Transferring the malaria baton

It was the mid-1970s, the early years of my professional career, and the world was recovering from the first malaria eradication campaign. This ambitious proposal to attack malaria was quietly abandoned for a variety of reasons, but largely due to inconsistent funding challenges and a monolithic technical strategy, namely indoor residual spraying with the synthetic insecticide DDT. Although some countries were able to eliminate malaria, there were many, including the entire African continent, that were not even involved in the campaign. And in those places where eradication efforts met with some success, the incidence of malaria rebounded predictably after the campaign ceased.

We learned a great deal from that campaign. And for me, a fledgling pediatrician and conscientious objector working in El Salvador for the US Centers for Disease Control, it was a sobering experience. The direction of my career was established after witnessing the catastrophic toll malaria had on El Salvador communities. I hadn’t set out to battle this infection and disease. In reality, it chose me.

As I look back on my career, I am frequently reminded of those who said that the challenges of malaria were too great to make headway. But for those of us who held firm to a belief that progress could be made, we focused our work on building an armamentarium of interventions and approaches and documenting health impact across a range of settings in the malaria endemic world.

We chose not to listen to the naysayers; instead, we immersed ourselves in the biology, the science, and the relevant program epidemiology. By doing that, we discovered ways to make a difference. And by focusing on how to lessen the burden of malaria, our task moved past the “impossibility” of impacting malaria’s staggering health and social burden. As the malaria parasite has evolved in biologic and programmatic complexity, it has remained the leading cause of death in wide expanses of the developing world.

Few people accomplish great things working by themselves. I’ve worked side-by-side with many intelligent, passionate, and committed people, all of whom share a belief in their work and in each other. Mentorship should be a high priority. PATH shares this priority by continually investing in the next generation, early on. These younger and talented people become your next set of committed colleagues, and leaders.

Most importantly, I’ve been incredibly fortunate in my personal life. I married a woman who shares my values, and equally I share hers. She is literally my partner in life and a very good malariologist by association and osmosis.

Over the course of my career, I have worked to remain hopeful and optimistic. The elimination and eventual eradication of malaria is the long-term goal, but remarkable progress has been made in the fight over the past 15 years alone. More than 6.2 million deaths have been prevented, an impact primarily felt across Africa and Asia, through increased access to the tools and programs that fight malaria. To me, there are a number of what seem to be key determinants to this recent progress:

• PATH is highly regarded and influential in global financing agencies, and these relationships are unique and well-deserved, but need to be continually cultivated.
• Those of us in the public health programming community must orchestrate a continually impressive series of meaningful successes; a generation of elimination successes at the margins of the malaria world will fail to impress. We must be successful in the “hard places.” These are the remote, low-resource areas where infrastructure is limited and delivery systems are challenging.
• Those who are guiding the process must be “single-minded.”

There must be a continued investment in the science of malaria. We do not know all that will be required to eventually eliminate malaria, much less to eradicate this parasite. PATH is providing global leadership to this campaign.

As the PATH Center for Malaria Control and Elimination illustrates, the key to progressive impact and ultimately success in achieving elimination will require building on successful approaches. PATH’s malaria portfolio has great breadth in terms of development of sound and innovative science, working intensely in a select number of highly challenging settings to develop and scale novel program approaches that can be documented and disseminated.

PATH is one of the key contributors to this global campaign and has the potential to be a leading contributor to work at the forefront of malaria elimination and ultimately eradication. I fundamentally believe that PATH is uniquely positioned to play a leadership role in the push to elimination.

• PATH’s Center for Malaria Control and Elimination fact sheet.