Genome publication must not divert attention from basic science and public-health goals.
Sir
After decades of relative neglect, malaria control is again high on the international research and public-health agenda. The exciting simultaneous publication of the sequence and functional analysis of the genomes of two malaria parasites, Plasmodium falciparum and P. yoelii, in this issue of Nature1, and mosquito vector Anopheles gambiae in Science2 should facilitate accelerated development of new drugs, insecticides, vaccine candidates and engineering of malaria-resistant mosquitoes.
The future availability of such powerful tools is a captivating prospect, but their allure must not divert attention from potential basic science and public-health goals that remain grossly underdeveloped. Our understanding of malaria-transmission ecology lags well behind our understanding of climate change or biodiversity loss. Most worrying of all is the absence of proven environmental interventions where they are most needed, in particular in sub-Saharan Africa.
Although the effectiveness of preventing mosquito proliferation in Asia, Europe and the Americas has been well known for 80 years (see, for example, ref. 3), spectacular historical successes against tropical African vectors should not be ignored. Successful programmes to control malaria transmission by A. gambiae — the predominant vector in sub-Saharan Africa — were initiated in the 1930s and 1940s and their effects sustained for two decades or more in Brazil, Egypt and Zambia4,5. There were three common features to these outstanding successes: they had integrated control, emphasizing environmental management and regular insecticidal suppression of larval stages of the vector; they used rigorous surveillance and adaptive tuning of the intervention package over time; and they employed multisectoral programme staff with expertise in clinical, ecological, entomological and epidemiological aspects of malaria, and in land and water management. The challenge now is sub-Saharan Africa itself, where the frequency of infectious bites means that vector control has not so far worked.
We are concerned that the current global malaria control campaigns (see, for example, ref. 6 for an overview), and in particular the emphasis on genomics and vaccine development likely to be stimulated by the new results, may delay the re-adoption of integrated methods, as happened with the euphoria that greeted the introduction of DDT as a control method decades ago. In addition to laboratory-derived tools, integrated malaria control in Africa will rely on basic and applied environmental science in situ.
None of these skills or tools can be applied without the essential infrastructure embodied by the second and third criteria outlined above. This is where contemporary public–private partnerships could make a profound difference in supporting and facilitating integrated malaria control, as in the successful programmes of the past. The Global Health Initiative of the World Economic Forum is playing an important role in fostering such partnerships7. The corporate sector — for example, Exxon-Mobil in Cameroon and Chad; British Petroleum in Angola; and Konkola copper mine in Zambia — is implementing integrated malaria control today.
Consequently, a detailed business plan is required for malaria control on a broader scale, analagous to that produced earlier this year by WHO for tuberculosis. The strengthening of human resources and infrastructure in Africa, together with the increased public funding available for malaria research and control initiatives, will enable successful re-adoption of proven approaches from the past while we eagerly await the benefits of the genomics revolution.
References
Nature 419, 498–542 (2002).
Holt. R. A. et al. Science 298, 129–149 (2002).
Kitron, U. & Spielman, A. Rev. Infect. Dis. 11, 391–406 (1989).
Killeen, G. F., Fillinger, U., Kiche, I., Gouagna, L. C. & Knols, B. G. J. Lancet Infect. Dis. 2, 618–627 (2002).
Utzinger, J., Tozan, Y., Doumani, F. & Singer, B. H. Trop. Med. Int. Health 7, 657–677 (2002).
Insight: Malaria Nature 415, 669–715 (2002).
World Economic Forum, Global Health Initiative: Resource Paper (World Economic Forum, Geneva, 2002). http://www.weforum.org/pdf/Initiatives/GHI_Resource_Paper.pdf
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Utzinger, J., Tanner, M., Kammen, D. et al. Integrated programme is key to malaria control. Nature 419, 431 (2002). https://doi.org/10.1038/419431a
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DOI: https://doi.org/10.1038/419431a
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