Foundation and define its niche as strengthening malaria research capacity in Africa in order to compete for support.
In 2005, the secretariat hosted the Malaria Research and Development Alliance that produced a detailed assessment of the global investment in malaria research and development showing a four-fold increase since the Dakar conference but indicated that only 3.8 percent was spent on malaria research capacity building. In 2006, the MIM Secretariat rotated to AMANET in Tanzania for five years following the fourth and largest yet Pan-African Malaria Conference in Cameroon attended by more than 1,500 participants from 65 countries supported by more than 25 sponsors. By 2007, MIM/TDR supported 69 malaria research grants to African scientists for a total of $12.9 million over ten years. These projects produced over one hundred research articles and trained over two hundred malaria research students. MIM/Com facilitated Internet connectivity to 24 sites in 16 African countries. MR4 received renewed contract support from NIH in 2006.
Between 1997-2007, 7 bilateral and multilateral initiatives, 5 public-private partnerships, 19 coalition and alliances/NGOs/foundations, 7 campaigns or grassroots networks, and 7 private industry initiatives were started to fight malaria intensifying the same problems recognized at the time of the Dakar meeting: lack of international donor coordination, fragmented funding, little capacity building in Africa and genuine partnership with African stakeholders. Many U.S. and European research sponsors of new malaria diagnostics, drugs, and vaccines finding the lack of malaria research capacity in Africa a major barrier to translating these products into public health successes. Over the its ten year life span, many partners have dropped long-term commitment to operational support for the MIM components. MIM is in a precarious but exciting phase of moving to Africa. Inherent in the wisdom of its founding principles, MIM nurtured its own leadership with increasing numbers of young African malaria scientists serving as advisors for MIM components, organizing the MIM conferences, and coordinating activities and fundraising. The MIM Pan-African malaria conferences garner increasing numbers of participants, sponsorship, and media coverage. Fostering MIM while doing its work likely will be the modus operandi for the MIM in the foreseeable future as its expected secretariat rotation builds organization management capacity throughout Africa and more leadership for the MIM components is assumed by the African malaria researchers MIM fostered.