Malaria is making a comeback in the Philippines after years of progress, and the country’s standard tests are missing the low-level infections that keep the disease circulating. This matters because the Philippines aims to eliminate malaria and several other infectious diseases by 2030, but it is running into multiple obstacles at once. Conventional diagnostics fail to detect sub-patent infections—cases too mild to trigger symptoms but still capable of sustaining transmission. Meanwhile, drug-resistant parasites are spreading across Southeast Asia, mosquitoes are becoming resistant to insecticides, and other vaccine-preventable and neglected tropical diseases persist or re-emerge. The country lacks an integrated monitoring system that can track all these threats simultaneously. The CoSTaR project will build that system. Researchers will refine molecular and serological platforms to measure residual malaria transmission, then adapt the serological platform to also assess exposure to other priority diseases in a single test. They will also map the genetic structure and drug-resistance profiles of persisting parasites, analyse how the human immune system allows parasites to linger, and provide baseline data on insecticide resistance in local mosquito populations. If successful, the project will give the Philippines a scalable, multi-disease surveillance tool that can guide elimination efforts, strengthen the health system’s resilience, and train a new generation of scientists equipped to sustain disease monitoring long after the grant ends.
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The Philippines has set a visionary goal of attaining zero or significantly reduced infections with malaria, several vaccine-preventable (VPDs), and neglected tropical diseases (NTDs) through an effective healthcare system by 2030. Yet, the country faces challenges in realising this goal. Malaria elimination initiatives are threatened by sub-patent infections that are missed by conventional diagnostics and sustain transmission, antimalarial drug resistance prevalent in Southeast Asia, increasing worldwide vector resistance to insecticides, and diagnostic failure. After years of consistent progress in defeating malaria, with only the province of Palawan reporting cases, the Philippines is currently experiencing a resurgence of Plasmodium falciparum and P. vivax. Consequently, many VPDs and NTDs persist, and in some cases result in outbreaks or re-emergence, despite effective measures. Although the Philippines has relatively low burdens of these diseases, achieving the ambitious goal of elimination necessitates building and, equally importantly, maintaining robust monitoring and surveillance systems for co-endemic diseases. Additionally, training a cadre of scientists who embrace innovations in laboratory, epidemiological, and data sciences is essential to support the country's determination to create a future free from the burden of many of these diseases. Our project, CoSTaR, rises to the challenge of disease elimination by developing sustainable and scalable solutions for malaria and priority infectious diseases in the Philippines. We will employ and refine effective molecular and serological platforms to measure residual malaria transmission in the population (WP1/2). Our serological platform for malaria is flexible and adaptable, permitting the simultaneous assessment of exposure to VPDs and NTDs that may persist in a population. We will develop this platform to address the country’s need for a first-of-its-kind integrated multi-disease monitoring system (WP5). Representing a paradigm shift in elimination efforts, this platform offers an evidence-based solution to understand population immunity against these diseases, define disease-specific transmission dynamics, and identify demographic and spatial risk factors associated with pathogen exposure, thereby complementing the government’s elimination initiatives. Solutions are also warranted to determine the biological factors that may affect residual malaria transmission. Thus, we will define the genetic structure and antimalarial drug resistance profiles in persisting parasites (WP3). Additionally, we will analyse the human host response enabling parasite persistence (WP4). In a supplementary study, we will provide baseline data on markers of vector resistance to insecticides currently being used in the country (SS). Our innovative solutions leverage the equitable and enduring partnership between the Department of Health’s (DOH) Research Institute of Tropical Medicine (RITM) and London School of Tropical Medicine and Hygiene (LSHTM) – lead teams in this project. Capacity strengthening and knowledge exchange, complemented by community engagement and stakeholder outreach, constitute the cornerstone of our project strategy (Cores). Along with Palawan State University (PSU), we will empower researchers and communities to be actively involvement in disease awareness initiatives. We will further enhance capacity in laboratory investigations and applied epidemiological analysis, nurture leadership and collaborative efforts among our researchers, and optimise the impact of our initiatives through close engagement with the local Municipal Health Office (MHO), and a wide range of local, regional, and national stakeholders. Ultimately, our efforts aim to strengthen the resilience and sustainability of disease monitoring in the Philippines, improve health outcomes, and leave a legacy of innovative and impactful research, along with well-trained researchers who will advance global health practices.
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