Multifaceted approach key to eradicating malaria

Evolution of Malaria panel
From left: Dyann Wirth, Daniel Neafsey, Irene Koek, Regina Rabinovich

October 25, 2017 – Throughout the twentieth century, researchers hoped to discover a “magic bullet” to cure malaria. But today experts realize that efforts to curb or eradicate the mosquito-borne disease must be multifaceted, from research to policy efforts to use of on-the-ground tools such as pesticides and bed nets.

That was the key takeaway from panelists at a Harvard Worldwide Week event titled “Looking Back, Moving Forward: The Evolution of Malaria,” held October 24, 2017 at Harvard T.H. Chan School of Public Health. (Read about another Harvard Worldwide Week program on malaria and climate.)

“The emerging malaria elimination strategy isn’t one tool,” said Regina Rabinovich, ExxonMobil Malaria Scholar in Residence at Harvard, director of the Malaria Elimination Initiative at the Barcelona Institute for Global Health, and moderator of the Harvard Chan event. “What we’re talking about is a strategy where tools like diagnostics, vaccines, predictive mapping, treatment, and surveillance systems need to be brought together in a system that would hopefully lead to elimination.”

The event included two panels—one focused on past efforts to curb malaria and neglected tropical diseases, the other on the future agenda for malaria eradication. Allan Brandt, professor of the history of science and Amalie Moses Kass Professor of the History of Medicine at Harvard, delivered opening remarks.

Neglected diseases

Participants in the first panel talked about the contributions of Kenneth Warren, who began the Great Neglected Diseases (GND) of Mankind Programme when he was director of health sciences at the Rockefeller Foundation. Warren helped introduce modern biomedical science to the study of infectious diseases in the developing world and brought a unique energy to the goal of providing cost-effective health care to the world’s poorest people.

“Warren animated the modern debate on neglected tropical diseases,” said Conrad Keating, writer in residence at Oxford University’s Wellcome Unit for the History of Medicine, who wrote a book about Warren published last spring. Joseph Cook, adjunct professor of epidemiology at the University of North Carolina’s Gillings School of Global Public Health, said that Warren used his position at the Rockefeller Foundation “both as a bully pulpit and as a convener of this great neglected diseases network.”

Jesse Bump, executive director of Harvard Chan School’s Takemi Program in International Health, said that the concept of a “magic bullet” to cure infectious diseases was at the heart of the GND, which made sense at the time. But tackling the last remnants of infectious diseases such as malaria will require a focus on strategies such as social action, education, broad-based development, and community engagement—“all the things that are really hard to take on,” he said.

The science of malaria eradication

Genomic studies of the malaria parasite hold promise for battling the disease, said Daniel Neafsey, assistant professor of immunology and infectious diseases at Harvard Chan School. With the ability to study many thousands of mosquito genomes, scientists are in a position to learn more about disease transmission, the impact of drugs and pesticides, and potential vaccine targets, he said.

Irene Koek, senior deputy assistant for the President’s Malaria Initiative of the USAID Global Health Bureau, said that her group’s efforts have used a range of tools to help control malaria, such as drugs, bed nets, pesticides, and treatments for pregnant women. She noted that people from both parties in Congress, as well as successive administrations, have been supportive of their work. “Our results have been good, and have been recognized as good value for the money,” she said.

Dyann Wirth, Richard Pearson Strong Professor and chair of Harvard Chan’s Department of Immunology and Infectious Diseases, talked about the goals of Harvard’s Defeating Malaria initiative. She said that it’s a multidisciplinary effort to address the breadth of the malaria problem, which poses challenging issues in medicine, science, policy, and behavior. “By bringing together many different groups and many different approaches, you can have an impact,” she said.

Karen Feldscher

photo: Sarah Sholes

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