Professor Tanner is Chief Executive of the Swiss Tropical and Public Health Institute (Swiss TPH), based in Basel. He is an epidemiologist and chair of medical parasitology and epidemiology at the University of Basel. Besides this, he is engaged in numerous activities and initiatives that research and control communicable diseases, notably malaria.
Q: You worked for a long time in Ifakara, Tanzania. Can you describe how this affected your career and views on public health in developing nations later on? What are important lessons that you learned?
A: When I came to Tanzania for the first time in 1979, I not only liked the place but also realized how important the career reorientation from a lab-based researcher to a public health researcher would be. Thus, working in Tanzanian peripheral research, resource and training centre made me rethink many issues from setting priorities in research, approaches to community-based work, precursors of demographic surveillance systems to undertaking large-scale emidemiological research and to translating research into policy and strategy. It also taught me - as I was in charge of the Ifakara Health Institute (at that time Swiss Tropical Institute Field Laboratory) - on how to develop it in order to reach - as it is now - an autonomous research, training and service/resources centre - with Tanzanian leadership and a novel form of governance. Thus, I not only learned of what partnership is and should be, but also how valuable it is to engage through partnership in aprocess of mutual learning for change.
Q: Your work has focused primarily on malaria and malaria vaccine development. From the first African trials with the spf66 vaccine to the present RTS,S vaccine, what is the take-home message of your experience about malaria vaccines?
The process of vaccine development against parasites is a difficult one owing to the complexity/virtuosity of the parasite's, particularly malaria, life cycle. For a biologist a most fascinating life cylce but only a frustration if you have to deal with it as a vaccine researcher or a public health specialist. The work for the past 20 years (we started in 1992 with the phase II/III of the first African malaria vaccine trial, SPf66) also showed that you can never make steps in research and development if you are only concerned...you must have the joy to discover, the joy to share and the joy to act in order to succeed. On a more technical level, we learn through the work with SPf66 how we really have to undertake phase II and phase III trials...the respective guidelines of WHO are largely based on this experience and are continuously updated through the steps we made over the past two decades.
Q: Massive efforts in malaria vaccine research over the past decades have not yet delivered a commercially available vaccine. Will we get one soon, and how soon will that be in your view? And what do you foresee will be the impact of such a vaccine?
A: The most promising candidates are (i) RTS,S and (ii) the whole irradiated sporozoite vaccine....the later iv the currently ongoing i.v. phase-2a and -2b prove successful. If all goes well with the clinical development plan, RTS,S can be registered in 2015 and then deployment can start....and application alongside with the EPI-programme in areas of high transmission will surely assist the ongoing integrated control efforts, i.e. will have the impact we learn about from the phase II/III-results. It might even be considered in special areas to assist elimination efforts. The vaccine will always only remain a great, most useful and needed additional component to the other existing control measures. In addition, and very importantly, these will only be first generation vaccines and we still need renewed efforts to get other building blocks (vaccines) that could be combined with RTS,S and new vaccines, second generation, particularly transmission blocking ones if we go for elimination as well as a huge effort to get also vaccines against P. vivax. A lot on this and these outlooks we presented in the malaria eradication R&D agenda, MalERA, all published in PLoS Medcine on 25 January 2011.
Q: Of the current malaria research being undertaken at Swiss TPH, can you give examples of really promising developments?
A: With pleasure:
- participation in the RTS,S clinical development plan as discussed above
- assisting Tanzania (and also other countries) in leading the up-scaling of the use of ITNs/LLNs to national level
- being involved in major PDPs as biological screening centre for the search of new antimalarials and by doing so being involved in finding (i) spiroindolones (together with NITD, GNF, MMV and Wellcome Trust) and (ii) second generation synthetic peroxides (together with MMV, Monash) as truly novel anti-malarials
- having generated the proof-of-concept for virosome-based malaria vaccines
- contributing to issues of access, clinical diagnosis standards and quality of care and health system thinking to increase the up-take of malaria control measure and of course other interventions
As you can see a great wide range of basic and applied research and of biomedical and social science research to comprehensively contribute to malaria control and elimination in many different endemic settings, including areas like PNG and the Pacific (Solomons, Vanuatu).
Q: In your opinion, what would be pertinent steps or opportunities to improve the way in which malaria is controlled in sub-Saharan Africa today?
A: A difficult question that needs to be tackled at many levels. Some key suggestions appear to me
- Adapting GMAP and really carefully tailoring it to the national and sub-national level
- Funding agencies and scientists to take up the MalERA R&D agenda....and thus a little bit more guided research than academic freedom
- Concentrate on P. vivax at the basic science and epidemiological level
- Use mathematical modeling to ask the right questions, to test feasibility of interventions and to look at potentials of intervention mixes....all things that cannot be studied in full in the endemic areas (time! and hence also ethics!)
- Maintain the momentum created at global and national levels among politicians, programme managers and scientists as well as funders/sponosors and not slow down because progress is not massive - continued, candid evidence-based advocacy!
- Start acting with the available tools and be ready to introduce new ones as they come along AND start also in the most difficult places like DRC, Nigeria....and all this must be followed by a scientific component guided by a surveillance-response concept and not by endless M&E that only accumulates data.