NIHR Global Health Research Group on Establishing Regional Hubs for Genomic Surveillance in West Africa, at the Wellcome Sanger Institute National malaria control programmes (NMCPs) need effective tools to monitor resistance to control measures and to provide early warning that their interventions are causing resistance to rise to unacceptable levels so they can change strategy. Advances in genome surveillance revolutionised the UK response to the COVID pandemic and demonstrated the power of this tool across the world. Proof-of-concept work being carried out as part of this programme of research at the University of Ghana (UG) and the MRC Unit in The Gambia at the London School of Hygiene and Tropical Medicine (MRCG) of malaria genetic surveillance in West Africa has included engagement with NMCPs.

Knowledge of genetics, genetic markers and genetic epidemiology is outside the domain of expertise of most NMCPs. Therefore, subject matter experts need to work with NMCPs to bridge the gap and support implementation. Discrete but connected hubs can support NMCP managed activities in different countries and integrate data generated into regional analyses. Hub leaders also serve as advocates to connect these data to a global data sharing network by forging strong relationships in both directions and acting as stakeholder representatives.

Bringing malaria genetic surveillance data across the world benefits public health. If a new form of parasite drug resistance or mosquito insecticide resistance emerges elsewhere in the world, it will greatly help an NMCP to monitor and manage the problem if the global genomic data for malaria surveillance is continually updated to incorporate the most useful genetic markers, which are likely to have been discovered elsewhere. However, those new to sharing data openly benefit from working closely with subject matter experts who are knowledgeable and sensitive to cultural, operational and technical challenges in achieving this. 

Rapid advances building on malaria genomic surveillance in West Africa have the potential to catalyse relationships and advancement in malaria. For example, building on capacity for malaria genetic surveillance, scientists at the University of Ghana utilised capacity built for malaria surveillance to develop sequencing tools to analyse the SARS-CoV-2 virus from confirmed cases in Ghana. Combined with local leadership, genomic surveillance tools can be applied to pathogens and viruses for both endemic and pandemic infectious disease. 

Following the implementation of genomic surveillance of malaria using Amplicon sequencing, the teams at UG and MRCG will strengthen their own discrete but complementary regional networks. The Wellcome Sanger Institute will support UG and MRCG in building capacity for managing multi-partner collaborations and scaling up sequencing operations. Hub leaders will work with their collaborators to provide training from sample collection through to the translation of genomic data into actionable knowledge. By the end of this project, we aim to be integrating these systems into the routine working practices of NMCPs in countries that are part of the regional networks of Ghana and The Gambia, and to provide a working example of how such systems could be deployed at other locations in Africa. 1. Implement amplicon sequencing tools to address specific use cases in malaria control.
2. Enable the regional sequencing hubs to achieve reliable production of genomic surveillance data.
3. Establish a sampling framework for genomic surveillance of parasites and vectors in selected locations.
4. Start to integrate genomic surveillance into national and regional malaria control initiatives.