Importance of vivax malaria
Once regarded as a relatively benign infection, Plasmodium vivax is now acknowledged to be an important public health threat, capable of causing life-threatening disease complications, debilitating recurrent infections, miscarriage and chronic infections. While major gains have been made in the reduction of malaria over the last decade, in almost all co-endemic regions these successes are far greater for Plasmodium falciparum than for P. vivax. Compared with P. falciparum, P. vivax exhibits far more extensive genetic diversity, and has numerous adaptive biological mechanisms, such as the ability to develop dormant liver stages (hypnozoites) and the emergence of transmissible blood stages (gametocytes) before clinical symptoms. These properties afford the parasite a variety of strategies to adapt to environmental challenges, including those imposed by intensive malaria control activities.
Establishment of Vivax Working Group
At APMEN’s inaugural meeting in 2009, Plasmodium vivax infections were identified as a common threat to malaria control across the region. The APMEN Vivax Working Group (VxWG) was established to specifically address this issue. The Working Group members included Country Partner representatives who are responsible for delivering national malaria control activities, along with technical experts from APMEN’s academic and research partner institutions. Together, the members developed a four-stage strategy to identify knowledge gaps, build regional consensus on shared priorities, generate evidence and change practice to optimize malaria elimination activities. The APMEN VxWG has since established itself as a unique forum for national malaria control programme managers, researchers and collaborative partners to exchange ideas, discuss regionally relevant issues and develop innovative approaches to vivax malaria challenges.
Approach to research
The Working Group’s activities are focused on addressing key questions defined by the APMEN Country Partners and are closely aligned with regional elimination strategies. These activities may be directly relevant to operational research, as well as more upstream research that will ultimately supply pathways to achieve these end goals. The Working Group’s programme responds to the emerging needs of countries as they move through their different stages toward elimination. The Group’s approach can be summarized by the following four-phase cycle (Fig. 1):
The VxWG is supported by a coordinating team from the Menzies School of Health Research (Australia). Professor Ric Price (Menzies) and Dr Sanchai Chasombat (Ministry of Public Health, Thailand) currently serve as the Working Group Co-chairs. The VxWG consists of representatives from APMEN Country Partners, Partner Institutions, WHO, and the APMEN Secretariat. Core funding support for the VxWG has been provided by the Australian Government (2010-2015). The Working Group also acknowledges funding contributions for past annual meetings and workshops received from Medicines for Malaria Venture (MMV), PATH and RITM.
Vivax malaria is a major impediment to malaria elimination in Asia Pacific countries. Addressing the challenges of vivax malaria has been a primary priority within APMEN’s regional strategy since the Network’s inception in 2009. APMEN’s Vivax Working Group (VxWG) has been supporting research and advocacy to address the challenge of vivax malaria, through reviewing the existing evidence for effective surveillance diagnosis and treatment, identifying key knowledge gaps and priorities, and implementing a process to translate relevant evidence into policy and practice.
The VxWG’s aim is to ensure that relevant, high quality research is conducted to meet the needs of Asia Pacific national malaria control programmes and regional elimination commitments. The Working Group achieves this by:
- Identifying knowledge gaps and operational research priorities necessary for the optimal control and elimination of vivax malaria
- Sharing research and operational experience between APMEN Country Partners to maximise synergistic activities and minimise unnecessary duplication
- Funding catalytic research projects to address key knowledge gaps, and facilitating their implementation, analysis and feedback to the Network.
- Developing and sustaining partnerships with key stakeholders involved in the regional elimination for vivax malaria (including but not limited to WHO, Malaria Atlas Project (MAP), WorldWide Antimalarial Resistance Network (WWARN), Malaria Elimination Group (MEG), Foundation for Innovative New Diagnostics (FIND), Asian Vivax Network, research institutions, funding bodies).
- Working through APMEN to advocate for improved funding of P.vivax control and research activities.
- Promoting collaborative research partnerships amongst APMEN Country Partners.