In July 2009, US President Barack Obama spoke to Ghana’s parliament about building a partnership between African nations and the wealthy nations of the world to address the many pressing issues facing Africa, including public health problems. In the same spirit, 12 years earlier in 1997, Harold Varmus, then Director of the US National Institutes of Health (NIH), called on scientists in wealthy nations (referred to as the North) to work with African scientists to address the enormous health burden imposed on Africa by malaria. In collaboration with the Pasteur Institute and the Wellcome Trust, he initiated the first meeting of what was later called the Multilateral Initiative on Malaria (MIM) in Dakar [1
]. Varmus played an essential role in articulating the need for Northern and African scientists to work together to expand African research on malaria and to reduce the awful disease burden of malaria in Africa. He was also instrumental in setting the achievable goal (as MIM’s first priority) of establishing internet connectivity between African and Northern scientists, enhancing the ability of African scientists to communicate with scientists worldwide and to gain access to the scientific literature. At the end of the first MIM meeting, Varmus committed the US National Library of Medicine (NLM), through an effort called the Multilateral Initiative in Malaria Communications Network (MIMCom) to help meet this goal. MIM differed from previous initiatives to foster science in Africa in that MIM involved scientists equally from Africa and from the North. The organizers of MIM understood that to a substantial extent, money for African research in malaria must of necessity come from the North, but believed that the scientific expertise must depend on African scientists as well as Northern scientists.
The first MIM meeting established focus groups for specific areas of research that included antimalarial drugs, pathogenesis, immunology, entomology, vector control methods, epidemiology, health systems, vaccines and case management [Final Report: International conference on malaria in Africa: Challenges and opportunities for cooperation, http://www3.niaid.nih.gov/topics/Malaria/PDF/senegal1997.pdf
]. The groups covered interventions, training and the funding (mechanisms of cooperation and support). Each focus group, composed of an equal number of scientists from Africa and from the North, was asked to identify the most important questions in its area and research strategies to provide answers, including ways to enhance collaboration. For example, Terrie Taylor chaired the pathogenesis group that identified variations in the pattern of disease in different localities as a ‘roadblock’ to testing experimental interventions in severe disease. This led to the creation of the Severe Malaria in African Children (SMAC) network, which has provided data on severe disease from several locations, facilitating studies that required large cohorts for analysis [2
]. Similarly, Dominic Kwiatkowski developed a collaborative network for genome-wide associations for severe malaria (malariaGEN) [3
]. Both of these networks involved African scientists and the training of new African members of the network. The antimalarial drugs focus group discussed the many problems facing nations of Africa in making decisions concerning the identification of effective drugs, and suggested a network to follow drug resistance in different African countries. Fred Binka, the chair of vector control methods focus group, identified the need to evaluate interventions, and established a program entitled the International Network for the Continuous Demographic Evaluation of Populations and Their Health (INDEPTH) [4
] funded by the Gates Foundation. The program identifies scientifically valid methodologies for longitudinal studies of the population health status and cost effectiveness of interventions in Africa.
The MIM Secretariat was formed to oversee coordination and communication within MIM and to organize a Pan-African meeting every 3–4 years. After the meeting in The Hague, the Wellcome Trust committed to house and to support the first Secretariat with the long-term goal of moving the Secretariat to an African institution (). This goal was met in 2006 when Wen Kilama took on the Secretariat at the African Malaria Network Trust (AMA-NET), an organization established to build capacity in Africa in vaccine testing.
Secretariats for MIM since its beginning in 1997a
In 1997, internet connectivity was universally identified by African scientists at the Dakar meeting to be a priority for the development of science in Africa. It was recognized that research could not be accomplished without internet connectivity for access to the scientific literature, discussion with collaborators and access to applications to funding agencies and online courses. Under the leadership of Julia Royall at the US NLM [5
], and later through the work of the Royal Institute of Technology in Stockholm, internet connectivity through satellite-based transmission was developed at 27 sites in 14 countries throughout Africa (). This was an enormous accomplishment at the time. Now internet connectivity is more readily available and cheaper in Africa than was the case a decade ago. In addition, the public digital library (PubMed Central), open-access journals and journals that provide free content to the world’s poorest countries through the HINARI (Health InterNetwork Access to Research Initiative) program of WHO have greatly increased the cost-free provision of scientific articles to all scientists in the developing world who have an internet connection. Thus, MIMCom is no longer as important of a component of MIM as it was at the beginning.
Figure 1 The Multilateral Initiative in Malaria Communications Network (MIMCom) provided enhanced connectivity for African scientists at 27 sites in 14 countries. Julia Royall, Chief International Programs at the US National Library of Medicine (NLM), was brought (more ...)
The biggest challenge from the time of the Dakar meeting to the meeting in The Hague (later in 1997) was to bring together funding agencies to form a central funding mechanism. Unfortunately, central funding was not achieved, and The Hague meeting was the low-point of MIM. After The Hague meeting, Tore Godal committed the WHO Special Programme for Research and Training in Tropical Diseases (TDR) to fund African scientists’ research through a new component of WHO/TDR, MIM/TDR. However, from the beginning in 1997, it was clear that all funding, for example that from the Wellcome Trust, could not be channeled through MIM/TDR because of the statutes of the funding agencies. TDR was an important funding agency with personnel and offices and, most importantly, with experience with capacity building in Africa (25% of their budget was dedicated to building capacity in developing countries). However, TDR had only a small budget (~$1.5 million) to invest in malaria research, and relied on donations for its funding. The National Institute of Allergy and Infectious Diseases (NIAID) of NIH recognized the building of science in Africa as one of the most important elements of MIM, and has consistently committed funds to this program, as has TDR. Other groups, such as the Rockefeller Foundation, AFRO (the WHO regional office for Africa) and The World Bank, committed funding to MIM/TDR for the short term.