The inaugural Alan J. Magill Malaria Eradication Symposium launched Monday evening at the 2016 ASTMH Annual Meeting with an all-star cast of malaria experts who left the clear impression that the vision of their late and beloved champion— of ending malaria in all its forms—is scientifically and logistically achievable
“Is malaria eradication really an extravagance? The answer is no,” said Bruno Moonen, deputy director of malaria at the Bill & Melinda Gates Foundation. “Because if we don’t aim for eradication, we will see the same problems coming back over and over again. Drug and insecticide resistance will continue to appear and a parasite that has been with us for millions of years will continue to adapt.”
Moonen noted that Magill’s definition of malaria was simple: “removing parasites from people until there are no more parasites left to be transmitted.”
Magill was the 2014 ASTMH President and was serving as director of the Malaria Program at the Gates Foundation when, in September of 2015, he died suddenly and unexpectedly. During his distinguished career, Magill regularly shrugged off skeptics who doubted whether malaria eradication was possible. Instead, he focused intently on what needed to happen operationally—in the lab and on the ground—to get rid of malaria once and for all. ASTMH leaders plan to hold a symposium on eradication in his name every year at the annual meeting.
“Alan was passionate about the injustice of malaria: wiped out in some of the world but taking a terrible toll on the rest,” said Melinda Gates, speaking to the symposium via a previously recorded video message. “There is so much much progress to build on,” she added. “Since 2000, malaria death rates have fallen 60 percent among at-risk populations.”
In a testament to the pace of progress, Pedro Alonso, director of the Global Malaria Program at the World Health Organization, noted that in just the last few months, two more countries—Sri Lanka and the Republic of Kyrgyzstan—have been added to the list of countries that have eliminated malaria.
Alonso pointed out that the best way to pursue eradication is to stay focused every day on reducing deaths and infections from malaria. “If we don’t first reduce death and disease, we will not eradicate malaria,” he said. Alonso also declared that “the WHO is unequivocally for eradication.”
Dyann Wirth with the Harvard T.H. Chan School of Public Health noted that Magill was insistent that malaria eradication had to include not just disease caused by the Plasmodium falciparum
parasite—which is responsible for the vast majority of malaria deaths—but also disease caused by the Plasmodium vivax
“Vivax (eradication) is the biggest challenge in the biological sense,” she said, because it “hides” in the liver where it periodically re-emerges to cause relapse infections.
Chris Drakeley of the London School of Hygiene and Tropical Medicine spoke to the need for eradication strategies that are guided by a detailed view of where malaria transmission is still occurring, something he said is not always apparent when testing people just for the presence of parasites.
He’s a proponent of screening for the presence of malaria antibodies, which are detectable far longer than the parasite. Drakeley said measuring malaria antibodies in people who live in areas where malaria is common offers a “more consistent measure of transmission than parasites rates,” particularly in places where transmission has fallen to particularly low rates.
Thierry Diagana with the Novartis Institute for Tropical Medicine discussed progress toward delivering a “knockout punch” via medications that can do many things at once: cure an infection, rid the body of any remaining parasites, and prevent future infections as well. He was particularly excited by advances in automated screening that are allowing scientists to quickly evaluate “millions of compounds” for evidence of activity against malaria. He said this work already has identified thousands of chemical “starting points” for new drugs.
Meanwhile, Diagana said advances in screening also are being used to identify new vulnerabilities in the parasite, thus presenting “more new drug targets.”
Diagana said today’s rapid discovery of new chemical compounds that could fight the disease combined with the discovery of new vulnerabilities in the parasite should provide “lots of reason to hope” that malaria can be eradicated.
Regina Rabinovich, co-chair of the symposium who is also with Harvard’s T.H. Chan School, said that malaria experts within ASTMH—and the giant ballroom was filled beyond capacity—need to see themselves as “problem solvers” committed to identifying a malaria challenge and working intently to overcome it. She urged all on the panel to each single out one problem that scientists should be focused on solving over the next year.
Moonen from the Gates Foundation said his issue is “duration”—improving the duration of various tools required to fight malaria, such as drugs and insecticides. Diagana with the Novartis Institute identified the need to focus on new treatments for Vivax malaria. Harvard’s Wirth called for an intensified focus on malaria vaccines. The WHO’s Alonso said “government ownership” of malaria eradication was crucial. And the London School’s Drakeley said he wanted more insight into whether people who harbor malaria parasites but no symptoms of disease are playing a significant role in malaria transmission.
Former ASTMH President Christopher Plowe of the Institute of Global Health at the University of Maryland School of Medicine—and a co-chair of the symposium—said for him the key issue is “integration.”
“The program people, researchers, advocacy folks—we all operate in our own world and speak our own languages,” he said. “For this (eradication) to really succeed we need to understand each other and make sure the tools we are developing can be taken up by the people at the other end of the spectrum.”