No. 64 February 2001 TDR UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR)

CONTENTS KEYNOTE ARTICLE 3 New focus on social, economic and behavioural research 4 Web of Science: A massive effort against Bridging the digital divide 5 Public/private diseases of : What partnership for research training: a new kind of TDR trainee role will research play? 6 : First vaccine trial By David Heymann, David Nabarro (World Health Organization) 7 : Expert Committee on control meets A massive effort 7 : Current against the diseases of

drug candidates WHO/TDR/Crump poverty is necessary to 8 Partners: The Institute meet the call by heads for Medical Research, of state for a reduc- Kuala Lumpur tion of serious illness 9 : Artesunate + sulphadoxine/ amongst the poor. pyrimethamine In this article, David combination pack Heymann, Executive 10 Do insecticide treated Director of the Com- materials merely delay childhood mortality? municable Diseases 11 Roll Back Malaria Cluster at WHO, and update: Research and David Nabarro, Execu- Development Strategy tive Director in the 12 Dengue: Increasing Director-General’s in the Americas Office at WHO, high- 13 Dengue: Chiang Mai A WHO-led massive effort against diseases of Bednets: how Declaration poverty (announced in October 2000) is a pro- can this cost-effective light the necessary solution for reducing 14 Genetic transformation cess that is primarily about prosperity and child mortality in Africa contribution of of a malaria mosquito strengthened health delivery systems, not best be delivered to research to a massive those in greatest need? 15 TDR Final Report series about diseases. It is about people and how to effort in developing improve their health, about health systems and 16 Publications how they respond to poor people. It is about getting well-tested and new disease control 17 Net news effective control interventions to the people who need them, tools and improving 18 New lease of life whether by reducing their costs, improving their distribution, increas- strategies to make for resurrection drug ing their efficacy, or slowing down the development of antimicrobial existing tools (drugs, resistance. Such a massive effort would involve a whole range of part- 18 Research needs vaccines, diagnostics) ners from public, private and not-for-profit sectors, bringing focus to 19 Deadlines the disconnection in what we actually do and what we would like to more accessible to 20 TDR Image Library do in terms of controlling the . > (next page) those in need.

www.who.int/tdr A massive effort...

(continued)> A massive effort would eventually make available a sustained high level of resources that would make possible both increased access to existing drugs, vaccines and diagnostic tests, and research to better use these existing goods and develop the new ones necessary. What is the place of research in this effort? Disease control today depends on cost-effective strategies to best use the many drugs, vaccines and diag- nostic tests that, when used properly, are capable of reducing mortality. But, today these strategies don’t reach all who need them, and maybe we can develop better strategies. So the massive effort will, in part, be about developing better strategies to make existing drugs, vaccines and diagnostic tests more accessible to those in need (e.g. the use of bednets in Africa would need to be scaled up 20 times using strategies that ensure better access and increase demand). Operational research is therefore required in a massive effort. With evidence in the form of data from well-designed operational research and its analysis and synthesis, we can demonstrate that existing interven- tions get drugs, vaccines and diagnostic tests to where they are needed in a TDRnews way such that they can be maximally used. is published three times At the same time, research in a massive effort is also required to develop WHO/TDR/Crump a year by the UNDP/World new tools – new drugs and vaccines, and easier-to-use diagnostic tests. Bank/WHO Special Adaptations of existing products, such as better fixed-dose combinations Programme for Research of drugs for tuberculosis and malaria, simplified for field use, are also and Training in Tropical required. Diseases (TDR). TDR, with its broadened disease mandate and new emphasis on opera- Full article text available tional research, is well placed to ensure the research necessary for a mas- on the TDR website. sive effort. As increased funds for a massive effort become available, the All material submitted balance between funds used to make existing vaccines, drugs and diagnostic to TDRnews undergoes edito- tests available, and funds for operational and more basic research and rial review. Articles and illustrations published in development, will be a great challenge. TDR has successfully maintained TDRnews which are not the correct balance between research and implementation in the past, and copyrighted may be repro- will surely rise to the task of doing the same as a massive effort continues duced, provided credit is to evolve. given to TDR and provided such reproduction is not used for commercial purposes. Articles do not necessarily reflect the views of WHO.

Managing Editor Dear Reader, Nina Mattock If you wonder why TDRnews has a new look, its because, in 2000, TDR completed its first quarter centu- Production team Andy Crump ry of existence. As we enter 2001, many things are changing – and rapidly. TDR is changing too, embark- Cathy Needham ing on a new strategic direction with regard to many of its activites. As part of the programme’s new Design and layout working practices, we will be greatly expanding our communications activities. In particular, we will be Lisa Schwarb using all our communications tools to encourage a 2-way information flow. Consequently, from now on, Tel. each issue of the new look TDRnews will have a ‘feedback’ section, which will carry a letter or correspon- (+41-22) 791-3725 dence from our readers. This could be feedback on something that has appeared in the newsletter, or be Fax observations and comment from readers on any aspect of TDR’s target diseases or the programme’s (+41-22) 791-4854 work. Please send us your comments and views (in writing or by e-mail) to: E-mail [email protected] Communications Unit, TDR, World Health Organization, 1211 Geneva 27, Switzerland Web or to www.who.int/tdr [email protected] Address TDR We look forward to hearing from you, and encourage and welcome the participation of all our readers in World Health Organization the effort to ensure a 2-way flow of information. Ed. Avenue Appia 20 1211 Geneva 27 TDR reserves the right to edit any correspondence published in the newsletter. Please note that we can neither guarantee publica- Switzerland tion nor are we able to return any materials submitted.

2 • TDRnews • No 64 • FEBRUARY 2001 BASIC AND STRATEGIC RESEARCH TDR increases its efforts in social, economic and behavioural research

The new Steering Committee on Implementation Research team Strategic Social, Economic and (formerly the Applied Field Behavioural Research (SEB) issued Research team). its first call for grant applications in In June 1999, TDR’s Joint Coordi- October 2000. Over the next 2-3 nating Board (JCB) approved the years, SEB will focus on supporting creation of a new Steering Commit- research that increases understand- tee on Strategic Social, Economic ing of: and Behavioural Research (SEB). • how large-scale social and eco- As mentioned in TDRnews No. 63, nomic forces affect inequality of SEB is located within the Basic and access to treatment, prevention Strategic Research team (STR) to and information related to infec- reflect its focus on basic social, tious diseases; economic and behavioural research • the implications of globalization issues of trans-disease and global on the persistence, emergence importance. and resurgence of these diseases. A Scientific Working Group (SWG) Studies of this nature will require of experts from a range of social, innovative research methods, economic and policy sciences met CONTACT involving multi-level analyses that in Geneva in June 2000 to set the allow for investigation of the effects overall direction for SEB. Dr Johannes Sommerfeld, of large-scale forces on local level In September, the SEB Steering TDR/STR, processes and outcomes. An impor- Committee met for the first time, SEB Secretary tant aspect of the Committee’s and developed a vision for the next Tel.: (+41-22) 791-3954 work will be to support capacity five years and a detailed workplan building to conduct such analyses. for the coming two years. Fax: (+41-22) 791-4854 The focus of SEB reflects WHO’s E-mail: Social science research growing interest in the complex [email protected] in TDR: past, present relationship between poverty and and future health. On a worldwide scale, infectious and parasitic diseases dis- From the beginning, TDR has placed proportionately affect populations The SEB workplan considerable emphasis on the living in poverty. Social, political and current call for social and economic aspects of and economic inequalities are cen- grant applications tropical infectious diseases and tral to the persistence and spread their control. From 1979-94, of these diseases, and the perfor- can be retrieved at TDR supported social science mance of health systems in protect- the TDR website: research through its Steering ing vulnerable populations from the Committee on Social and Eco- impact of these diseases often falls www.who.int/tdr/grants/ nomic Research (SER), and since far short of potential. Over the next workplans/seb.htm 1994, applied social science several years, the SEB Steering research has been supported by the Committee will examine these www.who.int/tdr/grants/ Intervention Development and issues within the context of global- grants/seb.htm ization, the changing role of the state, and the emerging role of or requested, by regular non-state actors (the private sector, mail, from the SEB secre- NGOs and civil society). tariat.

TDRnews • No 64 • FEBRUARY 2001 • 3 RESEARCH CAPACITY STRENGTHENING Web of Science: Bridging the digital divide

Public and private partners Major awards for electronic team up to facilitate the ject, researchers and scientists communication in science have flow of health information will begin to “read the same been approved for four centres journals, search the same data- via the Internet in Africa (which are all TDR bases, join in the same discus- partners in research) and five sion groups, compete for the centres in central Asia and eastern Europe. same grants; it will bring them into the interna- This is the first phase of a public/private initiative tional community of researchers and eventually – the Health Internetwork project – which aims improve the dissemination of their own results” to boost access by researchers and health work- (Dr Gro Harlem Brundtland, WHO Director- ers to reliable information via the Internet and General). to improve global public health by facilitating the The project aims to facilitate research in coun- flow of information worldwide. tries that have first-hand experience of diseases Partners in the initiative include the World and health issues that affect the poor. As to the Health Organization (WHO) and other UN organizations, the Open Society Institute (OSI), which is part of the Soros Foundation network,

leading information providers ISI(r) and Silver WHO/TDR/Morel Platter, and other public and private partners, SEE ALSO possibly including the leading scientific publisher, WHO press release Elsevier. In the first phase of the study, the nine centres www.who.int/ are to be provided with a ‘connectivity package’ inf-pr-2000/en/ consisting of hardware, wide band connectivity, pr2000-76.html full access to several databases and more than 100 medical journals (online, full text). For their part, the centres will help work out how to introduce locally-produced information to the Internet, stressing priority public health pro- grammes and local translation and adaptation of content as necessary. They will also help work roles of the different founding Internet cafe in out how to expand the project to the rest of partners, the private partners Burkina Faso. their country and region, and how to evaluate will focus on organizing compre- its impact. The pilot trial will test whether online hensive training for research staff, while the delivery of high-quality information and interna- WHO and UN will discuss provision of high- tional connectivity addresses the information and speed connectivity to the Internet with service communication needs of developing country providers in the eight initial countries. NGOs researchers. and foundations will provide resources and The four TDR partners selected in Africa for logistics support. the pilot phase are: After the one-year pilot phase, the intention is • Noguchi Memorial Medical Research to extend the facility to a large number of needy Institute, Accra, Ghana countries. It is anticipated that, by the end of • Malaria Research and Training Centre, 2003, some 13 000 new health information University of Mali, Bamako, Mali access points in some 40 countries will be • Makerere University Medical School, equipped with Internet technology, thus enabling Kampala, Uganda communication and networking among public • National Institute for Medical Research, health information users, and improving moni- Dar es Salaam, United Republic of Tanzania. toring of health situations. Research, and the sharing of knowledge through research, is fundamental to improving public health. Through the Health Internetwork pro-

4 • TDRnews • No 64 • FEBRUARY 2001 RESEARCH CAPACITY STRENGTHENING Public/private partnership for research training: a new kind of TDR trainee

Mahamadou Thera was on his way home after malaria. "What is 10-20 years the children to come and then spending 11 months in Belgium with a pharmaceuti- to develop a vaccine compared treated them with quinine, a to the hundreds of years we've highly-efficient drug but one cal company, learning design and management of been suffering from malaria?" which can only be used in a product development. He stopped off in TDR for a he says. hospital, as directed. After a few weeks to learn how TDR promotes good clinical During his 11 months with SB couple of years spent treating practices, and then returned to Mali, his home, Bio, Mahamadou has learned people, he realized that there how to design clinical trial pro- was something which was much to directly implement what he had learned during tocols, and conduct and moni- more important than simply these months. He hopes to use his knowledge tor studies ensuring respect of curing them in hospital, and and experience to manage malaria vaccine trials good clinical practice (GCP). "It that was community action. So that could begin as soon as mid-2001 was a new kind of collaboration he shifted from working in clin- for the company" says ics to working in public health. Mahamadou, "they had not par- In 1993, Mahamadou participat- ticipated in such a partnership ed in a malaria survey in his before, but they adapted very home town and helped estab- quickly." Back home, he works lish a malaria control pro- in a parasitology laboratory – a gramme, with which he worked WHO collaborating centre – for three years. Later he joined headed by Professor Doumbo. Professor Doumbo's laboratory. Already a small team of five Having worked in a malaria medical and pharmaceutical control programme, our TDR doctors exists in the vaccine researcher knows how com- unit at the laboratory. "There plex and time-consuming con- have been many clinical trials in trol is. He also knows the value malaria so far," says of open-minded discussion Mahamadou, "but not all of between researchers and con- them according to GCP stan- trol programmes – as a malaria dards." So, in the proposed tri- control programme coordina- Mahamadou is the first of a als of malaria candidate vac- tor, Mahamadou had regular new kind of TDR researcher cines, Mahamadou and the rest exchange with researchers. who is supported by a of the team will try to bring "Researchers have to learn public/private partnership in some kind of clinical monitor- what the needs are, and to capacity strengthening. Awards ing facility into practice. involve control programmes in under this scheme are for peri- Mahamadou was born in a the planning of their research ods of 12 months, and are beautiful mountainous area of activities." He suggests that explicitly for young nationals of Mali, a highly malarious region. perhaps there could be units malaria endemic countries who Returning home from his stud- of research within malaria con- have relevant control/research ies abroad (in Belgium and trol programmes, staffed with experience – they are advanced Romania), he was horrified to epidemiologists, who would trainees. In Mahamadou’s case, experience his first malaria have one foot in the control TDR's private partner is the transmission season as a young camp and one in the research pharmaceutical company doctor, in the paediatric ward camp. SmithKline Beecham Biologicals of a hospital in North Mali. (SB Bio, now GlaxoSmithKline), "There were so many cases of which is active in the field of severe malaria, of convulsions malaria vaccines. and coma, that I ran Mahamadou believes that a to the hospital director: 'Our malaria vaccine is, in the long home is exploding. All our chil- run, our best bet for control of dren are dying.’ ” He waited for

TDRnews • No 64 • FEBRUARY 2001 • 5 PRODUCT RESEARCH AND DEVELOPMENT First vaccine trial against visceral leishmaniasis

Results suggest that The results of the first trial of a vaccine may be associated Epidemiol, 1986, 15: 572-80 ) vaccine against visceral leishma- with a lower incidence of and Momeni and colleagues niasis in humans have been pub- in Iran (Vaccine, 1999, 17: 466- disease lished in The Lancet by Khalil et 72), both using whole killed al. (356 [9241] 4 November Leishmania. In the Sudan study 2000). In a study performed by scientists of the with two injections, responders had a 43% lower Institute of Endemic Diseases, University of incidence rate as compared to LST non-respon- Khartoum, Sudan, supported by TDR and assist- ders (7.2% vs.12.7%, p<.003). ed by Médecins sans Frontières (MSF)-Holland, There is a need to identify a suitable adjuvant a vaccine composed of autoclaved Leishmania to improve immunogenicity of killed Leishmania major promastigotes (Fesharki, et al. at Razi Vac- vaccines. Recent preliminary studies in Sudan, cine and Serum Institute, Iran) mixed with a low by the same team and using a new preparation dose of BCG (as adjuvant) was compared with of Leishmania + BCG with the addition of alum, BCG alone. are highly encouraging since various doses The trial was carried out in the Sudan, where induced a strong LST conversion in all (although visceral leishmaniasis is a major cause of morbid- small numbers of 5-8) volunteers. Further stud- ity and mortality and where, in the study areas, ies are being planned. there was a prevalence of 80-130 per 1000. CONTACTS Although drug treatment for visceral leishmania- Dr Howard Engers, sis does exist, it is not always available where needed. As well, it is expensive, comprising daily TDR/PRD injections for one month, and is associated with Tel: (+41-22) 791-3736 side-effects. Drug resistance is also becoming Fax: (+41-22) 791-4854 common. In Sudan, as in other endemic coun- E-mail: [email protected] tries, the development of a safe, effective and cheap vaccine would seem to offer the only real solution for controlling visceral leishmaniasis, Dr Philippe Desjeux, vector control being prohibitively expensive in TDR Leishmaniasis the vast endemic areas, although there have Research Coordinator, been encouraging results from pyrethroid impregnated bednet trials. The presence of CSR/EDC extensive cross-reactivity between different Tel: (+41-22) 791-3870 species of Leishmania was the rationale behind Fax: (+41-22) 791-4878 this trial of a vaccine made from L. major, that E-mail: [email protected] had proved almost 40% effective in one area of Iran endemic for L. tropica (see TDRnews No.57). A young Sudanese boy with visceral The double-blind study was carefully designed leishmaniasis; new and monitored. There was no evidence that two vaccine trials are injections of Leishmania + BCG offered signifi- encouraging.

cant protective immunity against visceral leish- WHO/TDR/Crump maniasis compared with BCG alone. However, the Leishmania + BCG vaccine did induce sig- nificantly higher rates of leishmanin skin test (LST) conversion (30% vs. 7% by BCG alone) at 42 days, which was associated with lower incidence of disease. Similar results, i.e. lower incidence of disease in LST converted than non-converted individu- als, have been obtained by others, including Mayrink's group in Brazil (Antunes et al., Int J.

6 • TDRnews • No 64 • FEBRUARY 2001 UPDATE Expert Committee on Control of Chagas disease meets

Advances in interruption of transmission trol and (eventual) elimination, was CONTACT highlighted as a major achievement in the undertaken by the Committee. Dr Alvaro Moncayo, Americas The advances in the interruption WHO/TDR/Crump TDR/IDE of transmission were underlined as The Second Meeting of the Expert a major public health achievement Tel: (+41-22) 791-3865 Committee on the control of in the Americas. The Committee Fax: (+41-22) 791-4774 Chagas disease was held in Brasilia, also defined research priority areas E-mail: Brazil, from 20-28 November 2000. with direct and immediate bearing [email protected] Prof J. R. Coura, Director of the on completing the interruption of Oswaldo Cruz Institute, Rio de transmission of Chagas disease and Janeiro, was elected chairman; developing new drugs to prevent Chemotechnica factory, Dr M. Lorca, from the School chronic lesions. A report of the Buenos Aires: A lit and smoking MUSAL fumigant of Medicine, University of Chile, meeting is under preparation and canister (produced at the was elected vice-chairman; and will be formally submitted to the factory for supply to the th Argentinian government). Dr F. Guhl from the University of 108 Meeting of the WHO Execu- When lit inside houses, Los Andes, Bogota, Colombia, was tive Board in May 2001. It will be the canister produces the rapporteur. published in the WHO Technical insecticidal fumes to kill the insect vectors of A thorough review of the different Report Series, as mandated by the Chagas disease. aspects of Chagas disease, its con- WHO Constitution.

UPDATE Counting current anti-TB drug candidates

Low number of drug candidates against mycobacteria (usually meeting’s conclusions, which CONTACT leads to call for more discovery M. tuberculosis) growing in vitro, will be published in report form Dr Richard Pink, research for new anti-TB drugs in some cases confirmed by in later this year: the number of TDR/PRD vivo experiments. This list realistic candidates for new Pharmaceutical companies and had been compiled from pub- anti-TB drugs, among com- Tel: (+41-22) 791-2665 academic research laboratories licly available sources by Dr pounds or classes of compound Fax: (+41-22) 791-4854 that work on antibiotics often Toshiko Imamura, working in currently known to have anti- E-mail: [email protected] test molecules for activity TDR with funding from the TB activity, is small – not more against mycobacteria, the Rockefeller Foundation. At the than one in clinical develop- causative agents of tuberculo- meeting, the participants (about ment, two or three in preclini- sis, but – for economic or 25 people, drawn from acade- cal development, and a handful other reasons – very few com- mia, industry and the public in the discovery phase. panies currently consider sector) updated and added to The lead times needed for developing active molecules this list, and discussed each development of an anti-TB further as specific anti-TB candidate on the revised list in drug are long (at least 10 drugs. How many of the mole- detail with respect to its likeli- years), and the dropout rates cules reported to have anti-TB hood of finally giving rise to a of compounds in development, activity are actually realistic safe, effective and inexpensive especially going from discovery anti-TB drug candidates? To anti-TB drug. The candidates into preclinical and clinical attempt to answer this ques- were classed as presently being tests, are potentially high. tion, a meeting was jointly con- in the research and discovery, These factors underline the vened by TDR and the Global preclinical or clinical phases of importance of more discovery Alliance for TB Drug Develop- development, and candidates in research – for example, based ment in December 2000, in different phases were discussed on the recently sequenced Geneva. The starting point for in separate breakout groups. M. tuberculosis genome – to the meeting was a list of about The last session of the meeting bring new anti-TB drug candi- 35 compounds or classes of drew together these discus- dates into the development compound with known activity sions and summarized the pipeline.

TDRnews • No 64 • FEBRUARY 2001 • 7 PARTNERS The Institute for Medical Research, Kuala Lumpur: 100 years of contributing to the health of the nation

The oldest research institute The Institute for Medical in Malaysia celebrates its tion in children have Research, Kuala Lumpur (IMR) 100th birthday with a look assisted programme – the oldest research institution managers to fine-tune in Malaysia – celebrated its back over its achievements disease control pro- 100th birthday in 2000. It was grammes in children. established in 1900 by the British as the Patho- Improved control methods for common dis- logical Institute, and its mission was to under- eases like dengue and malaria were developed take research in tropical diseases in order to as a result of research carried out on the effec- improve the living standards of the local popula- tiveness of insecticides and resistance to them in tion. From its beginning, the role and scope of disease vectors. In 1990, IMR researchers dis- the Institute’s work was wide and varied, covered the first insecticidal anaerobic killing encompassing research, diagnostic, investigative bacteria in the country, Clostridium bifermentans and consultative services, and training. Through- malaysia, and this discovery has been duly recog- NOTABLE ACHIEVEMENTS out its 100 years, the Institute has contributed nized by way of a 50-cent stamp commemorat- OF THE LAST TWO DECADES significantly in the field of health research and ing the centennial of the IMR. INCLUDE: the overall health services of the country and, Although commercialization of research findings for this, IMR can justly be proud of its achieve- is a recent activity, the IMR is proud to note ments. that, to date, three of its research findings have • New species of The IMR has a long and illustrious history of been commercialized: schistosome found conducting innovative biomedical research which • MOSBAC®, an aqueous suspension formula- has led to a better understanding of tropical dis- tion containing the spore-crystal complex • In vitro culture system eases in the region. Three of the most notable of IMR-BT-1, a Malaysian isolate of Bacillus achievements made in its early years of exis- thuringiensis, for the biological control of for the infective stage tence include: mosquito larvae larvae of Brugia malayi and • research into parasitology, including the • R-EST®, a test kit for the rapid detection of B. pahangi established diagnosis, treatment and control of malaria insecticide resistance • research into the cause and treatment of • Nutri-Cal, a nutrient analysis and food compo- beri-beri sition data management software. • research into the vector biology, ecology and Since independence, Malaysia has evolved from treatment of scrub typhus. an essentially agro-based society to an industrial- In the last two decades, research efforts at the izing one, resulting in changing lifestyles and IMR have led to several more new findings. A demographic patterns. In line with these new species of schistosome was found in river- changes, the IMR has, in recent years, embarked ine areas of Pahang between 1980-83. The IMR on new directions in its research, while retaining achieved a significant breakthrough in filariasis its traditional strengths in tropical medicine. In research by establishing an in vitro culture sys- 1990, the IMR was reorganized into five depart- tem for the infective stage larvae of Brugia malayi ments: namely tropical medicine, clinical pathol- and B. pahangi for the first time, and this has ogy, community medicine, support services and enabled the in vitro testing of potential filaricides administration, to meet the challenges of health in the fight against filariasis worldwide. Studies research more effectively. New areas of on nutritional status in rural areas have helped research undertaken included cancers and car- shape the nutrition programmes and laid the diovascular diseases as well as environmental foundation for many of the national nutrition health. In addition, biotechnology was intro- policies today. Studies of diarrhoeal diseases, duced as a new research tool to further enhance acute respiratory tract infections and immuniza- and improve our research capabilities.

8 • TDRnews • No 64 • FEBRUARY 2001 Main building of the Insti- tute for Medical Research.

cies in various fields of tropical medi- cine and public health. Specialized diagnostic Linkages with other testing remains a key function of the IMR, partic- research institutes and agencies are crucial ularly in the areas of HLA tissue typing and to IMR’s development. Two of IMR’s oldest link- cross-matching, endocrinology, biochemistry, age partners are the South-east Asian Ministers virology and bacteriology. of Education Organisation (SEAMEO) (since Today, the IMR, which continues to be the 1969) and the World Health Organization research arm of the Ministry of Health, is under- (WHO) (since 1978), and the IMR is thankful to going yet another phase of change to make it these organizations for their tremendous contri- more relevant to meet the challenges of the new butions to its research and training programmes. millenium. It is currently being reorganized to The more recent linkages include the Japan enable it to focus on important areas such as International Cooperation Agency (JICA) and infectious diseases, cancer research, cardiovascu- the Inter-Islamic Network for Tropical Medicine, lar diseases and nutrition, environmental health and we look forward to more such linkages in research, herbal medicine and allergic disorders. the future so as to further enhance networking In the years ahead, the IMR aspires towards a among researchers. culture of excellence in order to be able to con- Besides its research function, the IMR has been tribute even more significantly to the improve- very active in providing training and consultan- ment of health of the human population.

UPDATE An artesunate + sulphadoxine/ pyrimethamine combination blister pack for malaria treatment being developed

TDR, MSF and IDA are and long-lasting are of artesunate is being cantly lower than gen- working together to devel- urgently needed. Com- developed to meet the erally anticipated for op a blister package of bination therapy is need for high-quality, drug combinations. artesunate and sulpha- being advocated to affordable, effective The approach followed doxine/pyrimethamine delay the development and safe treatments is to consider this for malaria treatment of resistance and play a for malaria. The prod- medication as a "public significant role in uct will be produced good", and to address Malaria parasites are "rolling back malaria". entirely under GMP the proprietary right becoming increasingly A blister package con- (good manufacturing issues upfront. In this resistant to first-line taining one dose of practice) guidelines. respect, investments medications, and drugs sulphadoxine/pyrimeth- The final price of the are being made for the that are effective, safe amine and three doses product will be signifi- process to > (overleaf)

TDRnews • No 64 • FEBRUARY 2001 • 9 CONTACT (continued)> produce organization) was with the US Centers as possible receive an Dr Piero Olliaro, both raw material and selected. TDR will for Disease Control optimal dose of each formulated product oversee development (CDC). In this study, drug (not an under- TDR/IDE belonging to the public of the drug package. mostly African anthro- or over-dosage). Tel: (+41-22) 791-3734 sector. As a result, the Médecins sans Fron- pometric data rather Following completion Fax: (+41-22) 791-4774 cost of development tières (MSF) is funding than US population- of large, randomized, E-mail: [email protected] will not be included in most of the develop- based data were used controlled trials of the final price of the ment work with (the current CDC/ artesunate-containing drugs, and the process money received from WHO National combinations, work can be sub-licensed to the Nobel peace prize Center for Health is in progress on the third parties as need- awarded in 1999. Statistics standard is feasibility of fixed-dose ed. The choice of TDR is also contribut- based on a healthy US combinations of arte- development partner ing funds. population). Weight- sunate with other was made through a To ensure that drug for-age data from companion drugs, tendered process, and dosing is optimal, easy 137 000 persons from such as amodiaquine the International Dis- to administer in the disease-endemic areas, and mefloquine. pensary Association field, and based on primarily in Africa, (IDA, a non-profit sound scientific data, were used to ensure making pharmaceutical a study was conducted that as many people

UPDATE Malaria: Do insecticide-treated materials merely delay childhood mortality?

CONTACT Results from one of the first studies to address the treated curtains was carried out on the site of a Dr Jane Kengeya-Kayondo, existence of delayed mortality from use of insecticide- previous large-scale trial of the curtains, among treated materials a population of 90 000 in 158 villages in Burkina TDR/IDE Faso. This study was non-experimental in design Tel: (+41-22) 791-3737 – all villages received the intervention for three Fax: (+41-22) 791-4774 years (some had previously used the interven- E-mail: tion for an additional two years during the earlier trial). The study only aimed to show if [email protected] significant delayed mortality was occurring, not to measure its extent. Insecticide-treated curtains (ITCs) were found to provide substantial protection to people who slept in protected houses and also some degree of community protection by reducing the vector population. In the intervention area, WHO/TDR/Crump the entomological innoculation rates (EIRs) Results from the first study to be completed on indoors were estimated to be more than 90% the question of whether insecticide-treated lower than outside the area, while outdoors, materials such as bednets and curtains prevent, the EIRs were estimated to be more than 80% or merely delay, childhood mortality recently lower. There was no evidence of a ‘rebound’ became available. The study did not turn up any in vector densities over time. evidence that the predicted phenomenon of Interpretation of the mortality data was compli- ‘delayed mortality’ exists, even though not cated by the fact that, after a progressive reduc- excluding the possibility that it might exist. tion in mortality rate in the first two years, For some years, there has been concern that use there was a sharp increase of 11% in the final of insecticide-treated materials (ITMs) in hyper- year. However, this did not appear to be due endemic malaria areas might merely shift the to ‘delayed mortality’ because it occurred across predominant age of mortality to a higher age- all 0-5 year age-groups, slightly more so in the group – that because children may not be infect- youngest, and would have had to have been far ed early in life, they will not build up immunity greater (more than 50%) to put in question the to malaria, and so will succumb to the disease overall survival rate obtained through the use later on in life. Hence a study with insecticide- of ITMs during the first years of the study.

10 • TDRnews • No 64 • FEBRUARY 2001 PARTNERS Roll Back Malaria update: Strategy for Research and Development

Developing new malaria Research and development control tools and providing • Supporting the acceleration (R&D) features prominently in evidence to guide actions of development of new Roll Back Malaria (RBM), and drugs, vaccines and other form the basis of the RBM the following is an outline of the products WHO R&D strategy for this R&D strategy • Fostering innovative mecha- global movement. The strategy nisms for product develop- is based on two main aspects: ment such as public/private partnerships • Provision of evidence to guide actions in • Ensuring that the needs of malaria control in rolling back malaria. endemic countries influence priority-setting • Development of new tools, with empha- for R&D, e.g. through RBM presentations at all sis on getting R&D results into practice major R&D forums, from country to interna- as quickly as possible. tional level, and through making RBM country situation analyses widely available. Training and capacity strengthening are integral components. Whenever appropriate and possi- Ensuring quicker uptake of new ble, RBM R&D efforts will build on efforts tools through: already under way, e.g. RBM is working very • Regular review of the latest advances in tech- CONTACT closely with TDR, as its research arm within nology and research products WHO, and, outside WHO, RBM’s major R&D • Support for multisectoral discussion groups Dr Leonard Ortega, partners include the Multilateral Initiative on (scientists, technical experts, industry, funders, CDS/RBM Malaria (MIM), research and training institutions policy makers, interventionists, public health Tel: (+41-22) 791-2661 and regional R&D networks, foundations and officers) Fax: (+41-22) 791-4824 NGOs which support R&D on malaria. • Policy research in developing countries E-mail: [email protected] The foci of RBM R&D, and key functions and Improving application of existing actions, include the following: tools through: • Identification of knowledge gaps, and tools and SEE ALSO Increasing global investment in R&D product-needs, for RBM in endemic countries www.rbm.who.int on malaria through: • Putting existing interventions into wide-scale • Providing the necessary advocacy for and appropriate use increased spending on malaria R&D • Establishing effective linkages between resear- • Ensuring that increased investment in RBM is chers and control programme staff as an reflected in a proportionate increase in R&D integral part of RBM. expenditure. Capacity building through: Providing sound evidence – a corner- • Helping develop the capability to enable stone of the RBM strategy – through: malaria endemic countries to be self-reliant in • Supporting operational research to guide the operational research planning and implementation of control activities • Support for a number of scientific and training • Evaluating the impact and cost-effectiveness of institutions in advanced developing, and devel- control interventions oped, countries • Research-based decision support systems to • Strengthening of scientific research in the deal with the many complex demands of ‘South’ malaria control. • Support for R&D agencies building this capacity • Helping develop the capability of the malaria Supporting the development of new control sector to engage in evidence-based tools through: actions for rolling back malaria. • Providing ‘seed’ funding to initiate high- priority R&D

TDRnews • No 64 • FEBRUARY 2001 • 11 REGIONAL REPORT Dengue Fever/ Dengue Haemorrhagic Fever in the Americas

By Dr J.R. Arias and Dr Z. Yadon, PAHO, WHO Regional Office for the Americas

the geographical areas that are at highest risk using geographical WHO/TDR/Crump information systems, use of alternative ovi- cides (household bleach i.e. chlorine as 5.25% sodium hypochlorite solution) and larvicides (lime), epidemiological risk factors, and knowl- edge, attitude and prac- tices (KAP) studies. Dengue control in many countries of the Americas has been based on emergency interventions to face CONTACTS epidemics that have Dr Howard Engers, Dengue fever/dengue haemorrhagic fever In South America, appeared in countries TDR/PRD (DF/DHF) is on the increase in most of the coun- Dengue health education such as Paraguay, materials are aimed Tel: (+41-22) 791-3736 tries of the Americas. It appears that the trend of especially at children. Ecuador, El Salvador, dengue in many countries is very similar to the Guatemala, Honduras, Fax: (+41-22) 791-4854 situation in some Asian countries 20 or 30 years Nicaragua, Dominica E-mail: [email protected] ago: DF epidemics are being seen every three to and Costa Rica. Some countries that have a five years, and the incidence of DHF is ever- strong base in social communication and commu- increasing, particularly in Central America (in El nity participation (such as Panama) have been Salvador, Guatemala, Honduras and Nicaragua). spared the major epidemics of recent years. Dr Michael Nathan, This situation is the result of high densities of Cuba has a very strong vertical programme and CPE/PVC Aedes aegypti, the vector mosquito, brought its efforts have given it positive results even Tel: (+41-22) 791-3830 about by lack of an adequate supply of water and though, in 1997, it was the victim of an outbreak Fax: (+41-22) 791-4869 solid waste disposal, rapid uncontrolled urbaniza- in Santiago. Uruguay, even though infested with tion, and deterioration of the control agencies. the vector, has been free of autochthonous E-mail: [email protected] The circulation of multiple dengue serotypes and dengue since the vector was eradicated prior decentralization of health services have com- to 1960. Chile still remains free from the vector pounded the problem. (and dengue), also since its eradication before The PAHO/TDR Small Grant Programme has 1960. included dengue in its agenda for the past two The Pan American Health Organization has years. In the first year (1999), of 110 project drawn up a proposal for its member countries, proposals received, 11 were on dengue. Of the recommending they introduce more intersec- 16 projects that were funded, four were on toral actions into their prevention and control dengue. These projects were carried out in 2000. programmes, including social communication that In the second year (2000), 97 letters of intention may lead to behavioural change in individuals and were received of which 29 were on dengue. households to reduce vector species breeding Of the total, seven on dengue were short-listed. sites. Many countries have embraced this plan Project selection for 2000 took place in Decem- of action and are in the process of incorporating ber 2000 and the projects will be funded and it into their programmes. carried out in 2001. Research activities in the Americas have focused on operational aspects such as determination of

12 • TDRnews • No 64 • FEBRUARY 2001 Chiang Mai Declaration on Dengue Fever/Dengue Haemorrhagic Fever

Considering that Dengue fever (DF) is the most important mosquito-borne viral disease of humans. There has been a dramatic increase in geographic spread, numbers of cases and severity of disease in the past 30 years. Currently 2.5 billion of the world’s population, primarily in tropical developing countries, are at risk. Annually, there are estimated to be tens of millions of cases of the disease. Hundreds of thousands of these are of the more severe dengue haemorrhagic fever (DHF) which is a leading cause of childhood hospitalization and death in many countries. The economic impact of DF/DHF is comparable with that of other major infectious diseases such as malaria, tuberculosis and hepatitis.

And that Tools to reduce dengue morbidity and mortality are currently available for appropriate case management and mosquito control. Dengue is an environmental issue, its prevention and control requires collaboration with many sectors. Several countries have demonstrated that, with strong political commitment, the wide and wise use of these tools can result in successful control.

In recognition Of the magnitude of this global public health problem, and at the initiative of His Majesty King Bhumibol Adulyadej of Thailand, an international conference with over 700 public health specialists from 41 countries was held in Chiang Mai, Thailand, from November 20 to 24, 2000. The delegates of the First International Conference on Dengue/DHF in the new millennium

Recommend that all countries at risk for dengue transmission develop and implement sustainable prevention and control programmes, and

Resolve • To strongly endorse the WHO global strategy for prevention and control of DF/DHF; • To advocate increased political commitment and resources for improved and sustained prevention and control efforts; • To promote active intersectoral partnerships involving international, regional, national and local agencies, non-governmental organizations, foundations, private sector and community organizations; • To build and strengthen capacity of health systems for DF/DHF treatment, surveillance, prevention and control; • To pursue, encourage and support the development, application and evaluation of new and improved tools and strategies for DF/DHF prevention and control.

Chiang Mai, Thailand November 24, 2000

TDRnews • No 64 • FEBRUARY 2001 • 13 BASIC AND STRATEGIC The genetic transformation of a malaria mosquito

Scientists successfully Transforming the malaria- insert a functional gene tions easily. Genes associated transmitting mosquito into a into mosquitos with mosquito choice of food harmless insect which doesn’t host (animal or human) are carry the parasite has been the also being sought. Proteins goal of the TDR Molecular Entomology initiative and genes thought to be involved in recognizing since 1991. The insertion of a gene for green flu- human odours, and therefore important in orescence protein, as a marker, into the malaria host-finding, have been identified – cloning and transmitting Anopheles stephensi marks the begin- characterization of some of these olfactory ning of a new phase along the road to this goal.* genes in An. gambiae, the main vector of human The event is a breakthrough, although there is malaria in Africa, has begun. still a long way to go to reach the goal, which is An. stephensi is one of the major carriers of projected to be ten years away. The malaria in urban areas of the Indian subconti- green fluorescence gene is used as nent. Applying this transformation system to a model gene. It makes the mos- An. gambiae will speed up understanding of the quito glow green when excited physiology of the mosquito carriers of the with ultraviolet light and might, at disease and their interaction with the malaria a later stage, be replaced by genes parasite. Ultimately this work could lead to the which inhibit parasite replacement of wild mosquito populations with *2000, Catteruccia F. et al. development. Genetically manipulated ‘safe’ strains of mosquito unable to transmit Stable germline transformation larvae fluoresce when of the malaria mosquito Genes which inhibit para- exposed to UV light. malaria. Anopheles stephensi. site development in the Of course, numerous and important scientific, Nature 405 (6789): 959-62, mosquito are being iden- ethical, safety and regulatory issues will have to 22 June 2000. tified in a second line of be addressed before such a strategy could be research under the Molecular Entomology initia- used to control a vector borne disease. The tive. Interesting genes have already been found, benefits and risks associated with such an e.g. immune response genes. Key molecules in approach will have to be carefully assessed, the mosquito that are essential for the parasite with full consideration given to community, are also being identified, e.g. xanthurenic acid policy and socioeconomic reactions and impacts. was identified as a factor essential for activating The TDR committees of Social, Economic and the gamete stage of the parasite. This work will Behavioural research (SEB) and Molecular Ento- provide potential target genes for insertion into mology are formulating a joint initiative for this the mosquito genome. A third line of research purpose. This will focus on issues of risk percep- under the initiative is to develop mechanisms for tion, assessment and communication, ethics, driving the selected genes into natural popula- choice of sites and plans for deployment, and tions of mosquitos. Possible driving forces have socioeconomic issues associated with such an already been described e.g. using transposable undertaking. elements, which spread through natural popula-

Following page:

Example of TDR’s Final > Reports, a regular series of publications illustrating how TDR-supported research work is breaking new scientific ground, generating new knowledge, developing new tools and making innovative progress in the fight to com- bat tropical diseases.

14 • TDRnews • No 64 • FEBRUARY 2001 TDRnews • No 64 • FEBRUARY 2001 • 15 www.who.int/tdr/publications

TDR VARIOUS

• NATURE • Operational Medicine. Special Guidelines for focus: Malaria. Ethics Commit- Sponsored by MMV tees that Review and TDR. Biomedical 30 pages. Research. TDR/PRD/ETHICS/2000.1 31 pages. Available in English, French, German, Spanish, Turkish, Lao, Russian. • Reporting with pictures; a concept paper for researchers and health policy decision-makers, A. Haaland, O.B. Akogun, • Prospective O. Oladepo, O.O. Kale. Thematic Review TDR/IDE/RP/00.1 of TDR Research 80 pages. Capacity Strengthening. This manual followed from an operational field Meeting Report research project on Community-Directed (15-17 November Treatment of with ivermectin. • A focused research 1999, Geneva, It explains how communities can undertake agenda to influ- Switzerland). their own record-keeping and reporting with- HOW TO OBTAIN ence policy and TDR/RCS/PTR/00.1 out illiteracy being a constraint. The manual PUBLICATIONS practice in home 18 pages. describes the conceptualization, development, All TDR publications are management for testing and adaptation of a pictorial reporting available to download from malaria. • Recommendations form used in ivermectin distribution pro- Meeting Report of a Scientific grammes, summarizes the lessons learnt in the TDR website: (8-11 May 2000, Working Group the process, and relates these lessons and www.who.int/tdr/ Kilifi, Kenya.) on Tuberculosis. experiences to other research questions and publications/publications TDR/IDE/MHM/00.1 Meeting Report topics. It also summarizes the principles of or on request from 26 pages. (9-11 February visual perception among illiterates, upon which the form builds, and which were TDR Communications 2000, Geneva, • Recommendations Switzerland). confirmed by testing in different countries. of a Scientific TDR/TB/SWG/00.1 This publication is a succinct yet comprehen- Working Group on 13 pages. sive exposition of how policy makers and Dengue. health planners, among others, can extend Meeting Report the frontiers of health care at the ‘grass roots’ • TDR Strategy (3-5 April 2000, level, thus providing a substantial window of Geneva, Switzerland). (2000-2005). opportunity beyond simple drug delivery. TDR/DEN/SWG/00.1 TDR/GEN/SP/00.1/Rev.1 10 pages. 28 pages.

• Recommendations of a Scientific Working Group on Strategic Social, Economic and Behavioural Research. Meeting Report (31 May-2 June 2000, Geneva, Switzerland). TDR/STR/SEB/SWG/00.1 11 pages.

16 • TDRnews • No 64 • FEBRUARY 2001 OTHER PUBLICATIONS

• Bulletin of the World Health PLEASE ORDER FROM Organization, Special theme: Malaria. World Health Organization 2000, 78 (12): 1374-1491 Marketing and The theme section of this Bulletin covers a wide range of malaria topics, from combination Dissemination therapy (a review of its use in South-east Asia, 1211 Geneva 27 outlining the problems that need to be over- Switzerland come in order to adopt it successfully in sub- Direct Fax: Saharan Africa), insecticide-treated mosquito Price: ment of new anti- nets (a review of six studies comparing insecti- Developed countries: malarial drugs (a (+41-22) 791-4857 CHF. 20.– E-mail: cide-treated bednets with indoor insecticide Developing countries: review of the current spraying), to the possible use of genetically CHF. 14.– status of the P. falci- [email protected] modified Anopheles for vector replacement parum genome (a review of recent progress in molecular sequencing project studies of malaria vectors in three areas with and the unique insights it has generated, and ALSO AVAILABLE AT potential for near-term impact in malaria con- of the application of functional genomics www.who.int/bulletin/ trol: species identification, population genetics tools to the identification of new therapeutic and insecticide resistance), from the use of strategies and targets). A new section ‘Public geographical information systems in the plan- Health Classics’, takes a look back at the ning, execution and monitoring of interven- ground-breaking demonstration by Shortt tions (computerized mapping and management and Garnham in 1948 of the exo-erythrocytic of data stand to greatly assist the targeting of cycle of the malaria parasite, and includes a interventions against malaria), to the potential commentary on the significance of this discov- role of post-genomics research in the develop- ery from a modern-day perspective.

Net news The good news for researchers is that more and more scientific journals are becoming available in full text on the web. The bad news is that, for many, you have to pay for them. So where can you find free online access to full text journals?

CONTACT Free Medical Journals.com www.freemedicaljournals.com is dedicated to the promotion of free Cathy Needham, access to full text medical journals. It lists links to over 500 journals covering areas such as epi- demiology, infectious diseases, pharmacology, public health and tropical diseases. More selective TDR Web Editor is the new PubMed Central website www.pubmedcentral.nih.gov/, which provides a web-based Tel: (+41-22) 791-3786 archive of full text life sciences journals. Other sites of interest are SciELO www.scielo.org, Fax: (+41 22) 791-48 54 which focuses on South Amercian science journals, and the recently revamped Parasitology E-mail: Online www.parasitology-online.com, which offers free full text access to certain issues and [email protected] articles for a range of parasitology journals.

Of course, a trip to the library is likely to open more doors, as many subscribe at an institutional We welcome feedback level to services such as OVID www.ovid.com, which provide online access to journals for staff or any Net sites and working in the institution. Ask your librarian for details. observations.

TDRnews • No 64 • FEBRUARY 2001 • 17 BREAKING NEWS New lease of life for resurrection drug

Companies agree to make and Gillette, has recently introduced RESEARCH NEEDS donate 60 000 doses of eflor- Vaniqa™, an eflornithine-contain- nithine for use in treatment of ing cream, for removing facial hair in women – in collaboration Repositioning sleeping sickness with Dow Chemical Co., Akorn Manufacturing Inc., and Aventis of leprosy in TDR: The supply of eflornithine, nick- had agreed to make and donate named the ‘resurrection drug’ to MSF’s warehouse in Bordeaux, notice to leprosy because of its spectacular effect France, 60 000 doses of eflor- on comatose patients in late-stage nithine by June 2001 for use in researchers gambiense sleeping sickness, may treatment of sleeping sickness. at last be assured. WHO and This supply will last for Médecins sans Frontières (MSF) 3 years. Discussions are in In December 2000, Carlos Morel, have been working towards this progress between BMS, WHO/ Director TDR, and Bjorn Mel- end since 1999. TDR and MSF concerning the gaard, Director WHO Depart- Eflornithine was discovered in BMS proposal that, after 3 years, ment of Vaccines and Biologicals, 1980 by Dr Cyrus Bacchi, Pace production of eflornithine by agreed that leprosy research University, New York, through Dow Chemical Co. and Akorn previously under the purview of a TDR-supported study on Manufacturing Inc. could continue, the TDR Steering Committee on polyamine metabolism in try- but would have to be purchased. Immunology of Mycobacterial panosomes (the causative organ- The most critical part of these Diseases (IMMYC), will in future ism of sleeping sickness). This discussions relate to price: be integrated into each of the four study demonstrated that, in mice, MSF would like to see this pre- functional areas of TDR: Basic and eflornithine was effective against arranged at US$10 per dose Strategic Research (STR), Product the enzyme ornithine decarboxy- (as compared to, in 1997, a price Research and Development (PRD), lase, a key enzyme in the multipli- of US$20 per dose). Intervention Development and cation of trypanosomes. Following A course of eflornithine treat- Implementation Research (IDE), clinical trials, eflornithine was ment is typically one injection and Research Capacity Strengthen- registered for the treatment of a day for 14 days. Currently, ing (RCS). This move brings lep- gambiense sleeping sickness in preliminary clinical studies are rosy into line with all the other 1990. But eflornithine is expen- ongoing with an oral formulation diseases in TDR’s mandate, which sive, and unaffordable by the of the drug. If subsequent Phase have been addressed by the func- affected countries and conse- III clinical trials prove its safety tional units since 1994, and it will quently, manufacturing of the bulk and efficacy, oral eflornithine make TDR leprosy research more material ceased in 1995. could replace the injectable form sustainable. Dr Paul Nunn, in his However, in December 1999, and would be less expensive. position as TDR Leprosy Disease Hoechst Marion Roussel (now As well, the ease of administra- Coordinator, will coordinate TDR Aventis) granted to WHO the tion would allow its use on a activities with each of these area. production rights for eflornithine wider scale for the treatment of Researchers are invited to submit to find a third party manufacturer gambiense sleeping sickness. proposals directly to each areas (TDRnews No. 61). Now WHO/ according to their deadlines. TDR, in collaboration with MSF, have identified potential third party manufacturers. Available PLEASE SEE FULL DETAILS AND stocks donated by Aventis (the DEADLINES ON THE FOLLOWING PAGE French-German company holding the patent rights for eflornithine), in 1999, after formulation of all ADDITIONAL INFORMATION remaining bulk material, are pro- on research grants as well as jected to last until June 2001. As TDRnews was going to press, application forms are also news of the latest developments available through TDR’s website: was breaking. Bristol-Myers Squibb (BMS) – which, with www.who.int/tdr/grants

18 • TDRnews • No 64 • FEBRUARY 2001 DEADLINES Steering Committee and Task Force meetings

Meeting date Deadline BASIC AND STRATEGIC RESEARCH (STR) • Molecular Entomology (BCV) 24-27 September 2001 24 July 2001 • Pathogenesis and Applied Genomics (PATHO) 24-27 September 2001 24 June 2001 • Social, Economic and Behavioural Research (SEB) 4-8 June 2001 23 March 2001

PRODUCT RESEARCH AND DEVELOPMENT (PRD) • Drug Discovery Research (DDR) 26-30 March 2001 26 January 2001 • Vaccine Discovery Research (VDR) 28 May-1 Jun 2001 28 March 2001

INTERVENTION DEVELOPMENT AND IMPLEMENTATION RESEARCH (IDE) IDE Task Forces may call for specific proposals In memoriam at any time of the year according to their workplans. Sadly did TDR staff learn of the death of • Severe Malaria (SEVERE) March 2001* two staff members last year, May Gatan • Research on Drug resistance and Veronica Vaz, and Policies (RAP) March 2001* who are still greatly • Malaria Home Management missed, and of the (HOME-MGT) March 2001* following TDR associ- ates, Dr U. K. Sheth • Filariasis Intervention Professor/Director, Research (FIL) Early May 2001* Department of Pharma- • Intervention Research on cology, GS Medical and Chagas Disease (CHA) 2-4 May 2001 KEM Hospital, Mumbai, India; Dr Robert • Intervention Research on Mshana, Organisation (TRY) 4-6 September 2001 of African Unity, Lagos, Nigeria and member of RESEARCH CAPACITY STRENGTHENING (RCS) the TDR Vaccine Discov- ery Research Commit- • Research Strengthening Group (RSG) 2002 31 October 2001 tee; and PhD Research • Malaria Research Trainee Fred Msadallah Capcity Strengthening Salum, of the National in Africa (MIM) ** 2002 30 November 2001 Institute for Medical Research, Amani Research Centre, United Republic of Tanzania, * tentative who passed away in ** progress reports and renewals only May 2000.

TDRnews • No 64 • FEBRUARY 2001 • 19 TDR PHOTO/VIDEO MISSION Uzbekistan: Samarkand (23-30 October 2000) TDR World Health Organization Isaev Research Institute of Medical Parasitology Avenue Appia 20 1211 Geneva 27 • Leishmaniasis Labora- Switzerland Tel: (+41) 22-791-3725 tory facilities (where Fax: (+41) 22-791-4854 live Leishmania E-mail: [email protected] inocula are produced Web: www.who.int/tdr for a leishmanization programme. This offers potential for evaluating vaccine candidates. TDR is improving GMP in the institute as part WHO/TDR/Crump of an Institution Strengthening Grant). Technicians carefully mea- sure the rate of temperature Institute Medical reduction as live Leishmania • parasites are killed by freez- Clinic – Leishmaniasis ing in liquid nitrogen. ward. • Institute facilities (museum, library, conference room – WHO/TDR/Crump where WHO Regional Workshop of Malaria Participants in the malaria training workshop share data on the malaria situation in their countries and was being held). cover all aspects of research and control activities in the region. • TB hospitals TO OUR READERS - pulmonary We are unfortunately - extra-pulmonary. unable to accept for publication in TDRnews announcements (for meetings, new pro- grammes, institutions,

WHO/TDR/Crump publications, etc.) CONTACT which readers send us. All TDR Image Announcements which Library images can relate to research on be viewed on-line: tropical diseases would clearly be of interest to www.who.int/tdr our readers. However, because of limited TDR is also able to space in the newslet- provide a limited ter, we regret that we can publish only those number of CD-ROM A woman taking her DOTS drugs concerning events in dispensed at the TB hospital. of the Image Library which TDR is directly to institutions. involved.

20 • TDRnews • No 64 • FEBRUARY 2001