How science addresses developing world issues

How big a problem is malaria in the first decade of the 21st century?

Calls for a new era in malaria eradication

Lessons from the previous attempts to eradicate malaria

The flow of scientific knowledge amongst participants in the struggle

The role of scientific publishing houses

The importance of training and supporting endemic country scientists

Knowledge as a weapon in the struggle against malaria in sub-Saharan Africa

Dr Colin SutherlandLondon School of Hygiene & Tropical Medicine &

Hospital for Tropical Diseases

How big a problem is malaria in the first decade of the 21st century?

P. falciparum malaria has contracted from some areas where it was prevalent in the 1990’s.

The situation for the other 3 globally-distributed species is unclear.

A fifth species, P. knowlesi, is restricted to SE Asia where its natural hosts (macaques) are found.

Calls for a new effort to eradicate malaria in the 21st century

“Bill and I believe that these advances in science and medicine, your promising research, and the rising concern of

people around the world represent an historic opportunity not just to treat malaria or to control it—but to chart a long-term

course to eradicate it.

We know that the word "eradication" is troubling to many people with deep knowledge of malaria. It's an...audacious

goal—to reach a day when no human being has malaria, and no mosquito is carrying it.

This is a long-term goal; it will not come soon. But to aspire to anything less is just far too timid a goal for the age we’re in.

It's a waste of the world's talent and intelligence, and it's wrong and unfair to the people who are suffering from this

disease.”

Melinda Gates, Malaria Forum, Seattle, October 17, 2007

Eradication of malaria in the 20th century

FailureFailure

Success

Success

Success

Eradication of malaria in the 20th century –

What went wrong?

FailureFailure

Success

Success

Success

Strategies successful here …

…were not effective here.

Why do some believe we can eradicate malaria in the 21st century?

In the last 10 years, renewed international investment in research and malaria control in endemic countries has generated optimism

New intervention strategies have delivered substantial public health benefits

A new cohort of scientists, clinicians and public health experts are being trained in malaria research and control

0%

10%

20%

30%

40%

50%

60%

Asymptomaticinfections

non-severe malaria severe malaria

0 - 2 years

2 - 5 years

5 - 10 years

A challenge for eradication strategies:In highly endemic countries, severe malaria occurs in only a small

proportion of children infected with Plasmodium falciparum

A reduction of 86.3% in the incidence of clinical episodes of malaria, in a study of 1200 children in Senegal, using IPTc.

Badara Cisse Badara Cisse et alet al., 2006. ., 2006. LancetLancet 367: 659 – 667. 367: 659 – 667.

0.00

0.25

0.50

0.75

1.00

0 5 10 15 Weeks from commencement of the trial

treated = control arm treated = seasonal IPTc arm

Child mortality in a West African population protected with insecticide-treated curtains for a period of up to 6 years.

Diallo DA et al. 2004. Bull World Health Org 82: 85–91.

How can we make sure the knowledge needed to eradicate malaria in the 21st century reaches the people who need it?

FUNDAMENTAL RESEARCH >>>>>> Malaria research community

FIELD RESEARCH >>>>>> Malaria control programmes

CONTROL PRIORITIES >>>>>> Health ministry decision makers

POLICY PRIORITIES >>>>>> Malaria researchers

RESPONSIVE RESEARCH >>>>>> Malaria control programmes

Some current models of scientific publication relevant to malaria

Reader subscription Nature, Science, Lancet, NEJM

Learned Society Journal Transactions Royal Soc. Trop. Med. Hyg.

Am. J. Trop. Med. Hyg.

BMJ

Open Access, Govt pays Emerging Infection Diseases (U.S CDC)

Bulletin of the WHO

Open Access, Contributor pays Malaria Journal, PLoS stable

Malaria publications – Lancet 1990 – 1996

95. Systematic review of amodiaquine treatment in uncomplicated malaria. P Olliaro, C Nevill, J LeBras, P Ringwald, P Mussano, P Garner, P Brasseur. The Lancet - Vol. 348, Issue 9036, 2 November

72. Relation between severe malaria morbidity in children and level of Plasmodium falciparum transmission in Africa. Robert W Snow, Judy A Omumbo, Brett Lowe, Catherine S Molyneux, Jacktone-O Obiero, Ayo Palmer, Martin W Weber, Margaret Pinder, Bernard Nahlen, Charles Obonyo, Chris Newbold, Sunetra Gupta, Kevin Marsh. The Lancet - Vol. 349, Issue 9066, 7 June 1997, Pages 1650-1654.

61. Little to celebrate on the malaria centenary. Sanjay Kumar. The Lancet - Vol. 350, Issue 9078, 30 August 1997, Page 644.

56. Randomised placebo-controlled trial of iron supplementation and malaria chemoprophylaxis for prevention of severe anaemia and malaria in Tanzanian infants. Clara Menendez, Elizeus Kahigwa, Rosmarie Hirt, Penelope Vounatsou, John J Aponte, Fidel Font, Camilo J Acosta, David M Schellenberg, Claudia M Galindo, John Kimario, Honorathy Urassa, Bernard Brabin, Tom A Smith, Andrew Y Kitua, Marcel Tanner, Pedro L Alonso. The Lancet - Vol. 350, Issue 9081, 20 September 1997, Pages 844-850

55. Malaria catastrophe in East Africa. Anders Carlstedt. The Lancet - Vol. 350, Issue 9085, 18 October 1997, Page 1180

43. Molecular assays for surveillance of antifolate-resistant malaria. James G Kublin, Richard S Witzig, Anuraj H Shankar, Jorge Quintana Zurita, Robert H Gilman, Javier Aramburu Guarda, Joseph F Cortese, Christopher V Plowe. The Lancet - Vol. 351, 1998, 1629-1630.

37. Malaria disaster in Africa. Kevin Marsh. The Lancet - Vol. 352, Issue 9132, 19 September 1998, Page 924.

35. Inducible nitric oxide synthase polymorphism and fatal cerebral malaria. David Burgner, Weiming Xu, Kirk Rockett, Michael Gravenor, Ian G Charles, Adrian V Hill, Dominic Kwiatkowski. The Lancet - Vol. 352, Issue 9135, 10 October 1998, Pages 1193-1194

25. Intermittent sulphadoxine-pyrimethamine to prevent severe anaemia secondary to malaria in pregnancy: a randomised placebo-controlled trial. CE Shulman, EK Dorman, F Cutts, K Kawuondo, JN Bulmer, N Peshu, K Marsh. The Lancet - Vol. 353, 1999, Pages 632-636.

24. Malaria on Merseyside David Sharp. The Lancet - Vol. 353, 1999, Page 1452 .

19. Averting a malaria disaster. NJ White, F Nosten, S Looareesuwan, WM Watkins, K Marsh, RW Snow, G Kokwaro, J Ouma, TT Hien, ME Molyneux, TE Taylor, CI Newbold, TK Ruebush, M Danis, BM Greenwood, RM Anderson, P Olliaro. The Lancet - Vol. 353, 1999, 1965-1967

1. Efficacy of artesunate plus pyrimethamine-sulphadoxine for uncomplicated malaria in Gambian children: a double-blind, randomised, controlled trial. Lorenz von Seidlein, Paul Milligan, Margaret Pinder, Kalifa Bojang, Chukwudi Anyalebechi, Roland Gosling, Rosalind Coleman, Justin Ifeanyichukwu Ude, Abubakar Sadiq, Manoj Duraisingh, David Warhurst, Ali Alloueche, Geoffrey Targett, Keith McAdam, Brian Greenwood, Gijs Walraven, Piero Olliaro, Tom Doherty. The Lancet - Vol. 355, 2000, 352-357.

Publications – Malaria Journal 2007-8

1. Var2CSA Var2CSA DBL6-epsilon domain expressed in HEK293 induces limited cross-reactive and blocking antibodies to CSA binding parasites Pablo Fernandez, Nicola K Viebig, Sebastien Dechavanne, Catherine Lepolard, Jurg Gysin, Artur Scherf, Benoit Gamain Malaria Journal 2008, 7:170.

2. Plasmodium falciparum gametocyte sex ratios in children with acute, symptomatic, uncomplicated infections treated with amodiaquine Akintunde Sowunmi, Sulayman T Balogun, Grace O Gbotosho, Christian T Happi Malaria Journal 2008, 7:169.

3. Multiple insecticide resistance mechanisms involving metabolic changes and insensitive target sites selected in anopheline vectors of malaria in Sri Lanka M Devika B Perera, Janet Hemingway, SHP Parakrama Karunaratne. Malaria Journal 2008, 7:168.

4. Reduced paediatric hospitalizations for malaria and febrile illness patterns following implementation of community-based malaria control programme in rural Rwanda Amy C Sievers, Jennifer Lewey, Placide Musafiri, Molly F Franke, Blaise J Bucyibaruta, Sara N Stulac, Michael L Rich, Corine Karema, Johanna P Daily Malaria Journal 2008, 7:167.

5. The economic burden of malaria on the household in south-central Vietnam Chantal M Morel, Ngo Duc Thang, Nguyen Xuan Xa, Le Xuan Hung, Le Khan Thuan, Pham Van Ky, Annette Erhart, Anne J Mills, Umberto D'Alessandro Malaria Journal 2008, 7:166

6. Unforeseen misuses of bed nets in fishing villages along Lake Victoria Noboru Minakawa, Gabriel O Dida, George O Sonye, Kyoko Futami, Satoshi Kaneko Malaria Journal 2008, 7:165.

7. Integrated vector management: the Zambian experience Emmanuel Chanda, Fred Masaninga, Michael Coleman, Chadwick Sikaala, Cecilia Katebe, Michael MacDonald, Kumar S Baboo, John Govere, Lucien Manga Malaria Journal 2008, 7:164.

8. Insertion polymorphisms of SINE200 retrotransposons within speciation islands of Anopheles gambiae molecular forms Federica Santolamazza, Emiliano Mancini, Frederic Simard, Yumin Qi, Zhijian Tu, Alessandra della Torre Malaria Journal 2008, 7:163.

9. Malaria incidence in Limpopo Province, South Africa, 1998-2007 Annette AM Gerritsen, Philip Kruger, Maarten F Schim van der Loeff, Martin P Grobusch Malaria Journal 2008, 7:162.

10. The M18 aspartyl aminopeptidase of Plasmodium falciparum binds to human erythrocyte spectrin in vitro Sonja B Lauterbach, Theresa L Coetzer Malaria Journal 2008, 7:161.

11. Improving community health worker use of malaria rapid diagnostic tests in Zambia: package instructions, job aid and job aid-plus-training Steven A Harvey, Larissa Jennings, Masela Chinyama, Fred Masaninga, Kurt Mulholland, David R Bell Malaria Journal 2008, 7:160.

12. Spatial prediction of Plasmodium falciparum prevalence in Somalia Abdisalan M Noor, Archie CA Clements, Peter W Gething, Grainne Moloney, Mohammed Borle, Tanya Shewchuk, Simon I Hay, Robert W Snow Malaria Journal 2008, 7:159.

13. Establishment of a large semi-field system for experimental study of African malaria vector ecology and control in Tanzania Heather M Ferguson, Kija R Ng'habi, Thomas Walder, Demetrius Kadungula, Sarah J Moore, Issa Lyimo, Tanya L Russell, Honorathy Urassa, Hassan Mshinda, Gerry F Killeen, Bart GJ Knols Malaria Journal 2008, 7:158.

Summary and conclusions

Knowledge is a weapon of great value in the fight against malaria

Scientific publishing has a key role in the movement of this knowledge

Open Access is enabling a greater participation of African scientists in knowledge exchange

These scientists are part of an upsurge in research capacity in Africa

These scientists will make crucial contributions in the fight for malaria control

Thanks to:

Colleagues in the malaria research community

BA Festival of Science

BMC & the Malaria Journal

Wellcome Trust

UK Health Protection Agency