Malaria: How Do You Eradicate an Infectious Disease With No Vaccine?

Philip Eckhoff: Disease eradication is a very difficult challenge.
It’s been tried for a number of different diseases but it’s only worked so far for
smallpox which was the first human disease eradicated at the end of the 1970s and for
rinderpest which is a cattle disease or was a cattle disease before it was eradicated
everywhere in the world.
Global eradication has been tried before for malaria in the 1950s and 1960s and it didn’t
succeed for a number of reasons.
Right now almost half a million people die every year of malaria.
And which is an extraordinarily high number and a terrible burden although this number
used to be well over a million.
So there has been progress in terms of reducing this burden.
What one needs to do is different if you’re starting at a very high burden where everyone
is getting infected several times a year.
And what one has to do when one’s down to the last couple of cases in a given country.
The tactics change.
The strategy changes.
The tools change.
When starting out in terms of reducing the burden the most important thing is reducing
transmission and providing access to treatment.
So making sure that people have drugs that work is very important.
The second thing will be to give out things like bed nets to reduce the rate at which
people actually get new infections.
Then all of a sudden you can start to look at a country and see that there’s very little
malaria in certain parts of it.
And most of the malaria is concentrated in a few remaining pockets.
Then building the right surveillance and information systems and logistics to be able to target
enhanced efforts at those sections of the country becomes the next important thing.
It gets to the point where not everyone even in the highest remaining transmission areas
is infected.
We have to figure out who is still driving transmission, who is not receiving access
to the right tools and making sure that you extend access to everyone who’s driving
transmission and everyone who is still vulnerable to the disease.
And then in the end it becomes very interesting.
There will be only a small scattering of cases here and there and finding them and responding
to them quickly with good case management ends up becoming one of the most important
tools in the end game.
So understanding where a given country is along this continuum, scaling up the tools
and most importantly the information systems and ability to deliver treatment all along
that continuum.
Fundamental aspects of health systems end up becoming really important from start to
finish.
On a problem like malaria eradication, disease eradication in general, getting rid of infectious
diseases, it is very fundamentally an interdisciplinary problem.
There will be people from the medical side of things.
There will be people from health systems and operations.
People who know immunology, drug development, vaccine development, mosquito science, entomologists.
At the same time there’s also a really good role for people who are good at mathematics,
people who are good at software, people who are good at data systems.
And the interesting thing is when you have a question that’s really core to your part
of the problem and you bounce it off someone from one of these other disciplines often
they will come up with a better way of actually framing and looking at your specific question.
Sometimes they might even find a better question that actually gets rid of the main challenge
you were trying to deal with.
There’s a famous saying that if a problem seems intractable increase the scope of the
problem.
And that actually becomes really evident in the power of collaboration.
If you’re looking at how can we in this one domain of say drug development get rid
of malaria.
That might be an intractable question but then you bring in the people who are good
at vector biology, the people who are good at vaccines, the people who are good at data
information systems and computing and the people who are really good at health systems
and logistics.
And all of a sudden you have a bigger problem but one where you can actually work together
and solve this.
It requires a lot of learning in terms of how to speak each other’s language and how
to listen to each other.
And how to actually take the time to build these bridges to other fields and to really
see the advantage and the impact of doing this well.
It’s not easy.
It’s much easier to just sit in a room and talk to other people from your discipline
where you all already speak the same academic or research or operational language.
But it is very much worth building these bridges and cross linking.

Malaria: How Do You Eradicate an Infectious Disease With No Vaccine? | Philip Eckhoff

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