Posted on 21 July 2020
Karen Barnes, Professor of Clinical Pharmacology at the University of Cape Town and Co-Chair of the South African Malaria Elimination Committee, discussed the importance of involving communities in malaria programmes. She used her work with the Lebombo Spatial Development Initiative as an example. LSDI was a socio-economic partnership among South Africa, Eswatini, and Mozambique, that relied on health workers, selected by their communities, to supply malaria treatment and diagnostics and refer patients for care. Workers who sprayed the inside of homes were also selected by their communities. Dr Barnes explained that this sort of trust formed the basis of the programme. Community engagement also helped with other crucial aspects, such as encouraging patients to finish their courses of treatment, emphasising the importance of malaria control even in less affected areas, and working with migrant populations to stop the spread of the disease.
Dr Ian Graham, Director of BioYork and Weston Chair of Biochemical Genetics at the University of York, talked about artemisinin, the difficulties of a sufficient and consistent supply of the plant-based chemical, and the growing problem of resistance to the drug. He described his work with the Centre for Novel Agricultural Products to increase yields of Artemisia annua, the source of artemisinin. Lack of supply is one of the greatest challenges of malaria control, as the plant has become less economical for farmers to produce. Dr Graham and his team have, through molecular breeding, produced hybrid variants that have a higher yield and can be grown by small scale farmers. With a wide range of partners, he has been working to make these hybrid seeds competitive in the market and to reach commercial partners. He emphasised the importance of involving funders in this process to bring down the cost of engineering hybrids. He also encouraged the sharing of data and material among researchers to improve production even further.
Dr Rajitha Wickremasinghe, who is Professor of Public Health and former Dean of the Faculty of Medicine at the University of Kelaniya in Sri Lanka, described how the country managed to eliminate malaria. In total, the effort took over a hundred years from 1911-2016. There were periods of success and other times when things moved more slowly. But the campaign continued; even during the civil war between 1983 and 2009, rebel groups were incorporated into treatment strategies. There were very few implementing partners: the Anti Malaria Campaign, the Ministry of Health and two local nongovernmental organisations, which followed a comprehensive strategy of using diagnostics, treatment, and vector control. Sri Lanka has an excellent public health system with good transport and connectivity across the country, which proved crucial to the effort. Dr Wickremasinghe also noted the importance of having a flexible funding schedule to allow programmes to be agile and responsive to local realities. He also said that the majority of a budget should be allocated to human resources and technical assistance, rather than insecticides and diagnostics.
A Q&A followed the discussion. All speakers agreed that the greatest threat to malaria elimination is drug resistance. Preventing this and developing comprehensive public health systems are the most essential control strategies.
Please find the recording of this webinar on our YouTube Channel.
The Centre for Global Health Histories at the University of York is indebted to our speakers for contributing to the seminar. We also thank WHO and the Wellcome Trust for making these seminars possible.
This event report is written by Alexandra Bradbury (MA, Medical History and Humanities), University of York