Professor Brendan Crabb AC and Associate Professor Helen Evans AO with 774 ABC's Jon Faine.
The global battle to fight and eradicate malaria will ramp up next week in Melbourne when the inaugural Malaria World Congress (MWC2018) gets underway from 1-5 July.
Despite past success in global malaria control, the disease remains a major public health risk in tropical regions globally and this year the World Health Organization warned that progress in the fight to eradicate malaria has stalled. More than 430,000 die from the disease each year and there are 216 million cases globally. Leading malaria researchers have argued not enough is being spent on eradication programs and drug-resistant strains of the disease are emerging.
Burnet Director and CEO, Professor Brendan Crabb AC, who is also a leading international malaria researcher, explained to the ABC 24 Breakfast team why the Malaria World Congress is so important to the global agenda to eliminate malaria.
He also spoke candidly with Radio National’s Geraldine Doogue on Saturday Extra.
Listen to the program which also features Dr Rima Shretta, an
expert on financing malaria elimination initiatives in low and middle-income economies, currently on secondment with the Asia Pacific Leaders Malaria Alliance (APLMA).
Congress Founder, Professor Crabb joined fellow Co-Chair Associate Professor Helen Evans AO on 774 ABC Melbourne’s Conversation Hour hosted by Jon Faine. Listen to the program here.
An edited transcript of the Convo Hour is below featuring Jon Faine (JF), Professor Crabb (BC) and Associate Professor Evans (HE).
Jon Faine: I thought malaria was one of those diseases that was disappearing?
BC: You can be excused about thinking that in this part of the world. Many parts of the world that used to have it don’t either – the UK, Italy, the US – all used to have major malaria problems.
It is still one of the most infectious diseases in the world, one of the most important health issues in the world and one of the most important drivers of poverty, so its still a highly significant issue.
HE: I think it’s important that people understand that half a million people die globally from malaria each year and about 216 million people contract malaria. In Australia many people don’t know much about it unless they travel or are in the defence forces. Australia has been declared ‘malaria free’ since 1986 but it impacts on us. As Bill Gates said: “It’s now preventable, treatable and beatable” and so we need to do that.
JF: So what is malaria?
BC: It’s a parasitic disease, a very small, single-cell parasite that infects our red blood cells and through that infection causes all sorts of clinical syndromes. Its transmitted by mosquitoes, a certain type called an anopheles mosquito. There is a life cycle between mosquito and humans for this tiny parasite.
JF: So one unlucky bite is enough?
BC: One unlucky bite is enough. As few as three or four or five parasites go to your liver initially after a bite and stay there for up to two weeks. After that up to 10,000 – 100,000 parasites come out of your liver and shortly after you have up to one per cent of your red blood cells, if untreated, affected by an enormous parasite burden in one person.
JF: What are the first symptoms that you notice?
BC: You won’t notice anything for a number of weeks because the liver-stage is sub-clinical. But a week after that the extra fever, the chills, influenza-like symptoms will develop. If untreated it can become much more severe, especially if you have no immunity to the disease it can become life threatening.
JF: What is the treatment now?
BC: Various antimalarial drugs generally relying on one last active compound, called artemisinin and its derivatives. And one of the big dramas unfolding around malaria is the emerging resistance in this region to that last line drug, so you would get combination therapy based on artemisinin.
JF: So prevention is better than cure so if you are in a region with these mosquitoes you wear long sleeves, lots of sprays …
BC: If you live there then insecticide-treated bed nets are the most effective public health tool that we have for malaria. The key danger period is dusk. Bed nets are not that effective if they are not treated with insecticide. So it’s the chemical on it is more important than the bed net itself. Unfortunately the mosquito has evolved resistance to both the insecticides and they change their biting behaviour. So they start to bite during the day. Mutation in evolution is a constant battle.
JF: Who is most affected by malaria in the world?
HE: It most impacts on women and children for a number of reasons, particularly pregnant women who are more susceptible to malaria because their immunity is lower. Malaria can lead to miscarriages, stillbirths and low birth weight babies. Children under five are the most impacted especially in Africa.
JF: Can you be bitten by a mosquito carrying the disease but not contract malaria?
BC: Yes you can. If you grow up in a malaria-endemic area and get malaria quite a number of times and you live, you develop a level of immunity and that immunity will protect you against the clinical disease – getting sick – for the rest of your life. But it won’t protect you against actually carrying parasites. This is a very important principle when you think about elimination. But if you are pregnant you become susceptible again to malaria during the first pregnancy. In subsequent pregnancies you have developed immunity to pregnancy-associated malaria.
JF: How come the mosquitoes don’t get malaria?
BC: They do. The reason why this particular species of malaria is so attuned to be the transmitter is that it is in the ‘sweet spot’ of the parasite. Evolutionary it doesn’t kill the mosquito so it doesn’t set up a life cycle. So it’s a finely tuned evolutionary balance.
JF: Is it only humans that get malaria?
BC: Of the species of malaria that humans get – Plasmodium – is the gene essence of several species that are only human.
HE: It is a disease of poverty so it is really marginalised communities, especially women and children who often don’t have an active voice. Also a lot of migrant workers and itinerant workers are affected. For example, in Myanmar where there are a lot of forest workers they don’t have bed nets and they often aren’t tied into the health system, so it’s a disease of poverty but it also creates poverty. It has an enormous financial impact and a vicious cycle. If we are talking about sustainable economic development that will lead to peace and security, malaria makes a big impact – it keeps individuals, communities and countries poor.
JF: Is it true that gin and tonic is a preventative?
BC: It is unfortunately not true. The link there is the quinine in tonic is an antimalarial but not near enough in tonic to have an effect.
JF: Why is Melbourne hosting the Congress when Australia is malaria-free?
BC: Melbourne is a centre of excellence in malaria research and there are historical reasons for that. The response to malaria really is global; it’s not just centred in those countries where malaria is at its worst such as the poorer countries. Most western democracies work really hard to address malaria and Australia is no different – both from the humanitarian perspective that it’s the right thing to do for our neighbours and friends, and its also good for us (Australia). Its good to have a healthy and prosperous region and malaria is synonymous with keeping countries down.
JF: Where are the delegates coming from?
HE: We have delegates from 69 countries across the globe are attending including a lot from this region, and many from sub-Saharan Africa where there is the biggest burden of malaria, and where there is the most progress to be made. Also some are coming from Latin America where there has been a lot of progress until recently and now some backsliding is happening. For example in Venezuela when their economy went kaput malaria has just rebounded (and polio has just been rediscovered there).
JF: How does this happen?
BC: It is synonymous with health systems that are no longer functioning. A vaccine preventable disease like polio is at the micro level.
HE: They (Venezuela) don’t have the money for it (vaccines) but they also don’t have the health systems to actually deliver the services. It becomes a vicious cycle when a country’s economy declines or when they are still fragile, the health systems start to fall apart and then you get all these health issues rebounding. Infectious diseases like malaria and TB come back.
BC: There will be about 1000 people at the Congress (MWC2018) but the most exciting thing for us is the demographic of those people (delegates) who haven’t come together before. Just over a quarter will be scientists but also politicians, policy makers, those on the frontline delivering the intervention and the affected communities as represented by Civil Society Organisations, will all be at the same meeting at the same time discussing the same problem. That’s the crux of this congress. We need creative solutions to eliminate malaria.
JF: It’s not so much about medical science as it is about political will and communicating with communities.
HE: Absolutely, it’s about all of those things. We do need research and new tools in terms of diagnostics. We don’t have a strong vaccine yet despite one being trialled in Africa. That’s what inspired us to hold this Congress – to have everyone working together. Everyone in the end tends to find it easier to work in their comfort zone. The AIDS epidemic is a classic example of where we realised it wasn’t only the science – we needed to get everybody together including the politicians, the affected communities and the frontline service providers. The malaria-affected community is very different to the AIDS affected community where you had highly articulate, highly educated, very driven affected communities. In malaria we don’t have that.
JF: So many examples around the world where they don’t trust the scientists.
HE: That’s why it’s so important to have the affected communities there (at MWC2018) so they learn to trust the scientists. If they don’t trust the health services you are not going to get cooperation either. Ebola was a good ‘wake up call’ for everyone. In Guinea when the teams went out to communities and told them they were going to take the dead bodies away they actually closed ranks. You need to have them on-board, understanding why you need to work together to make progress.
JF: You grew up Brendan in Papua New Guinea (PNG). Modern medicine is not often trusted.
BC: It’s not the major problem facing PNG in implementing health systems, its an incredibly poor country and has other challenges, ethnic challenges, it’s the most diverse country in the world so they have their challenges that are above and beyond whether or not they believe the science. My view is that the science is still winning. People do accept science whether its epidemiology or new tools.
What’s happening now is tremendous success in malaria control in 40-50 countries – up to four to five million lives saved in the last decade. But in 10 or so countries it is not only not working the situation is getting worse and part of the reason for that is we don’t have the answers. It isn’t just implementing the tools. The transmission is too intense. It is too hard. We need more powerful tools so the science does really still matter.
Burnet will bring you updates from the MWC2018 on our website and across our social media channels throughout the Congress.