Partnerships are sine qua nons for effective work in international health. While individuals, institutes, and agencies comprise the usual coalitions, research, training, and control activities are also essential in international science and public health, and a balance between these components must be fostered. Support for research is particularly important when effective disease control interventions do not exist or are not available for managing emerging or reemerging infectious diseases. The five presentations in this panel represent outstanding examples of the need for close links between research, training, and control activities.

In 1998, the Burroughs Wellcome Fund (BWF) and the Wellcome Trust launched a joint research effort focused on infectious diseases of the tropical developing world. This grant program addresses parasitic, bacterial, and viral infections of importance to developing tropical countries and their collaborators in developed nations. The North American and United Kingdom institutions that have funded projects must make the tropics their center of operations. The program is an experiment for the fund, allowing the BWF to explore a new, collaborative approach to health philanthropy compared to prior experience when focus was on a specific scientific topic, often investigated outside of tropical areas.

The Fogarty International Center (FIC) of the National Institutes of Health (NIH) advances health research through international scientific cooperation and is the center for NIH international activities. The Multilateral Initiative on Malaria (MIM) is an alliance of organizations and individuals that aim to facilitate international collaboration and cooperation in scientific research that will lead to the control of malaria. The rotating secretariat of MIM was moved from the Wellcome Trust to the FIC in 1999 on recommendation of the partners. To ensure that research findings are applied to malaria treatment and control, scientists in malaria-endemic countries must be at the forefront of research addressing the local malaria situation.

MIM supports research that will lead to better use of current control methods and development of new and sustainable methods of malaria control in endemic countries. MIM works to strengthen and sustain malaria research capacity in endemic countries through regional and international scientific collaboration and training. It promotes regional and international communication and cooperation to maximize the impact of resources and to avoid the duplication of effort. MIM also aims to facilitate dialogue between researchers and control program personal in malaria-endemic countries to promote research that will address the needs of malaria control programs and eventually encourage collaborative research between these two groups. Finally, MIM facilitates communication among scientists, public health professionals, and policymakers to ensure that research findings lead to policy changes at the government and international levels.

The research grant component of MIM remains with the Special Programme for Research and Training in Tropical Diseases (TDR)/World Health Organization program. The task force on malaria Research Capability Strengthening (RCS) in Africa, coordinated by the United Nations Development Programme/World Bank and WHO Special Programme for Research and Training in Tropical Diseases (TDR), represents a collaborative funding strategy involving multiple agencies and governments to promote capacity-building activities carried out by MIM in Africa.

The task force was established to promote human resource development by supporting the research activities of partners as instruments for capacity-strengthening in malaria-endemic countries. A total of 112 proposals involving 42 countries (25 from Africa) and over 200 partner institutions and research groups have been reviewed since RCS's inception in 1998. The proposals cover a wide range of malaria research topics, including the clinical and molecular basis of drug resistance, drug policy, immune responses to malaria infection, evaluation of natural products used for antimalarial activity, diversity of parasites, home management of patients, vector biology, and epidemiology of malaria. The task force has recommended funding 23 proposals involving 24 African and 8 European countries and the USA, with annual budgets ranging from US $60,000 to US $250,000.

Twenty Ph.D. and 17 M.Sc. training grants were also approved in connection with funded projects. In addition, support was recommended for a few proposals to promote interactions between partners for improving protocols and collecting data. The objective of malaria RCS grants is to develop or strengthen core African research groups engaged in basic and/or applied science to develop effective control tools for malaria and improve health policy strategies. The task force considers that there is an urgent need to attract scientists with new skills to foster partnerships based on national and regional priorities, mutual and complementary scientific objectives, expertise, and shared responsibility. The partnerships will provide opportunities to study specific aspects of malaria in multiple sites.

Members of the East African AIDS Training Initiative have developed a model for HIV/AIDS education and training for community-based health- care workers at the grass roots level. The goal was to implement a community-owned program which could be readily adapted for the needs of any resource-poor community. Two factors led to developing the program. First, requests were received for education and training from members of the health-care community in Nairobi; second, education and training delivered at the grass roots level is believed to be the most effective vehicle for introducing rapid social change. This program involved a 3-day residential workshop and continues to be monitored with quarterly site visits in support of participants. Outcomes demonstrate the positive effects of partnerships among community members, funding organizations, and individual charitable donors. The careful development of individual action plans coupled with ongoing support of training mentors via site visits has contributed to the success of this program.

The International Trachoma Initiative is focusing on the world's leading cause of preventable blindness. An estimated 6 million people are blind or visually impaired due to trachoma, and an additional 150 million have the disease. Trachoma is an infectious disease caused by the bacterium Chlamydia trachomatis. The disease is most common in children but causes blindness in adults, particularly women. Poverty is the fundamental determinant of trachoma. It results in a lack of basic sanitation, medical care, drugs, and education on prevention and cure in trachoma-endemic areas. Pfizer, Inc. and the Edna McConnell Clark Foundation founded the International Trachoma Initiative (ITI) in November 1998 with the explicit mission of working to advance the elimination of trachoma and the blindness it causes. A WHO-approved strategy called SAFE is simple, sustainable, and addresses both cure and prevention:

• Surgery for trichiasis--the immediate precursor to blindness

• Antibiotics to treat active disease

• Facial cleanliness to reduce transmission

• Environmental improvement to control the agents of the disease

In ITI countries the antibiotic used is Zithromax (azithromycin), donated by Pfizer. A single oral dose of Zithromax once a year is as effective as the standard treatment of tetracycline eye ointment 2 times a day for 6 weeks. The ITI is currently working in five countries: Morocco, Tanzania, Mali, Ghana, and Vietnam. The ITI works with ministries of health to devise an operating plan and joins WHO, United Nations Children's Fund, and nongovernmental organizations to carry out this work.

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