WINTER DIALOGUES OF AFRICAN MALARIA COALITION
MIT 26-27 JANUARY 2013
Despite the cold weather, malaria was definitely in the air in Cambridge during the last week in January. Shortly after the African Malaria Coalition held our Winter Dialogues at MIT, Harvard held a Malaria Forum just up the river. There were important differences in the two meetings, but the subject was clearly the same; how to strengthen the fight against malaria.
African Malaria Coalition and the Harvard Malaria Forum
Our two-day Dialogues at MIT explored ways to improve the fight by adding durable methods to the current ephemeral strategy used in Africa, while the Harvard Forum at the Kennedy School discussed ways that business could help (Harvard Gazette). The Harvard Forum on 30 January featured Ray Chambers of the UN, Suzanne McCarron of Exxon-Mobil, Naohiro Takahashi of Sumitomo Chemicals and Dyann Wirth of the School of Public Health, for a 2-hour discussion of the needs and possibilities for support, especially regarding bednets. The forum was also supported by the Harvard Global Health Institute.
The MIT Winter Dialogues of the African Malaria Coalition
The Winter Dialogues at MIT, a continuation of our quarterly dialogues normally held in Manhattan, included (1) a review of attempts at malaria control in Africa by the historian James Webb from Colby College, (2) an insider’s view of the current situation in Geneva with the WHO malaria program by Clive Shiff of Johns Hopkins, and (3) engineering approaches being developed at the Parsons Water Resources Laboratory at MIT by elFatih elTahir and his several graduate students. Participants in the Dialogues included faculty and students from MIT, Boston University, Johns Hopkins, Yale, Colby, and Bentley University. Countries represented besides the US and Canada, were Sudan, Ghana, Nigeria, Zimbabwe and Egypt.
Subjects of Dialogues
James Webb reviewed the history of efforts at malaria control in Africa, leading up to the present efforts by WHO and other international agencies. He noted that most attempts at malaria control had been only temporarily effective, followed by a Malaria Rebound as the control efforts withered due to resistance developing to the drugs and biocides. Thus epidemic malaria occurred among the populations who - in the meantime - had lost their immunity.
Webb says the persistence of international agencies in this kind of blind attack can best be attributed to ignorance, which historians are dedicated to fight. But he also said that it is no longer excusable. Thus a more rational and informed approach is required.
Shiff presented new approaches to epidemiological monitoring being used in Zambia, and suggested that they be used routinely to improve control efforts throughout Africa. Rapid Diagnostic Tests and cell phones have been linked in a system which gives accurate and weekly monitoring of changing geographical patterns of malaria incidence (Kamanga 2010).
The field research presented by Fatih and his MIT group featured computer analyses of malaria transmission in Niger and Ethiopia (Bomblies 2009, Yamana 2010). In addition to simulating transmission and proposed interventions, another objective of this work is to develop ways of building and operating hydropower and irrigation systems in Africa to reduce risks of malaria transmission. Koka Reservoir in Ethiopia is being monitored as a first step toward this objective. Presentations were also made on River Blindness and Rift Valley Fever (Jobin 2013).
General discussions of the historical and current programs to control malaria in Africa explored ways to strengthen the technical and institutional problems with the current strategy of drugs, bednets and biocides (Jobin 2012). The ephemeral nature of this chemically-based strategy needs to be strengthened by adding more durable control methods (Jobin 2010).
It was pointed out that the currently under-funded strategy of WHO is again facing the same brick wall of resistance to drugs and biocides which has crippled previous attempts. The gap in global funding for malaria control poses severe challenges.
The presentations also explored more permanent methods - such as better reservoir design and operation for suppression of mosquito breeding - as additions to the current WHO strategy. It was noted that WHO and all global stakeholders should train national epidemiologists and entomologists for permanent positions with local governments, to give a more durable face to the fight.
The Two Malaria Meetings in Cambridge
There were curious differences between the two meetings in Cambridge, especially related to the puzzling numbers used by Ray Chambers regarding the goals and progress of the effort in Africa. He repeated the aspirational goal of zero deaths from malaria by 2015. But this is perhaps part of his promotional orientation, which stressed the decline and shortfall of current funding. However his efforts are also important for our African Malaria Coalition, given the need for additional financial support for all malaria programs (Kiszewski 2007). A note of caution about the recent spread of drug resistance was raised by Wirth at the forum.
In summary, the two meetings in January complemented each other, and indicated the broad nature of the effort to improve the fight against malaria in Africa. These MIT Winter Dialogues of our Coalition were the most successful so far, a very collegial and informative interchange within a remarkably diverse group.
In addition to the references cited below which are available on Amazon.com or PubMed by author citation, I can send you more detailed summaries of the presentations if you are interested.
Bomblies et al 2009, A mechanistic approach for accurate simulation of village scale malaria transmission. Malaria J. Oct 2;8:223.
Harvard Gazette 2013, Science and Health Section, Feb 3.
Jobin 2011, 2012 and 2013, Blue Nile Monographs 1, 2 and 4, by Boston Harbor Publishers.
Kamanga et al 2010, Rural health centres, communities and malaria case detection in Zambia using mobile telephones: a means to detect potential reservoirs of infection in unstable transmission conditions. Malaria J, Apr 15, 9(96)
Kiszewski et al 2007, Estimated global resources needed to attain international malaria control goals, Bulletin WHO, 85(8).
Yamana et al 2010, Early warnings of the potential for malaria transmission in rural Africa using the hydrology, entomology and malaria transmission simulator (HYDREMATS). Malaria J. Nov 12, 9(323).
Coordinator for African Malaria Coalition
970 560 1182
DETAILED SUMMARY OF WINTER DIALOGUES
Very collegial and informative experience
Because of differing immunity, Northerners - generally white European and American colonizers - have been slow to understand the nature of malaria among Africans. This is shown in the mania for eradication among Northerners, while Africans are fairly relaxed about even trying national programs to suppress malaria.
Unfortunately this has resulted in only temporarily effective attempts at malaria control, followed by a Malaria Rebound as the control efforts wither and epidemic malaria occurs among the populations who, in the meantime, have lost their immunity.
Webb says the persistence in this kind of blind attack can best be attributed to ignorance, which historians are dedicated to fight. But he also said that it is no longer excusable, and requires more a more rational and informed approach.
His evaluation of the current condition of WHO in Geneva is that shrinking funding has curtailed their activity. The gap in global funding for malaria poses severe challenges to control efforts. The people in WHO Geneva now function mostly in advisory and training capacities, with little power to execute programs. While they have formed Expert Committees to deal with certain crises, they have few resources for rethinking their strategy.
WHO and all the global stakeholders in malaria should focus on training local epidemiologists and entomologists to work in African Malaria Control Units. This will require the countries to offer solid career opportunities for these trained people.
The research presented from 3 of his doctoral candidates included testing of the HYDROMATS computer simulation of malaria transmission in West Africa by Teresa Yamana. This detailed computer application can be used to simulate interventions for tentative malaria control efforts. However before it can be used to evaluate the effect of climate change on malaria, it requires more robust information on the effect of climate change on rainfall. Temperature predictions of climate change models are fairly robust, but rainfall predictions are shaky.
Fatih’s students are also monitoring a small reservoir in Ethiopia with the eventual plan to test water-level management as a technique for mosquito control developed by the TVA in the US. In preparation, Noriko Endo has completed a year of monitoring Koka Reservoir south of Addis, used for hydropower and irrigation. A major source of skepticism about applying the TVA fluctuation technique in West Africa has been due to the tendency for Anopheles gambiae to breed in temporary shallows, which might increase with frequent fluctuations in water level. Fortunately the dominant vectors in Ethiopia and much of East Africa are An arabiensis, An funestus and An pharaoensis which prefer stable water levels, similar to the vectors in the Tennessee Valley, and would thus probably be very susceptible to fluctuations. Thus Ethiopia might be a very suitable location to test water-level fluctuations for mosquito control around moderate-size reservoirs.
Another student - Hamed Ibrahim - made a presentation on the potential for micro-hydropower to be used to prevent River Blindness in West Africa. Local availability of affordable electricity could also be helpful in fighting malaria, using electric fans to make sleeping in rooms closed against mosquitoes more comfortable.
Brief presentations were made on a proposal to rescue the failing WHO malaria program in Africa, and on the risk of Rift Valley Fever around African dams. Details on these two items are available as Blue Nile Monographs Three and Four, published by Jobin with Boston Harbor Publishers.
In a surprising coincidence, the Kennedy School held a Harvard Malaria Forum on Wednesday 3 February, just after our Dialogues. The meeting involved business representatives, and was entitled “Hitting malaria from all sides.”
In some respects I was puzzled by the main presentation by Ray Chambers - the UN Special Envoy for Malaria - until I decided that the focus of the meeting was actually promotional, hoping to raise funds for the diminishing donor contributions. This probably explains his use of the aspirational goal of Zero malaria Deaths by 2015, and other vague numbers which gave an unrealistically rosy view of the struggle. In comparison, I think our meeting had a very different focus, trying to improve the strategy for fighting malaria by adding new strategies to the current approach.
After reflection, I think we don’t want to contradict what the Harvard Forum was saying because we certainly need more funds for the effort. Perhaps we should see our role as supplementing what they are doing, with more precise and valuable additions. One bit of realism came from Dyann Wirth of HSPH who pointed out that looming drug resistance confirms that malaria is in a potentially explosive phase. No one mentioned the other shoe; that resistance to the current biocides is also spreading.
NEXT MEETING OF COALITION
There were at least two ideas about or Spring Dialogues. One was to continue at MIT or Manhattan, but the other was to meet in Washington DC and after or meeting go out to Congress and government agencies to lobby for more support for a broad-based attack on malaria in Africa.
To explore these various possibilities, it was suggested by Sophie Beauvais and Mike Reddy that we have a virtual discussion, perhaps to prepare talking points that we could use in our lobbying effort. Or we could think of establishing an MIT chapter of our African Malaria Coalition, as suggested by Fatih and Jim Webb.
Fatih also proposed that we organize a research proposal to further explore the TVA and other environmental and engineering approaches to suppressing malaria, in Africa. Ethiopian reservoirs seem to be a good location because so many of us have recent experience there.
William Jobin, Sc.D.
Director of Blue Nile Associates
President of Boston Harbor Publishers
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