Jane and I went to the 2015 Cochrane Lecture at Green Templeton College last night to hear Professor Nicholas White speaking on Malaria control: past, present and future. It wasn’t overly technical and packed with fascinating bits of information and the odd touch of of humour. However, the conclusion was less upbeat than I had expected or hoped.
My expectation was that Professor White would explain how malaria was on its way to join diseases such as smallpox, existing only in a few highly controlled laboratories for reference and completely eradicated from the wild. It turns out though that there is a swathe of territory, particularly in a band across the middle of Africa, where infection rates are still high and drugs that seem amazing when first tested quickly lose their efficacy. One of the problems is that anti-malarial drugs leave behind a few resistant survivors among the Plasmodium that cause the infection and these lead to new generations that are not harmed by the same treatment. Far from being on the verge of eradication there is a possibility that malaria could increase and spread.
That said, malaria has been greatly reduced worldwide in modern times. Parts of the UK were malarial and it was a huge problem in areas like the southern states of the US. How did we succeed there with a much more primitive understanding while now, when we can analyse malaria at a genomic level, we seem increasingly powerless to contain it?
I think some of it is down to the fact that we understand better the side effects of some of the mechanisms which were formerly used, like widespread use of DDT as an insecticide. With recognition of the devastation this wreaks on a whole swathe of insects, rippling up the food chain, and potential direct risks to human health, this wouldn’t be acceptable today and, as with the Plasmodium itself, there is also the factor of breeding resistance. It was probably also helped by improved health, housing and sanitation standards; malaria can’t be beaten back as a single target but has to be considered as part of a wider system.
I hope Professor White and his colleagues make some wonderful and unexpected advances in the next few years but it certainly isn’t just a matter of inexorable time seeing us victorious.