Will we ever eradicate malaria? Through concerted health campaigns, smallpox and rinderpest have been eradicated, and significant diseases such as polio may soon follow. Yet malaria remains widespread. We asked expert Tamsin Lee if this could change. Health © koujim30/stock.adobe.com “Forever? Ever ever ever? I couldn’t possibly say ever ever,” says Lee, a specialist in Resilient and Sustainable Systems for Health at the Global Fund. “But in the foreseeable future, I don’t see the malaria parasite being eradicated.” What she can envision, though, is the eradication of malaria deaths – currently standing at over 600 000 per year. “This would require sustained and varied interventions, such as bed nets, treatment – and preventative treatment – which are consistently adapted for changing circumstances.” Epidemiologically speaking, malaria is a particularly tricky disease to defeat. “The malaria parasite and the human immune system evolved alongside each other like a game of cat and mouse,” explains Lee. This pernicious parasite has different variants. which allow it to hide from the human immune system, which also makes it challenging to target with vaccines and treatment. Malaria’s transmission via mosquitoes adds further complexities. Mitigating this transmission requires controlling the diseases in humans as well as in mosquitoes – if not eradicating mosquitoes entirely. In addition, says Lee, these challenges are specific to their individual settings, which are continually changing: due to climate change, changes in socio-economic status, conflict or shifts in government and healthcare priorities. Modelling resistance in the malaria parasite In the EU-funded EstAMR project, Lee worked on simulations to model resistance of the malaria parasite to the latest antimalarials. This explored socio-economic status as an aggravating factor in the prevalence of drug resistance, which might arise in places where only lower-quality drugs are affordable. Lee and her team also developed a spatio-temporal model able to simulate infections in time and space. Using this simulated data, the team could identify those healthcare centres that are more prone to an emergence of drug-resistant malaria. In an ideal world, there would be unlimited funding and resources: this could actually change the game in fighting the disease, says Lee. “Unlimited resources would change decision-making to allow for a longer-term vision,” she adds. This would mean monitoring the parasite in different locations and settings, to understand how it adapts, and identifying mutations when they occur to modify treatments or insecticides. There is hope yet. Scientists have developed three classes of antimalarial vaccines: vaccines that block transmission of the infection between human and mosquito, pre-erythrocytic vaccines that target the parasite in the liver before it passes to the blood system, and blood stage vaccines that reduce the amount of the parasite circulating in a patient. With enough ingenuity, resources and concerted action, malaria might one day follow smallpox into history. This research was undertaken with the support of the Marie Skłodowska-Curie Actions programme. Click here to find out more about Tamsin Lee’s research: Modelling anti-microbial resistance to help prevent malaria Keywords EstAMR, malaria, parasite, transmission, vaccines, mosquitoes
