YSPH scientist continues work in malaria’s “heartland,” sub-Saharan-Africa, to stem a deadly disease.
Dr. Sunil Parikh, M.D., M.P.H., an assistant professor in the Department of Epidemiology of Microbial Diseases at the Yale School of Public Health, has studied malaria since early in his career. Much of his research now is in Africa, particularly Uganda and Burkina Faso, countries particularly hard hit by the mosquito-borne infection. His research incudes fieldwork, with both individuals and populations, and laboratory-based approaches to optimize the use of antimalarial drugs. On World Malaria Day 2013 (April 25), Parikh sees cause for both optimism and concern: some countries are starting to defeat malaria, but its incidence is unchanged elsewhere, there is no vaccine in sight and adequate funding to fight the disease is a constant concern.
Is the end of malaria within sight?
SP: A number of countries on the boundaries of the malaria endemic region now have the end of malaria realistically within their sights. However, for the bulk of the malaria heartland, namely sub-Saharan Africa, the end is far from within reach.
What obstacles need to be overcome to make this happen?
SP: The critical first step, namely a bold global call for action, has already been taken. Translating this call into action is much more complicated. The primary and biggest challenge is improving the health infrastructure in affected areas. More specifically, we have to improve our deployment and utilization of the control and treatment measures that we already have at our disposal, and recognize that the approach to combating malaria must be tailored for different areas. We must also continue to support novel research and development, as the tools we currently have are not enough to achieve elimination.
In terms of the burden of malaria today, where are most of the cases geographically and how many people are afflicted?
SP: Over 90 percent of the burden of malaria lies within sub-Saharan Africa, with young children and pregnant women being most at risk. Estimates would suggest that over 600,000 cases and nearly 2,000 children will die as we observe World Malaria Day.
How does this range and number of cases compare with 10 or 15 years ago?
SP: The World Health Organization estimates that there has been approximately a 26 percent drop in death rates over a decade. Importantly, however, reductions haven’t been universal, and many endemic regions have seen little change and even increases in disease rates. This is certainly the case for areas within countries that I am working in, namely Uganda and Burkina Faso.
How and why has this happened?
SP: This is the real question, and the answer is complex. The gains have primarily been achieved by aggressive deployment of control measures such as bednets, improved drugs to treat malaria and novel diagnostics. These advancements have been made possible largely through improved levels of funding from non-governmental and governmental funding sources. Sadly, we have already seen a plateau and decrease in funding, and history tells us that this is the first step toward a resurgence and loss of any gains we have achieved.
Describe the research that you do with malaria.
SP: I work on translational studies of malaria, namely studies that involve a combination of studying malaria in the field, both from an individual and population-based level, and asking laboratory-based questions from those samples. Our pharmacology-based research occurs primarily in Uganda, and seeks to optimize the use of the most widely used antimalarials in children, pregnant women and in the context of the overlapping HIV epidemic, with the goal of informing treatment guidelines. Our research in Burkina Faso focuses on characterizing the earliest immune responses to malaria in two populations who appear to have a different susceptibility to malaria. In both cases, I have been fortunate to work hand in hand with wonderful Ugandan and Burkinabé researchers.
How were you drawn to this disease?
SP: I have always had an interest in working abroad in developing countries. While in medical school, I came down with malaria while working at a hospital in India. It was certainly an eye-opening personal experience, but I was also amazed to see how this devastating disease was simply viewed as an unavoidable part of life. I then had the opportunity to work in Peru on a malaria field study. This experience made it clear to me that I wanted to work on field-based research. As I have continued to work in malaria, I have been fascinated by its long history and mark on humanity, the incredible complexity of the disease, and the emerging challenges that it continually throws at us.
Briefly describe the vector culprit responsible for malaria transmission.
SP: Malaria is a parasite that is transmitted by the bite of a mosquito as it takes a blood meal. A much better understanding of the ecology of this vector will be critical if we are to make any significant and sustainable strides in controlling and eliminating malaria.
Is there an effective vaccine now in use or a potential vaccine on the horizon?
SP: Sadly, no. While tremendous effort and funding has gone into vaccine development, the most advanced vaccine candidate recently showed sobering results in young children. The vaccine community has several other candidates in earlier stages, but efforts to produce a more effective vaccine will require a much better understanding of antimalarial immunity and are years away.
Microsoft’s Bill Gates has criticized funding priorities, noting that more resources are allocated to fight baldness than malaria. Is there adequate funding to defeat this disease?
SP: His point is clear, and it is certainly difficult to increase funding for malaria in a consumer driven marketplace. That being said, we have seen a large increase in funding for malaria over the past decade, largely boosted through initial efforts by the Gates Foundation and others. Unfortunately, even in this recent period of increased funding, the shortfall is significant, and certainly will grow as we see funding levels decrease as a result of global economic struggles.