In honor of World Malaria Day, ASTMH asked some of our malaria expert members and colleagues what inspired them to specialize in malaria, what stands out in the fight against malaria and what will be the economic benefit of a malaria-free world. Other interviews in this series include: Past President Christopher V. Plowe, MD, MPH, FASTMH; Rear Adm. Timothy Ziemer of the President's Malaria Initiative; Councilors Nicole Achee, PhD, ASTMH, Laurence Slutsker, MD, MPH, FASTMH, David A. Fidock, PhD, Rick Fairhurst, MD, PhD, FASTMH; Stephanie Yanow, PhD, Assistant Scientific Program Chair; Capt. Judith E. Epstein, MD, of the Naval Medical Research Center; and Col. Robert M. Paris of the Walter Reed Army Institute of Research.
What situation or person inspired you to specialize in malaria?
I had an interest in travel and international issues from a young age; I am not sure why. After training in Internal Medicine, I decided to pursue Infectious Diseases with an international focus. This could have involved study of any of a range of infections, but in fact led to training in malaria research with Jim Leech, MD, at UCSF, who was a fantastic laboratory mentor. After about a decade of only studying malaria in the lab, I began translational research in Africa, driven by key collaborations with (ASTMH members) Moses Kamya, MBChB, MMed, MPH, PhD, in Uganda and Jean-Bosco Ouedraogo, MD, PhD, in Burkina Faso.
Saving lives is what drives you, but what do you see as the economic benefit to eradicating malaria?
The huge impact of malaria as a deadly infection is obvious, but many don’t think too much about its more mundane impact. In endemic countries the vast majority of episodes of malaria are uncomplicated, and thus not life-threatening. Yet, each of these episodes has significant consequences, with illnesses that lead to children missing school and parents missing work due to their own illnesses or those of their children. Trips to health clinics can be costly, in terms of direct clinic costs, travel costs, and the costs of missed work, and children may suffer six or more episodes of malaria per year. In addition to the economic consequences of missed work, malaria’s long-term impacts probably include effects on neurological development and learning, which can have economic impacts long after the episodes of illness.
In thinking about malaria control and elimination efforts in the last five years, what stands out most for you?
The last five years have been exciting, with, for the first time in memory, clear improvement in malaria indicators in many areas. These improvements are likely due in large part to increasing access to key malaria control measures, in particular, highly effective artemisinin-based therapy, insecticide impregnated bednets and indoor spraying of insecticides. On the other hand, over the last five years we have seen clear worsening of the situation regarding resistance, both of malaria parasites to available drugs and of mosquitoes to available insecticides. And we have continued to see the difficulty of developing a highly effective malaria vaccine. So, we can forsee both continued improvements as we move (slowly) toward malaria elimination, but also major challenges.