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Rethinking Malaria – Why Now

By guest contributors Dyann Wirth, Rose Leke and Michelle A. Williams

Malaria elimination is possible. Ten countries have been certified “malaria-free” in the past five years, including China, which eliminated the disease from 30 million cases to zero cases. However, progress toward elimination has been uneven. Today, Africa bears 90% of the malaria burden and progress has stalled. In 2020, there were 240 million cases of malaria and 637,000 deaths worldwide. This is the same level of human suffering as was the case in 2015. Now is the time, we must act.  

COVID-19 mobilized the world, proving that it is possible to meet public health challenges quickly and effectively through international cooperation on health research and innovation, multisectoral coalitions, and collective action. This level of global action is exactly what is needed to end malaria.

Malaria, a threat to the most vulnerable in populations with long-term societal impact, must be approached as a societal problem of health and economic development, not just as a medical problem. Malaria elimination efforts must be led by endemic countriesin partnership with multiple stakeholders within each country.  Leadership must come from all levels of government, from community advocates to national leaders. In countries recently certified “malaria free,” the common feature is effective governmental leadership coupled with technical expertise and a strong community health workforce.

The COVID-19 pandemic has laid bare the limitations and inequities of our global health systems, most particularly in challenges related to the global health workforce. Investing in the health workforce is essential. Empowering health workers through education, training, and creating sustainable career paths that include fair wages for community health workers, are fundamental to progress. To end malaria, we need a workforce that takes a problem-solving approach and includes players from multiple sectors. Experts in diverse disciplines—behavioral and social science, communications, finance, data science—must come together with community leaders to focus on resolving the barriers to malaria elimination. Universities and educational institutions can enable the training of this workforce at all levels.

Malaria data should be valued, visible, timely and employed by the public and policymakers in the same way COVID-19 data has been used for decision-making. Real-time data has been critical in other disease elimination programs such as smallpox and polio. Why not create Malaria Dashboards at the community level and national level to track progress and inform policy? Malaria has a “toolbox” of interventions, including the newly recommended vaccine, and the best mix of these tools will be defined by the locally derived data.

Malaria elimination policy and practices must be integrated into the broader health system without losing the focus on reduction of disease burden. Accelerating innovation for new tools and new ways of using existing tools is critical. Endemic countries have a great potential for entrepreneurship, research, and development. The malaria community should harness that potential.

Now is the time to imagine and keep working towards a malaria-free world—we know it can be achieved.

Read more from the Rethinking Malaria collection on PLOS Global Public Health:

About the authors:

Professor Dyann F. Wirth (Richard Pearson Strong Professor of Infectious Diseases, Harvard T.H. Chan School of Public Health, Chair, WHO Malaria Advisory Group, co-Chair, Rethinking Malaria in the Context of COVID–19) has been a major leader in malaria research for more than 30 years. Recognizing the importance of bringing cutting-edge genomic science to the study of infectious diseases, she joined the Broad Institute of MIT and Harvard shortly after its establishment to lead its infectious diseases initiative. two-term Using a multidisciplinary approach, her group explores challenges related to mosquito biology and the malaria parasite.

Leveraging the genomic tools of the human genomic project, the group has applied state-of-the-art technologies and novel approaches to better understand the fundamental biology of the malaria parasite, evolution, and mechanisms of drug and insecticide resistance. This work has provided completely new insight into how the malaria parasite has evolved, specifically in the areas of population biology, drug resistance, and antigenicity. The group’s current efforts seek to determine both the number and identity of genes expressed by the parasite in response to drug treatment and to evaluate the role of these genes for parasite survival. This work aims to understand basic molecular mechanisms in protozoan parasites. Current findings have made significant contributions to advancing our understanding of malaria vaccine efficacy with long-term R&D goals to discover and apply preventive and therapeutic interventions against malaria infection. The group’s research activities are made possible through collaborative research partnerships with investigators, universities, and clinical centers in Africa, Asia, and the Americas.

In addition to her research and teaching efforts, Professor Wirth directs Harvard’s Defeating Malaria: From the Genes to the Globe Initiative, a university-wide effort to produce, transmit, and translate knowledge to support the control and eradication of malaria. Wirth is past chair of the Department of Immunology and Infectious Diseases at the Harvard Chan (2006–2018). She is a member and current Chair of the World Health Organization’s Malaria Policy Advisory Group (MPAG), fellow and past president of the American Society of Tropical Medicine & Hygiene (ASTMH), a fellow of the American Academy of Microbiology and American Association for the Advancement of Science, and member of the National Academy of Medicine of the National Academy of Sciences. Professor Wirth is the first female recipient of the ASTMH’s Walter Reed Medal, a recipient of ASTMH’s Joseph Augustine LePrince Medal, was honored with BioMalPar’s Lifetime Achievement Award, and earned the USF Presidents Global Leadership Award. She is a past board member of the Burroughs Wellcome Fund and the Marine Biological Laboratory.

Rose Gana Fomban Leke (Emeritus Professor of Immunology and Parasitology, University of Yaoundé I, co-Chair, Rethinking Malaria in the Context of COVID-19) is Emeritus Professor of Immunology and Parasitology at the University of Yaoundé I. Her primary research interests center on the immunology of parasitic infections, in particular, malaria. Professor Leke has a keen interest in global health issues and has been involved in the worldwide Polio Eradication Initiative, global malaria elimination activities, and health systems strengthening efforts. She has been very effective in the training of the next generation of scientists, namely the empowerment of the young female scientists and women overall. Higher Women Cameroon, a high-impact mentoring program, is one of her primary initiatives.

In March 2013, she stepped down as Head of the Department of Immunology and Parasitology at the Faculty of Medicine and Biomedical Sciences and Director of the Biotechnology Centre at the University of Yaoundé I. Professor Leke is Executive Director of the Cameroon Coalition against malaria, Chair of the Multilateral Initiative on Malaria (MIM) Secretariat, member of the Canada Gairdner Foundation Global Health Award Advisory Committee, President of the Federation of African Immunological Societies, a fellow of the Cameroon Academy of Sciences CAS, a fellow of the African Academy of Science AAS, a fellow of the World Academy of Science, and two-term Council member of the International Union of Immunological Societies.

Professor Leke is co-Chair of Harvard’s Defeating Malaria: From the Genes to the Globe Initiative Executive Board (alongside Michelle Williams, Dean of the Faculty at the Harvard Chan) and Chair of the Board of Directors of the National Medical Research Institute. She serves as Vice President of the Scientific Committee of Cameroon First Lady’s Research Centre. She is a member and Chair of the African Advisory Committee for Health Research (ACHR) and Global ACHR; a Board member of the Global Forum for Health Research; and served as Vice-Chair of the Technical Evaluation Reference Group (TERG) of the Global Fund to Fight HIV, TB, and Malaria. She was awarded a Plaque of Honor in recognition of her “outstanding Services and dedication in leading the TERG” in 2009.

She has served as a consultant on several past/current committees of the WHO, including the Malaria Policy Advisory Group, Malaria Elimination Oversight Committee, Global Certification Commission, Emergency Committee for Polio Eradication, and the Chair of the African Regional Commission for the Certification of the Eradication of Poliomyelitis. She also served as Chair of the Data Management Committee for a trial on Azithromycin-chloroquine, and was a member of the Scientific Advisory Group for Ebola vaccine trials in Guinea. In 2011, she was one of six women who received the African Union Kwame Nkrumah Scientific Award for Women and received the 2012 award for Excellence in Science from the Cameroon Professional Society. In 2014, she served as the Aggrey-Fraser-Guggisberg Memorial Lecturer at the University of Ghana and was awarded a Doctor Honoris Causa (DSc). In 2015, she was elected International Honorary Fellow of the American Society of Tropical Medicine and Hygiene.

In 2018, she was elected one of nine women as Heroine of Health and was celebrated at a special event in Geneva in the presence of the Director-General World Health Organization (WHO), the Regional Director of the WHO/African Regional Office, and the Cameroon Minister of Health. On November 23, 2018, she was crowned by the Cameroon Medical Council as Queen Mother of the Cameroonian Medical Community.

Dean Michelle A. Williams is Dean of the Faculty, Harvard T.H. Chan School of Public Health, and Angelopoulos Professor in Public Health and International Development, a joint faculty appointment at the Harvard Chan School and Harvard Kennedy School. She is an internationally renowned epidemiologist and public health scientist, an award-winning educator, and a widely recognized academic leader. Prior to becoming Dean of the Faculty at Harvard T.H. Chan School of Public Health in July 2016, she was professor and chair of the Department of Epidemiology and program leader of Harvard’s Clinical and Translational Sciences Center (Harvard Catalyst) Population Health and Health Disparities Research Program.

Dean Williams joined the Harvard Chan faculty after a distinguished career at the University of Washington (UW) School of Public Health. While at UW, she served as co-director of the Center for Perinatal Studies at the Swedish Medical Center in Seattle, WA. She developed and directed the Reproductive Pediatric and Perinatal Training Program at the UW, held a joint appointment in Global Health from 2008–2011, and was an affiliate investigator at the Fred Hutchinson Cancer Research Center 1992–2010.

As an acclaimed researcher, Dean Williams’s scientific workplaces special emphasis on the areas of reproductive, perinatal, pediatric, and molecular epidemiology. She has extensive experience in carrying out large-scale, multidisciplinary research involving the collection and analysis of epidemiological data (e.g., sleep characteristics, physical activity, dietary intake, and environmental exposures) and biological specimens (e.g., blood-based biochemistry/biomarkers, flow cytometry, genetic variants, whole-genome expression of mRNA and miRNA), both domestically and internationally.

Dean Williams has published more than 425 peer-reviewed research papers ranging from studies of modifiable behavioral and environmental determinants of adverse health outcomes to genetic and genomic studies of common complications of pregnancy and chronic disorders among children and adults. She has successfully administered large-scale, clinical epidemiology studies that seek to understand genetic and environmental causes of adverse pregnancy outcomes and other non-communicable disorders along the life course. Dean Williams also developed and directed (for more than seven years) the Reproductive Pediatric and Perinatal Training Program at the UW. In 1994, Dean Williams developed and is currently directing, the NIH-funded multidisciplinary international research training (MIRT) program that allows for the development and operations of undergraduate and graduate student training in global health, biostatistics, and epidemiology in over 14 foreign research sites in South America, South East Asia, Africa, and Europe. She was appointed Board Co-Chair of Defeating Malaria: From the Genes to the Globe Initiative at Harvard University in 2016.

Dean Williams has been recognized for her excellence in teaching, as the recipient of the Harvard Chan School’s Outstanding Mentor Award (2015), the White House’s Presidential Award for Excellence in Science, Mathematics, and Engineering Mentoring (2012), the UW’s Brotman Award for excellence in teaching (2007), and the American Public Health Association’s Abraham Lilienfeld Award for education in epidemiology (2007). She earned undergraduate degrees in Biology and Genetics from Princeton University in 1984. She earned a master’s degree in Civil Engineering from Tufts University, and a master’s and doctoral degree in Epidemiology from the Harvard T.H. Chan School of Public Health and Harvard University

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