63rd ASTMH: Accelerating to Zero

What impresses me the most about walking the halls of the ASTMH is the breadth of the research on display. From the most minute details of the parasite’s surface proteins to the challenge of getting drugs to millions of people in mass screen and treat (MSAT) campaigns, malaria is being looked at from every angle.

If there was a single thread that ran through the sessions I attended today it was that malaria is not a homogeneous problem. It differs country to country, region to region, town to town and now research is revealing that in many places malaria rates are clustered even within the same town. Intuitive this should be obvious – mosquitoes need a water source to breed and it stands to reason that malaria rates would be highest near that water source – and yet a population based bio-medical approach treats everyone’s risk as being equal. It’s not.

Fascinating work is being done in Zambia to map the occurrence of malaria at the household level and identify determinants of risk. In Namibia and Kenya mobile phones are being used to map mobile populations in real time to identify risks of malaria importation from one region to another. And Dr. Adam Bennett, who has presented at our Boot Camps introduced the concept of “hotpops” or hot populations – groups that are occupationally or behaviorally at higher risk for malaria, i.e. artisanal gold miners.

One way to address these populations may be to take a page out of the HIV book. Over the last 30 years ministries of health have been forced by the HIV/AIDS epidemic to break out of their clinical comfort zone and embrace innovative peer outreach models to reach high risk populations. Similar approaches may help malariologists identify and intervene with high risk (often underserved) populations as we try to push to zero.

And pushing to zero is on everyone’s mind. From mass drug administration to MSAT to vaccines and transgenic mosquitos the research community is filling its toolbox for the final push. I ended the day at a reception hosted by Malaria No More and the University of California San Fransisco’s Malaria Elimination Initiative. Looking around the room as the various speakers exhorted us to redouble our efforts I saw young brilliant researchers from around the world, public health professionals dealing with the disease day in and day out and a cadre of people who have been in public health long enough to be jaded. And it’s the hopefulness I saw in that last group that lifted my spirits.

PMI’s Bernard Nahlen brought it home to me when he talked about the sea change he’s seen in the tools available. When Bill Gates announced a commitment to elimination on the part of the Gate Foundation in 2007, it was roundly understood as an aspirational but unrealistic goal. No one thinks that any more – it’s an inevitability. The only question is how quickly can we do it – and every bit of speed we can muster is another child that doesn’t have to die.

As Nahlen pointed out, the city of New Orleans was itself quite malarious. With concerted public health effort that era is behind us. We can walk down Bourbon street without worrying about the mosquitos. We can enjoy New Orleans jazz from a balcony restaurant steeped in the tradition of the south. And we’re on the path to that day when Africa will be similar – one will be able to sit at a sidewalk cafe in Dakar or Accra or Lilongwe, listen to their distinctive musical heritages and give no thought to malaria at all. Zero.

written by Matt McLaughlin, Program Manager
Stomping out Malaria in Africa