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Can we outsmart malaria? A question of tactics

Posted by on November 11, 2014

DARADara Annett is a PhD student in the Deu group in the Department of Parasitology, currently at the NIMR until the move to the Crick Institute in 2016

Malaria is one of humankind’s oldest battles. Our understanding has increased rapidly in the last century but there are still around 200 million cases reported per year and more than 600,000 deaths [1].

When I was applying for PhDs as a Chemistry graduate I had no specialist biology background, but I knew that I wanted to put my skills to use in a field that had an impact on global health and disease. My work involves identifying new drug targets in the malaria parasite. Although this is very early in the process of drug discovery, I know that it is working towards translational research. This excites me and will keep me coming in every day for 4 years.

In October, as part of annual Biology Week, the Society of Biology held a debate at the Royal Institution entitled “Malaria eradication: Can we do it? Should we do it?

I thought “Should we do it?” Well, yes obviously! Chairperson Professor Chris Whitty, DFID, was quick to clarify that of course they all agree that in a perfect world, malaria would be eradicated. The question was far more complex, “Should we TRY to do it NOW?”

Where should the scientific community be focusing its efforts? Going for full eradication of malaria in Africa would require a huge global effort and investment in vaccines and mosquito targeting, and great vigilance on the part of people and governments.

Currently, control of malaria requires vector control methods and malaria therapeutics, this may sound more doable and less costly, but it is a constant drain on money and resources. Malaria is a huge economic burden on an affected country and its severity correlates with lower income levels and economic growth. From this perspective any money spent on eradication would be an investment for a country’s future. So the debate becomes about allocating resources, what to spend it on and where to spend it…

Professor Janet Hemingway, Liverpool School of Tropical Medicine, had just arrived back from India, where she had been working with indoor spraying against mosquitos. She said, “Malaria is a disease of poverty”; more developed housing, irrigation of land and deployment of protection such as mosquito nets can rid some communities of the disease altogether. The best-documented cases are on islands like Mauritius and Sri Lanka. Mainland Africa obviously poses a larger challenge. So can it be done?

Professor Eleanor Riley, LSHTM, gave a pessimistic view of the current situation. Most people are aware of the huge challenges in finding a vaccine for HIV. Finding a vaccine for malaria is orders of magnitude more difficult than that. Malaria is a complex organism with multiple species and huge variation. Its life cycle also includes a sexual stage. This means that each malaria parasite, and therefore infection, has the potential to be as different to each other as you and your neighbours are.

As for therapeutics, Riley commented that to combat drug resistance a major eradication effort would have to include tens of different drugs being stockpiled ready for release all at once. However, the ethical implications of holding back effective treatments for any length of time are huge.

Professor Robert Sinden, University of Oxford, believes we can do it, if our research efforts are focused in the right places and continually directed towards translational eradication applications. One of his examples was widening the range of life stages that are studied, not just human blood stages but also the mosquito stage.

Dr Tony Holder, National Institute for Medical Research, thinks that focussing on basic biological research is the way forward to help better understand this complex organism and find better and varied targets. Some people think that all research undertaken should be ultimately translational for healthcare. However, important discoveries in basic research inform and generally lead to translational research. For example, a “basic biological discovery” made by his research group in their lab, is helping to develop a diagnostic product to screen blood transfusions.

After the debate, I felt the full weight of the burden of Malaria. I am surer than ever that research is the key but that it needs to be broad; including research into the parasite and the vector, therapeutics and vaccines, in the medicinal, economic, and political world. If we keep one eye open in the direction of continent wide eradication, our current goals might converge to a place where it is finally possible.

[1] World Malaria report 2013 – WHO

See how the debate unfolded via social media in our Storify summary, or read more on our blog:
Eradicating Malaria: The evolution problem by Dr Tony Holder
Malaria control drains financial and human resources by Professor Robert Sinden

Find out more about Biology Week on our website.

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