Throughout the twentieth century, researchers hoped to discover a “magic bullet” to cure malaria. But today experts realize that efforts to curb or eradicate the mosquito-borne disease must be multifaceted, from research to policy efforts to use of on-the-ground tools such as pesticides and bed nets.

That was the key takeaway from panelists at a Harvard Worldwide Week event titled “Looking Back, Moving Forward: The Evolution of Malaria,” held Oct. 24, 2017 at Harvard T.H. Chan School of Public Health. (Read about another Harvard Worldwide Week program on malaria and climate.)

“The emerging malaria elimination strategy isn’t one tool,” said Regina Rabinovich, ExxonMobil Malaria Scholar in Residence at Harvard, director of the Malaria Elimination Initiative at the Barcelona Institute for Global Health, and moderator of the Harvard Chan event. “What we’re talking about is a strategy where tools like diagnostics, vaccines, predictive mapping, treatment, and surveillance systems need to be brought together in a system that would hopefully lead to elimination.”

The event included two panels—one focused on past efforts to curb malaria and neglected tropical diseases, the other on the future agenda for malaria eradication. Allan Brandt, professor of the history of science and Amalie Moses Kass Professor of the History of Medicine at Harvard, delivered opening remarks.

Neglected diseases

Participants in the first panel talked about the contributions of Kenneth Warren, who began the Great Neglected Diseases (GND) of Mankind Programme when he was director of health sciences at the Rockefeller Foundation. Warren helped introduce modern biomedical science to the study of infectious diseases in the developing world and brought a unique energy to the goal of providing cost-effective health care to the world’s poorest people.

“Warren animated the modern debate on neglected tropical diseases,” said Conrad Keating, writer in residence at Oxford University’s Wellcome Unit for the History of Medicine, who wrote a book about Warren published last spring. Joseph Cook, adjunct professor of epidemiology at the University of North Carolina’s Gillings School of Global Public Health, said that Warren used his position at the Rockefeller Foundation “both as a bully pulpit and as a convener of this great neglected diseases network.”

Jesse Bump, executive director of Harvard Chan School’s Takemi Program in International Health, said that the concept of a “magic bullet” to cure infectious diseases was at the heart of the GND, which made sense at the time. But tackling the last remnants of infectious diseases such as malaria will require a focus on strategies such as social action, education, broad-based development, and community engagement—“all the things that are really hard to take on,” he said.

The science of malaria eradication

Genomic studies of the malaria parasite hold promise for battling the disease, said Daniel Neafsey, assistant professor of immunology and infectious diseases at Harvard Chan School. With the ability to study many thousands of mosquito genomes, scientists are in a position to learn more about disease transmission, the impact of drugs and pesticides, and potential vaccine targets, he said.

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