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Q&A with Pedro Alonso of the Malaria Eradication Agenda (malERA) and a researcher at the Barcelona Centre For International Health Research (CRESIB), Spain talks to TropIKA.

4 Nov 2009

Priya Shetty

Source: TropIKA

Pedro Alonso

Pedro Alonso is helping to lead the Malaria Eradication Agenda (malERA), and is a researcher at the Barcelona Center for International Health Research (CRESIB), Spain.

Q: Why was malERA set up and what is its goal?

A: malERA is the response of the malaria community to the challenge of establishing the goal of eradication. We are trying to undertake a careful, balanced exercise trying to pick the best brains around the globe on how to eradicate malaria. There are two underlying concepts. One is to engage the research community so that they are never detached from eradication attempts. The second is that we don’t think that we can eradicate malaria with the current tools. If we people have access to existing tools, we could save millions of lives, but not eradicate the disease. So we need an R&D component to be thinking about new tools and what knowledge gaps we need to overcome to move towards eradication.

Also, malERA is not a self-perpetuating group – each of us are self-standing scientists – but we felt compelled to come together to develop this agenda. malERA is a time-limited exercise of extensive consultation with the wider malaria R&D community to identify how does our current research strategies and programmes need to change to develop those tools. We are working towards a white paper next April to outline what the research agenda for eradication.

Q: Some researchers are worried that if the funding focus shifts to long-term eradication goals it will divert attention from key control measures – are these concerns valid?

A: I think this is a concern but it’s not likely to happen. We strive to be very explicit that the research agenda now manages our problems today; ie, we need new first-line treatments, and contain artemisinin resistance. This needs to continue to happen but on top of this we need to think about research priorities if we are to one day eradicate malaria. These are not exactly the same lines of R&D.

So far, malaria research has been driven by the global strategy of control – reduction of morbidity and mortality. So our development of drugs has been targeting that, as has our development of diagnostics. If we want to interrupt transmission, we need different types of drugs, vaccines, and diagnostics, and so on. This agenda is aimed at curing sick patients but not stopping transmission.

Q: What lessons can we learn from the eradication efforts of the 1960s?

A: The most important problem was the assumption that those driving that effort knew everything that needed to be known, and that they had the tools to wipe out malaria. So eradication became a belief system. They abandoned research. There was a sense that with the available tools, there was enough to eradicate malaria. But it turns out that they didn’t have all the information or all the tools necessary. This had severe consequences for the following years. There were no malariologists, and there were no new products. That was partly responsible for the huge surge in malaria that followed this attempt.

Malaria is so complex that eradication will not be simple. There is a slight overhype in the success of control programmes. The partial success we are seeing in some programmes still fall short from what elimination and eradication require.

Q: Do you have a timeline in mind?

A: No, in malaria making predictions is bound to be catastrophic. For example, more than 20 years ago we were being promised that a malaria vaccine was around the corner. Now we are very close but it’s taken a lot longer than anyone would have predicted. We are cautious in terms of timelines but ambitious in terms of the thinking of what needs to be done.

Q: Some malaria scientists are arguing that we know exactly what to do to eradicate malaria, that all we need is funding and better systems; this sounds like an echo of the 1960s over-optimism. What do you think?

A: I agree. In some places, malaria could be eliminated in some places. It now has been in Dubai, Kuwait, Morocco, and the UAE. With the current tools, it could be eliminated from significant parts of the globe. But I vehemently don’t think that with the current tools we can eliminate malaria from places where it’s entrenched, including sub-Saharan Africa. There are weak health systems, the vectors adapt, the political systems are problematic. We cannot eliminate from some parts of the world and not others, because it will come back. We have seen this in Madagascar. When we say eradication, it has to be worldwide.

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