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The science of eradication 1

June 17, 2012 - 12:49 -- Ricardo Ataide

I have just arrived (about 4 days ago) from a leadership course held at the Harvard Business School entitled Malaria: Science of Eradication. This course is a joint effort by Dr Dyann Wirth, Dr Pedro Alonso and Dr Marcel Tanner and is intended to be the first of many. The next course has already been allocated to Barcelona, home of Dr Pedro Alonso's ISGlobal. 

Several fields of work and study were represented at the course this year: UN, WHO, UNICEF, PATH, CHAI, The Bill&Melinda Gates Foundation, health ministries, Universities,  the private sector (Sumitomo, Genzyme, Intellectual ventures, ExxonMobil), among many others. 

As I stated in an earlier post, I was a bit concerned about the lack of basic researchers in the entire meeting. After all, what is the perception about basic science and it's role in the eradication of malaria? But let us start from the beginning.

(as Colonel Orth, present at the meeting, said at the beginning of his presentation, this represents my personal view of the course and not that of the course organisers...)

from the very first session of the first day it was clear that the room consisted of people with different expertise and different views on how malaria should be addressed. The first challenge of the day was to comment on the global malaria goal of near zero deaths by 2015. Most people jumped to its defence. It is an aspirational goal, they said. I disagreed and generated a bit of controversy by saying that being a scientist and not someone with a political position, I preferred a realistic goal to avoid losing credibility. My words were: if we have already seen that one strategy does not fit all countries, why would one goal do it? Despite this, it was reassuring to listen to Dr Alonso state that they were pushing for an expansion of the research portfolio to include the other malaria parasites (seeing that a lot of resources are allocated o falciparum alone), with a special emphasis on vivax. The day finished with Dr Julio Frenck, former minister of health of Mexico and now Dean of the faculty at the Harvard School of Public Health, emphasing the need for a diagonal approach for fighting malaria, at the same time increasing the malaria related efforts and strengthening the basic health system.

On the second day of the course a basic malaria biology session took place to make sure everyone knew what was going to be discussed during the next sessions. It is always great to see how enthusiastic people get about the malaria life cycle, and how much we still need to learn. It was also a day dedicated to learning from other diseases and their eradication campaigns. What could we learn from Smallpox, polio, guinea-worm? We learned that eradication is achievable, needs political involvement, requires enormous financial efforts (especially during the last mile, a term that became one of many key ideas of the meeting) and that it is time to attack the hot-spots of the disease and start moving away from the "shrinking the map" concept. We also learned that Resistance, lack of commitment, over-confidence and lack of R&D have somehow prevented some of those diseases from eradication. Of course that none of those diseases is as complex, biologically or socially, as malaria but it was great to hear some of the strategies employed. Back to malaria and it's epidemiology we got  to the notion that better maps are necessary to pinpoint malaria hotspots and also that the notion that fever=malaria has to change. "you get what you inspect, not what you expect". 

Let me know what you think of these two days. I'd like to get an idea from the more general malaria community.

In the mean time I'll prepare other posts describing the remaining sessions.

Comments

Bart G.J. Knols's picture
Submitted by Bart G.J. Knols on

Dear Ric,

Many thanks for posting about this course - this is really a nice job of you, to share your experiences with the broader malaria community. Of course we have discussed the 'zero deaths' issue already on MalariaWorld before, but since you ask my opinion, I think this is pie in the sky. The timeframe needed to reach zero is much longer, although I remain convinced that it can be done.

Good to see that the course addressed the pitfalls and requirements for elimination - I hope you also had some sessions that looked into why we were so successful in the 1950s and 1960s, and why everything collapsed afterwards (in terms of making headway in elimination).

I look forward to read more.

Thanks,

Bart