Day 3 of the course started on anti-malaria drugs. We discussed who should take them and some of their effects, what they should be used for ( treatment? Prevention?) and against what (just Pf? Pf and Pv? All parasites?). The most heated debates arose when the issue of resistance came about. Someone mentioned resistance to artemisinin and immediately some voices rose to say that that is still not a given. There are indeed reported cases of treatment that had to be extended but not of treatment failure as such, which means that, real resistance is still not fixed in the parasite population. This also prompted a bit of debate around the "are we all over-reacting at the spread of resistance?" issue. From that we also learned that resistance to chloroquine arose in Cambodja, in an area of low transmission, with less circulating parasite genotypes than in other regions, and that that fact is in itself a mystery. Dr Pedro Alonso also said he wanted to bring to the table the "C"-word: chemoprophylaxis. Should we do it?
this was also a day to discuss a bit about vector biology and control. From EIR to blood indexes. From studies done using olfactory sensors of anopheline mosquitoes on drosophila to the best time to expose mosquitoes to insecticide. From IRS to ITN. A lot of the knowledge that seems to be out there about these two interventions, for example, is purely empirical. We know they work, but exactly how much they contribute in reality and sometimes even how, is difficult to assess. Besides, we are talking about interventions that target very specific anopheline mosquitoes: those that bite indoors. What about those that like the outdoors? Granted that African anophilines that are excellent malaria vectors prefer the indoors, but other mosquitoes don't. As for the IRS the questions posed were: how many sprays a year? Who sprays? Who monitors? Who pays for it? For the case of the ITN: how many should be distributed? How should their use be monitored? Should it be monitored? Who shall make them? locals? How should they be distributed and by whom? Can they start accounting for cultural differences? Customer taste? Can they be more resistant to wear and tear?
Next came the vaccines. As would be expected, Dr Pedro Alonso told us some of the results of the RTS,S vaccine that will be licensed soon. Finally a goal that the malaria community will reach! He said. The RTS,S vaccine will be licensed for use in 2015 and although some of us may still be a bit weary about the results, it is undoubtedly a huge concerted effort. Of course that we have to try and find surrogates of protection, which as of today still nobody as a clue. It was at this poin in the course that the emphasis on transmission blocking vaccines and gametocytes started. As the course organisers told us, this is a paradigm shift.
after a session of how to diagnose malaria and the merits and pitfalls of RDTs we went on to discuss Dr Marcel Tanner's passion. Surveillance, surveillance, surveillance. it should be used as an intervention and we should be making decisions on the minimal essential data necessary and not wait for all the possible data. I retained the word RAPopDyn and challenge you to decipher it!
I'll stop here and discuss on another post the following days where the economy, the possible involvement of the private sector and more in depth looks at some particular case-studies were discussed.