Malaria: What Next?

The second and third days of the Malaria Forum conducted by the Bill and Melinda Gates Foundation turned out to be as stimulating and inspiring as day one. Important research was reported in a continuous stream. As a layperson, I’m an interested observer with no scientific knowledge but I heard enough to be encouraged, even inspired, by what is happening despite my limited scientific understanding.

For example, we heard about a successful phase one trial of a new malaria vaccine for children. The vaccine must go through additional trials requiring months if not years, but progress is being made.

We heard about new pesticides in development that are safer for the environment, longer lasting and require fewer applications.

A report was presented explaining how gnomic research can identify weak points in the parasitic genome. This could allow researchers to consider where genetic intervention might be successful and could result in engineering mosquitoes that don’t carry the parasite, are made sterile, or even result in mosquitoes that don’t bite humans, according to one researcher.

A report was given on development of synthetic artemisinin, the most hopeful and efficacious compound for treating malaria. This means the complex challenge of cultivating, extracting and producing the compound from natural sources could be bypassed using laboratory control and, equally important, synthetic compounds can be manipulated to address resistance.

Resistance is a big issue and it was discussed by many researchers who noted that malaria was drastically reduced in the 1930s, only to come roaring back a few years after eradication efforts declined. One researcher called the parasite a daunting insurgent and warned that progress in reducing the incidence of malaria cases is actually the most dangerous stage because it lulls us into believing we can cutback on research and innovation. History tells us this gives the parasite the opportunity to adapt and spread quickly, becoming even more difficult to fight.

Many presenters called for a multi-pronged attack and frankly criticized the malaria community for its competitiveness and failure to collaborate in the past. Dr. Robert Sinden, a researcher at the Imperial College London, said, “The real competition is not other scientists, the real competition is the parasite.”

“We have to think big and take risks,” Dr. Tadataka Yamada, President of the Global Health Program at the Bill and Melinda Foundation, said. “We can’t let barriers get in the way. We must share information openly and freely. Withholding knowledge only makes people die faster.”

The prevailing tone of the forum, however, was collaboration and creating new partnerships built on the recognition that no single entity can eradicate this disease.

There was discussion about the interconnection of malaria with maternal-child health, HIV/AIDS, tuberculosis, community-based health care, national health systems and its debilitating drain on developing nations’ economies.

This interconnection is significant because improved delivery systems, strengthening national health systems, training community health workers and creating effective information delivery are comprehensive benefits.

Reaching rural villages with information to change behaviors was discussed and many representatives referred to “faith-based” groups which haven’t been integrated into the total effort.

I was part of a panel that discussed how to engage people of faith in addition to others including civic and political groups. The response was affirming and appreciative for these new partners in the fight.

Innovations targeting malaria aren’t limited to this disease alone. But it is an entry point because it’s so pervasive. This point was reinforced by Brig. Gen. Brian Chituwo, Minister of Health of Zambia.

He noted that Zambia is at “the epicenter of HIV/AIDS, but our net distribution has made great strides in improving rates of infection for malaria and contributed to an improvement of health in general. This reduces susceptibility to opportunistic diseases.”

Debilitation from malaria is so heavy a burden some estimate the loss of productive workers and output reduces GDP in the worst affected countries by 12%. Reducing the incidence of malaria could free up health systems and economic drain and set the stage for greater productivity.

This is the first meeting of this kind I’ve attended so I have no basis for comparison. But the level of discussion and the flow of creative ideas here was amazing. The challenge to eradicate malaria posed by Bill and Melinda Gates was heard clearly and affirmed. But it’s an enormous task and one that will take a generation or more. In fact, no one is prepared to put a timeline to it for fear of raising expectations that could backfire if not met. No one wants to see another failure in this struggle.

But as I listened to the conversation it felt as if there was a sense in the room that this challenge can be met. I heard determination to see the task through. I heard urgency to end the dying, and recognition of the inequity of this disease with its heavy burden on the poorest of the world. I heard references to the ethical dilemma of not tackling eradication. Melinda Gates said anything short of eradication is ethically unacceptable.

I wonder if I was witnessing a seminal event, one in which the battle to eradicate a killer disease was joined. It’s too early to tell, but I hope this is so.

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