Building the WWARN community in Africa
The launch of WWARN’s second regional centre in Africa is a key step towards building local capacity in this malaria endemic region.
Dr Ambrose Talisuna was appointed Director of the East Africa Regional Centre in March this year, based at the KEMRI-Wellcome Trust Research Programme in Nairobi, Kenya. Dr Louis Penali has become Director of our new West Africa Regional Centre, based at the Université Cheikh Anta Diop, in Dakar, Senegal.
Both are experienced and well respected figures in the malaria community. Ambrose Talisuna worked on drug resistance surveillance for over 15 years, initially with the Uganda Ministry of Health, then the Institute of Tropical Medicine in Antwerp and later the Medicines for Malaria Venture. Louis Penali was Head of the Malariology Department and Scientific Director at the Pasteur Institute in Ivory Coast for 18 years.
They both agree on the urgent need to step up action to combat antimalarial resistance across the continent. Chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) resistance are widespread and malaria outbreaks are being reported in some locations previously considered too elevated for malaria transmission, such as the highlands of Kenya. Some scientists believe this is due to climate change, while others blame human migration.
There are fears that this situation will worsen if artemisinin resistance in falciparum malaria, recently described in Western Cambodia, spreads westward, repeating what was observed in the CQ and SP era, over 50 years ago.
"Artemisinin resistance poses a global public health threat, with the greatest potential effects in sub-Saharan Africa where the disease burden is highest and where systems for drug resistance monitoring and containment are weakest," warns Dr Talisuna.
"Unlike the years when CQ and SP resistance first emerged on the eastern coast of Africa, new economic and development links have increased significantly human contact between Asia and Africa. It is only a matter of time before artemisinin-resistant malaria emerges somewhere in Africa," he adds.
Although there are regional differences – transmission in East Africa is predominantly perennial, while in West Africa it tends to be seasonal – both need to develop and validate new tools for early warning and detection of resistance, agrees Dr Penali.
"Most African countries now recommend artemisinin combination therapy as first line regimen for uncomplicated malaria. Unfortunately, this policy shift has resulted in the demise of systematic drug resistance surveillance. The activities of sub-regional networks are very limited, due to lack of funding and the changing technical requirements for monitoring ACT efficacy," he explained.
"Consequently, a concerted effort is required to develop and validate new tools that are highly sensitive and could quickly be incorporated into routine surveillance to provide early warning and early detection of artemisinin resistance should it emerge in Africa. The WWARN Regional Centres will be crucial in this endeavour."
Dr Talisuna and Dr Penali are now leading initiatives designed to stimulate antimalarial resistance surveillance in the continent. The WWARN East Africa Regional Centre has recently been elected to lead the research and academia constituency on the executive coordination committee of the Roll Back Malaria East Africa Regional Network (EARN).
The priority for the next two years is to stimulate drug resistance surveillance research in the region, says Dr Talisuna, and reactivate networking activities. Data sharing will be key to identify the first signs of resistance. "This will provide the right environment for a productive collaboration between researchers and national malaria control programmes, and will facilitate faster translation of research findings to policy and practice. WWARN is well suited to steward this."