Preamble

The Multilateral Initiative on Malaria Society representing the Global Community of Malaria Researchers and Partners, in her 8th outing at the Pan African Malaria Conference holding in Kigali, Rwanda, took cognizance of the Yaounde “Declaration for accelerated malaria mortality reduction in Africa: commitment that “No one shall die from malaria” The Ministers of the HBHI countries “acknowledged with deep concern, despite the progress made, the sobering accounts presented annually since 2017 in the WHO World Malaria Report that reveal an alarming stalling of progress in the WHO African Region. They stressed on the urgency of addressing the root causes of this stagnation, such as changing ecology and vector behavior; low access to and insufficient quality of health services, including gender-related and financial barriers within households; a global economic downturn and inadequate domestic funding; humanitarian crises, including conflicts, natural disasters and migration; climate change; and biological threats such as insecticide and drug resistance, HRP2/3 deletions as well as invasive malaria vectors. The Ministers thereby committed to concerted action to end malaria deaths by reinforcing the "High Burden High Impact” (HBHI) approach to sustainably and equitably address malaria by building on four pillars (political will, strategic use of information for action, better technical guidance, coordination) and two enabling platforms (functional national health systems and the adoption of a multisectoral approach).

We welcome the adoption of the entirety of the Yaounde Declaration and emphasize our support in particular of Resolution 6 of the declaration where the Ministers pledged to “Build collaborative partnerships for resource mobilization, research and innovation”

Resolution 6

Build collaborative partnerships for resource mobilization, research and innovation

In support of the Resolution 6 of the Yaoundé Declaration, the Multilateral Initiative on Malaria Society (MIM) and her global malaria community of Researchers and Partners propose research and implementation priorities for the next decade (2025-2035) in three thematic categories;

Endorsement 6.1

Strengthened Capacities and Collaborations

6.1a - To strengthen Capacities and Collaboration as well as international & cross-border collaborations of affected communities, policymakers and researchers through standardized malaria surveillance systems, local funding schemes and data sharing

6.1b - To foster Community Engagement & Resource Mobilization through proactive health promotion and effectiveness and the need to broaden the financial base beyond the traditional sources of malaria funds to include bilateral and multilateral agencies, philantropy, corporate social responsibility and tax tariffs.

6.1c – To promote elimination-focused innovative partnership to gain broader equity, that will galvanize progress towards an Africa-led and technology driven dynamic responsiveness.

6.1d – To encourage capacity building in Endemic Countries in research and sustainable partnership with university institutes and centers of excellence and advance innovations in Data Science & Analytics, Bioinformatics, Genomics, Economic analysis

Endorsement 6.2

Investments in Research and Innovation

Calls on researchers and research funders;
6.2a – To study ways to improve Case Management in Children and Pregnant women, including in new tools for prevention and treatment especially for children under 5 and in the first trimester of pregnancy by facilitating their safe inclusion in clinical trials at an earlier stage. To conduct research that demonstrates the effectiveness of strategies that improve care provider practices and adherence to guidelines and the added value of adolescent-friendly, school-based and community- based services that enhance outreach to young children and other high risk groups.

6.2b – To ensure Drug Efficacy & Resistance Monitoring, mitigate artemisinin partial and potential ACT resistance by development of Triple ACT (TACT) or the introduction of multiple first-line treatments (MFT) that could delay the emergence of partner drug resistance, and prolong the useful therapeutic lifespan of the currently used ACTs. Calls on researchers to generate robust molecular and genomic data from routine surveillance through therapeutic efficacy studies and to use these to develop mathematical models that can forecast treatment efficacy.

6.2c – To foster drug discovery and new therapies through a deeper understanding of how antimalarial drugs act. To invest and make progress with the novel drug targets in classes of proteases, protein kinases, Plasmodium sugar transporter inhibitor, aquaporin-3 inhibitor, choline transport inhibitor, dihydroorotate dehydrogenase inhibitor, isoprenoid biosynthesis inhibitor, farnesyl-transferase inhibitor and enzymes involved in lipid metabolism and DNA replication through pre-clinical and clinical development phases. To focus on drugs that exhibit a high potency, a low propensity for resistance, a pharmacokinetic profile that favours infrequent dosing, low cost, great safety and tolerability in women and infants, and a Plasmodium transmission blocking molecule against the parasite and against the vectors. To repurpose current and formerly used drugs and seek new combinations and strategies of drug combinations and natural products, to delay progression of drug resistance through in vitro, in vivo and in silico drug designed strategies.

6.2d – To optimize vector control strategies, researchers are encouraged to develop new vector control tools that effectively address outdoor malaria transmission as well as appropriate digitalisation of mass ITN campaigns, social and behavioural change. Call on researchers to address the threats of new invasive Anopheles species considering the risks and impact of climate change on vector control. Lessons should be accquired to anticipate resistance development in mosquitoes by detecting genes and genetic variants of resistance early enough to track the spread and impact of resistance in order to prolong the efficacy of these new insecticides. Reseaerchers are called upon to develop innovative approach such as Gene Drive and Wolbachia-based control tools as well as spatial repellents and Attractive Toxic Sugar Baits.

6.2e To study gaps in knowledge in the Biology, Immunology and Pathogenesis of malaria through the concomitant investigation of the genomic diversity of Plasmodium and the human population beyond hemoglobinopathies in terms of infection, carriage, transmission, immunity, drug and vaccine resistance and progression to disease with the consequent severity of outcomes. Research should include currently undetermined host-parasite genome-genome interactions.

6.2f – To reinforce Malarial Chemoprevention (MC) (both Seasonal and Perenial) through assessing the impact and cost-effectiveness of optimized deployment with different drug regimens, alongside other malaria prevention interventions such as new ITNs and malaria vaccines and their differential impact in different settings. To study the protective efficacy of these MC programs in addition to the impact of Sulphadoxine-Pyrimethamine on changes in the microbiome within the different target groups.

6.2g – To accelerate malaria vaccine development and roll-out through the pursuit of the different candidate molecules already in clinical trials towards their next phase validation. Call on researchers to investigate pathogen-specific immune-regulatory networks that can provide insights into the host immune response to P. falciparum infections, identifying immune signalling pathways as targets for enhancing vaccine efficacy. To encourage structure-based vaccine designs that entail the isolation of profoundly neutralizing monoclonal antibodies (mAbs) elicited in response to Plasmodium infection. To further investigate the impact of host genetics, specifically HLA types and wider HLA restricted epitope coverage and cross-species immunity, vaccination responses including multivalent vaccines development, mRNA-based vaccines that enable comprehensive protein expression. To use existing technology to identify antigenic variations, crucial epitopes, immune correlates, vaccine delivery platforms, and adjuvants and determine the optimal immunization schedules to maximize the induced response that confers protection.

6-2h - To investigate the effects of climate change on malaria through multi-disciplinary surveillance and analyses using longitudinal long term matched indicators of climate (rainfall, temperature, vegetation), malaria (entomological, epidemiological, genomic) and socio-economic (urbanization, migration, economic development etc). To investigate the geospatial, temporal and scenario modeling analysis of malaria vulnerability due to climate change and solutions for mitigation and adaptation. To strengthening climate and health literacy of researchers, of health systems and of population risk preparedness

Endorsement 6.3

Investments in Africa-Based Innovative Products Manufacturing

6.3a- To encourage investment in innovations needed to achieve a compact of global, regional and national funders commitment to fully meet the financial needs for the R&D objectives of the WHO Global Technical Strategy on Malaria, requiring USD 850 million annually up to 2030.

6.3b-To invest in a sustainable African-based pharmaceutical industry committed to manufacture quality-assured health products for the need of the continent and for global supply security

6.3c- To promote investments in innovations across the spectrum of diagnosis, prevention and treatment with emphasis in university and research centers to be product oriented

We, members of the MIM Society and representatives of her malaria global community of researchers and partners have therefore affixed our signatures before these delegates affirming and encouraging the pursuit of these objectives with determination.

Signed in Kigali this 25th day of April, the year 2024.

Prof. Rose Leke	Co-Chair, MIMSOC
Prof. Jean Pierre van Geertruyden	Co-Chair, MIMSOC
Dr. Daniel Ngamije	Global Malaria Program, WHO
Prof. Dyann Wirth	Defeating Malaria, Harvard
Dr. Michael A. Charles	RBM Partnership to End Malaria
Prof. Wilfred Mbacham	Executive Dir, MIMSOC Sec
Prof. Claude Muvunyi	Chair, MIM LOC, RBC
Prof. Evelyn Ansah	Co-Chair, Scientific Com
Dr. Aimable Mbituyumuremyi	Rwanda Biomedical Centre
Dr. Eric Remera	Co-Chair, Scientific Com
Dr. Jean Louis Mangara	Rwanda Biomedical Centre
Prof. Oumar Gaye	MARCAD, UCAD Dakar, Senegal
Prof. Abdisalan Noor	Visiting Prof. Harvard Chan SPH
Dr. James Tibenderana	Malaria Consortium, UK
Dr. Sylvie F. Drabek	Medicines for Malaria Venture, CH
Dr. Tarryn Haslam	PATH, USA
Dr. Philip Welkhoff	Bill and Melinda Gates Foundation, USA