Learning From the Best About Malaria Eradication

By Omar Sajjad, IGHS master’s student

With more than 200 million new cases every year, malaria ranks among the world’s most burdensome infectious diseases. If the current efforts to eradicate it prove successful, we would be witness to possibly the greatest public health achievement of the twenty-first century.

Omar Sajjad meets with his mentor, Dr. Jennifer Smith

My capstone project aims to build upon these efforts in its own small way. I am currently researching the movement patterns of high-risk occupational groups in Vietnam to better characterize why these populations are so susceptible to malaria. Infectious disease response has always been my primary area of interest within global health. In college, I was especially drawn to the polio eradication campaign; here at UCSF, my attention gravitated toward malaria eradication, an endeavor of similar scope but of arguably greater life-saving potential.

UCSF has been at the forefront of malaria research and response through its Malaria Elimination Initiative (MEI). Having stayed locally for my capstone, I was given a unique opportunity to break through the initial mystique surrounding the MEI by corresponding with and learning from some of its faculty and affiliates.

I interviewed four professionals – three faculty and one visiting lecturer – whose career foci span the entomology, the epidemiology, and even the ethics of malaria: Dr. Jennifer Smith, a senior research scientist at MEI and my research mentor; Dr. Hugh Sturrock, a spatial epidemiologist at MEI; Dr. Melissa Graboyes, an assistant professor of medical history at the University of Oregon and recent guest lecturer on malaria eradication at UCSF; and Dr. Neil Lobo, a senior entomologist at MEI.

Given the variety of interests, it was not surprising that these professionals cited a variety of influences on their career trajectory. For instance, Sturrock discovered his passion for epidemiology at the University of Edinburgh, where his undergraduate honors project focused on fungal control of mosquitoes. “I’ve been interested in diseases ever since,” explained Sturrock, “as it was a way to combine my interest in science with something that had the potential to impact some of the most vulnerable people on the planet.”

Graboyes was motivated to study the ethics of malaria eradication while conducting research for her book on the history of medical ethics in East Africa. She came across archival materials of the Pare Taveta Medical Scheme, an attempt at malaria elimination in Kenya and Tanzania in the 1950s. According to Graboyes, the scheme was eye-opening in “demonstrating how the different stakeholders could be very much out of alignment and how there are ethical questions raised about how public health interventions could and should end.”

Indeed, most of the faculty acknowledged that large-scale disease control programs have not always been effectively managed. Lobo mentioned that there often has been “a focus on intervention strategies that are not necessarily applicable to many settings and to certain proportions of transmission at a site.” These strategies must instead be locally adapted and flexible to shifting transmission dynamics. Graboyes is concerned with another related problem informed by her research in East Africa: lack of proper communication between interventionists and their target communities. She stated, “Scientists don’t always recognize that these interventions have a long history and that local communities often remember it, and I [also] worry when community members don’t understand the risks of lapsed malaria intervention efforts.” Clearly, there is improvement to be seen by both parties globally.

MEI has routinely been lauded as a case of “doing things right”, and this is largely a reflection of its workforce, work culture and priorities. As Sturrock put it, “The group is unique in that it brings together those working on financing, advocacy, surveillance and epidemiology. There is also a strong focus on supporting country efforts rather than simply producing papers.” Lobo singled out the strong work-life balance supported by MEI; although similar organizations like to talk about it, he seldom sees it in practice.

It was clear throughout my correspondences that there is a deep sense of gravity to the MEI staff’s work – their research has the ability to directly impact countless human lives. So how does this sense of gravity inform their work?

As it turns out, it can have both positive and negative effects.

Smith noted that the opportunity to inform programs and improve impact in low-resource settings is usually a positive pressure. On the other hand, she said, “There can also be a negative pressure to show results given the high costs of research and sometimes inconclusive outcomes.” Lobo agreed on both points. As a positive, he added that the gravity of his research places pressure on him to get work done since “this [research] is not about me…it’s about something far bigger.”

The MEI’s agenda-setting work is the direct result of this kind of altruistic mindset. Examples of MEI’s forward-thinking approaches against malaria include the DiSARM platform co-created by Sturrock and sugar baits, a vector control tool employed by Lobo. “Although malaria epidemiology is complex and moves quickly,” said Smith, “there is always room for innovation.”

I am truly blessed to be working with the MEI, and I have no doubt that its efforts will hasten the day that malaria becomes history.