Malaria burden
Malaria is considered to be one of the highly prevalent infectious diseases and the most common cause of death after tuberculosis. Malaria is caused by protozoan parasite (Plasmodium species) and is transmitted from one human to another by the bite of infected Anopheles mosquitoes. The malaria parasite has a complex multistaged life cycle in two hosts, vertebrae hosts and female Anopheles vector mosquito. (Fig.)
Fig: The malaria parasite life cycle involves two hosts. It is transmitted from one human to another by the bite of infected Anopheles mosquitoes during a blood meal, which inoculates sporozoites into the human host. Sporozoites infect the liver cells where they multiply asexually over the next 7-10 days (causing no symptoms), mature into schizonts which further rupture to release another form, the merozoites. Merozoites infect red blood cells and are responsible for the clinical manifestations of the disease such as anemia (CDC, DPDx - Laboratory Identification of Parasites of Public Health Concern).
Key risk factors that have been identified for malaria are environmental, parasite, host nutritional status, host immune status, etc. that influence the severity and recurrence of the disease. Early diagnosis and prompt treatment is essential to control and prevent malaria. For the identification of Plasmodium species in human blood samples, the currently available diagnostic tools are point-of-care Rapid Diagnostic Tests (RDTs), microscopy and PCR-based methods. India has successfully limited malaria exposure through rigorous use of indoor residual spray (IRS) and Long-Lasting Insecticide impregnated Nets (LLINs) distributed under National Programme. In the majority of cases in India to treat malaria, artemisinin-based combination therapy (ACT) is being used since 2011 as an effective first-line treatment. It has become imperative to strengthen the surveillance system in order to determine the disease pattern and strategize preventive and therapeutic interventions.
India constitutes the largest population in the world at risk of malaria, with 85% living in malaria-endemic zones for both P. falciparum and P. vivax malaria. However, over the past two decades, India has made impressive progress in malaria control. According to National Vector Borne Disease Control Programme (NVBDCP), the malaria burden has declined in India by over 65% from 1.0 million cases in 2016 to 0.34 million in 2020 (till September), and deaths caused by malaria have also declined by over 85% from 331 deaths in 2016 to 47 in 2020 (till September). The WHO report 2020 also has appreciated India’s research for decline in malaria.
This success has provided a strong foundation for the commitment by the highest levels of leadership of the Government of India (GoI) to eliminate malaria in India by 2030. This target for malaria elimination is in line with the WHO Global Technical Strategy adopted by the World Health Assembly in May 2015 and subsequent commitments by the other Heads of Government in the Asia Pacific Region.
NVBDCP of India has developed a comprehensive framework to achieve the overarching vision of “Malaria free India by 2030”. The strategies are based on WHO-recommended principles and pillars for malaria control and elimination which have been adapted to India. The NVBDCP’s National Strategic Plan clearly recognizes the critical role of research to support and guide malaria elimination efforts. A common research platform is required across the entire spectrum including operational research for developing new strategies, optimizing the deployment and impact of existing and new tools, determining the ideal mix of interventions to tackle specific situations, improving surveillance and basic research for the discovery of new tools.
MERA-India
The purpose of Malaria Elimination Research Alliance (MERA) India is to identify, articulate, prioritise and respond to the research needs of the country in a coordinated and combinatorial way to eliminate malaria from India by 2030. MERA-India was launched by the ICMR Director General, Dr Balram Bhargava, on the eve of ‘World Malaria Day’ in 2019. It is a conglomeration of National and International partners like World Health Organization (WHO), National Vector Borne Diseases Control Program (NVBDCP), and medicines for Malaria Venture (MMV), medical colleges and several Multi-National Companies (MNCs) working towards malaria control and elimination. The mandate of the alliance is to bring together researchers working in the field of malaria in the ICMR and non-ICMR Research Institutions, Universities and National Programs. MERA-India fosters multicentric studies in thematic areas to provide a platform for pan-India data. The alliance, spearheaded by ICMR-National Institute of Malaria Research (ICMR-NIMR), launched a call for proposals focused on priority research areas and received an overwhelming response from researchers globally.
Journey till date
The leadership conducted few PRC meetings with eminent malaria researchers of different thematic working groups (TWGs) after the launch of MERA-India last year. The meetings were organized to discuss and strategize key areas of malaria-like parasite biology, vector control and epidemiology. MERA-India launched a call for proposal and received an overwhelming response from researchers globally (More than 175 concept notes) and shortlisted proposals were categorized according to the following thematic areas:
a) Low density infection and transmission potential
b) Vector biology and control
c) Community behavior
d) Migration
e) Artificial intelligence
f) Geographical information system
In continuation, MERA India organized a two days ‘Brainstorming Meeting’ of the investigators to develop multi-centric projects in thematic groups at ICMR Headquarters, New Delhi. The mandate of the meeting was to develop multi-centric study models that cover pan India issues related to Malaria research and elimination. The meeting was an opportunity for the participants to have a one-on-one discussion with the experts and learn from their exhaustive experience to work as a team. Based on the Coordinators’ feedback on the applications and their interactions with the participants, the Principal Investigators (PIs) and Co-Investigators (Co-Is) were shortlisted to submit the full applications throughout the country. However, in this first round of call for proposals, only four themes (LDI+TP, VB+C, CB and M)were taken into consideration. Under theme Migration, only one proposal was considered as it was not restricted only to Migration but is an annual activity as a result of pilgrimage. The theme migration was dropped in the current round due to the recent Covid19 induced nationwide exodus. Also, the whole dynamics of migration were changed because of movement in migratory population during lockdown. For the theme artificial intelligence, the committee did not find any suitable proposal and the competitive investigator to work in the field of AI. It was decided the work progress of all awarded projects under different themes will be reviewed regularly every six months till their completion.
Based on malaria epidemiology, types of parasite, vector prevalence and pan India approach, several sites at 07 states (Uttar Pradesh, Rajasthan, Gujarat, Goa, Tamil Nadu, Chhattisgarh and Assam) were shortlisted for the studies (Map). With the help of experts, common objectives protocols and methodologies were developed for all sites in order to maintain research quality and uniformity of data generation. All the proposals, developed with the help of experts, are in process of funding. All the investigators will work under the guidance of experts for the entire duration of the funding and the progress of all projects will be evaluated frequently within specific time duration.
