In advance of World Malaria Malaria Day, ASTMH asked some of our malaria expert members and colleagues to reflect on the global fight against the disease and to peer into their crystal balls and let us know what might be on the horizon. Other interviews in this series include: Admiral Tim Ziemer of the President's Malaria Initiative, ASTMH President Alan J. Magill Judith E. Epstein of the Naval Medical Research Center, Kent Kester of Sanofi Pasteur and Science Consultant Jessica Taaffe.
Laurence Slutsker, MD, MPH, Director for Division of Parasitic Diseases and Malaria for the CDC Center for Global Health (CGH)
Why are you drawn to malaria research?
I started in malaria 27 years ago when I joined CDC. My first trip to Eastern Africa was one I’ll never forget. I walked into a District Hospital ward in western Kenya and was overwhelmed with the site of tiny children, packed 4-5 to a bed, all suffering from malaria. It has been compelling to be part of the effort to address this public health menace, and gratifying to see the progress over the last decade.
While much remains to be done, in many places there has been significant improvement by combining advances in research (ITNs, diagnostics, treatment, prevention in pregnancy) with effective program scale up. Research has been and must continue to be a cornerstone of continued progress. We will not succeed If we rely on the tools and strategies we have now to get to where we need to be in the future.
As we approach World Malaria Day, what is the biggest challenge with this disease?
I don’t think there is one single challenge –we need to keep our eyes on several balls at the same time. Technically our research must find new tools and strategies to deal with parasite resistance to drugs – particularly artemisinin resistance – the spread of which represents a true threat to global health security. Addressing this challenge will require not only new drugs, but research in novel ways to use the drugs we currently have to drive down transmission. Similarly, rising to the challenge of insecticide resistance requires new compounds and new delivery strategies.
Operationally, we need to achieve much greater progress in program scale up in the huge and complex countries with the highest malaria burden. Also key is to explore new and better ways to get the strategic information we need in real time through improved surveillance and response to allow programs to be more efficient and more effective. From a leadership and political perspective, we need to maintain momentum and focus on investing in malaria program and research. There is ample evidence from history to show that when our attention and focus wanes, malaria roars back with a vengeance.
Where do you see the most promise?
In a word – commitment, manifest in many places and at many levels. At the global level, the commitment of partners to develop a budgeted action plan that provides a framework for the contribution and investment of all sectors and partners is critical. At the national level, the commitment of endemic country leadership to a vision of progressive malaria control leading ultimately to elimination is a sea change. It raises the stakes and sets the highest bar possible, but also allows us to think about what was once unthinkable – an end game for malaria. That aspirational goal cannot be achieved without continued commitment to and support for research, balanced with substantial investments in program scale up. There are promising developments in strategies and tools for vector control, drugs, vaccines and their delivery, diagnostics, surveillance and response, and community level engagement approaches. With continued commitment at all these levels, these promises can be realized and implemented to defeat malaria.