Integrated Malaria Molecular Surveillance: A unified approach to malaria control

Nsa Dada, assistant professor in the School of Life Sciences and Biodesign Center for Fundamental and Applied Microbiomics, is first author on “Towards integrated malaria molecular surveillance in Africa,” a paper published today in Cell Press’ Trends in Parasitology journal. The paper focuses on Integrated Malaria Molecular Surveillance (iMMS), and how it can expand malaria genomics initiatives.

Malaria remains one of the world's most persistent public health challenges, with a significant burden on regions such as sub-Saharan Africa. In recent years, researchers have made strides toward a more coordinated approach to combating malaria through iMMS. This approach aims to bring together molecular and genomic efforts to create a comprehensive understanding of malaria transmission, aiming to transition from a reactive to a proactive stance in managing the disease.

iMMS represents a strategic effort to integrate various molecular and genomic research initiatives on malaria into a unified system. It focuses on understanding the intricate relationships between the malaria parasite, the mosquitoes that transmit it, the human hosts they infect, along with the microbes that are associated with each of these components. The goal is to use molecular tools to anticipate and address challenges like drug resistance and vector adaptability to insecticides before they become widespread issues.

Dada described the benefit of iMMS: "We think that integrating our efforts, the molecular and genomics efforts in studying malaria—rather than working in silos—would help us better understand the dynamics of malaria transmission and come up with effective control systems." This changes the way researchers approach malaria: from a reactive effort to a proactive strategy to improve malaria management​.

For meaningful progress, shifting from reactive to proactive malaria control strategies is crucial. The integration of molecular and genomic tools into surveillance systems could be a game-changer in predicting resistance patterns and preventing outbreaks before they occur. "One of the reasons why we want to integrate malaria molecular surveillance efforts is so that we can come up with a more proactive means of malaria surveillance," Dada explained, emphasizing the need for preemptive action in tackling the disease's evolution​.

Overcoming challenges in malaria research

One of the significant barriers to advancing malaria research is limited  expertise in handling and analyzing genomic data in malaria-endemic areas. Dada points out, "There have been lots of challenges related to limited expertise in analyzing the large amount of molecular, especially genomics data being generated by this type of research on the continent." To address this, initiatives have been launched to train African scientists in bioinformatics and genomic data analysis, ensuring that local researchers are well-equipped to interpret and use the data.

Additionally, logistical issues such as delays in the supply of essential laboratory materials and the limited availability of consumables remain significant challenges. Dada says that, "Sometimes supplies arrive, and they're compromised due to protracted customs processes or broken cold-chain logistics, and we can't use them for anything, or sometimes we just don't have access to those consumables." Collaborative efforts, the article says, are underway to streamline supply chains and ensure that researchers have consistent access to the necessary tools and resources​.

The global impact of iMMS

While the primary focus of these efforts is on Africa, it also draws valuable insights from successful malaria control efforts in regions like the Greater Mekong Subregion in Southeast Asia. The Greater Mekong Subregion has successfully implemented integrated molecular surveillance systems geared towards containing artemisinin partial resistance and multi-drug resistance, demonstrating that such a comprehensive approach can significantly improve malaria control outcomes. Dada notes that they, "have highlighted a successful implementation of malaria molecular surveillance in the Mekong sub-region that we can draw from" to inform efforts throughout Africa​.

The article emphasizes that collaborative efforts involving stakeholders from different countries are essential for overcoming common challenges and developing an integrated approach to malaria molecular surveillance on the continent.

The framework used during the COVID-19 pandemic, where molecular surveillance played a critical role in monitoring and controlling the spread of the virus, serves as a model for how similar strategies could be applied to malaria and other diseases. "We are drawing from the coronavirus pandemic... we came together as a scientific community and were able to share data," she explained, highlighting the potential for global collaboration in addressing health crises beyond malaria as the principles of iMMScould one day be applied to other infectious diseases.

The potential of iMMS applications extend beyond Africa and malaria-specific studies. The molecular and genomic tools developed through this approach could also be adapted to other regions affected by mosquito-borne diseases, such as Southeast Asia and Latin America. "There is malaria in Southeast Asia, there's malaria in Latin America, and these tools are applicable to all of these other geographical regions," Dada says. Furthermore, the article explains that principles of iMMScan be applied to other infectious diseases, allowing for a broader use of molecular surveillance techniques in global public health​.

Dada says that both ASU and SOLS’ emphasis on interdisciplinary research provides a conducive environment for tackling complex scientific issues like malaria. "I do work at the intersection of vector biology, microbial ecology and bioinformatics, and I also have an interest in public health. I wanted a place where I could integrate all of these areas of interest, and SOLS offers that space.”

As these efforts continue to evolve, it promises to not only advance malaria control in Africa but also to provide a model for tackling other infectious diseases globally. The ultimate goal is to enhance our capability to predict and prevent disease outbreaks, moving closer to the eradication of malaria and other vector-borne illnesses.