Malaria: How Do You Eradicate an Infectious Disease With No Vaccine? | Philip Eckhoff | Big Think

Philip Eckhoff: Disease eradication is a very difficult challenge. It’s been tried for a number of different diseases, but it’s only worked so far for smallpox, which was the first human disease eradicated at the end of the 1970s, and for rinderpest, which is a cattle disease or was a cattle disease before it was eradicated everywhere in the world.

Global eradication has been tried before for malaria in the 1950s and 1960s, and it didn’t succeed for a number of reasons. Right now, almost half a million people die every year of malaria, which is an extraordinarily high number and a terrible burden, although this number used to be well over a million. So there has been progress in terms of reducing this burden.

What one needs to do is different if you’re starting at a very high burden where everyone is getting infected several times a year, and what one has to do when one’s down to the last couple of cases in a given country. The tactics change, the strategy changes, the tools change. When starting out in terms of reducing the burden, the most important thing is reducing transmission and providing access to treatment. So, making sure that people have drugs that work is very important.

The second thing will be to give out things like bed nets to reduce the rate at which people actually get new infections. Then, all of a sudden, you can start to look at a country and see that there’s very little malaria in certain parts of it, and most of the malaria is concentrated in a few remaining pockets. Building the right surveillance and information systems and logistics to be able to target enhanced efforts at those sections of the country becomes the next important thing.

It gets to the point where not everyone, even in the highest remaining transmission areas, is infected. We have to figure out who is still driving transmission, who is not receiving access to the right tools, and making sure that you extend access to everyone who’s driving transmission and everyone who is still vulnerable to the disease. In the end, it becomes very interesting.

There will be only a small scattering of cases here and there, and finding them and responding to them quickly with good case management ends up becoming one of the most important tools in the end game. Understanding where a given country is along this continuum, scaling up the tools, and most importantly the information systems and ability to deliver treatment all along that continuum are fundamental aspects of health systems that end up becoming really important from start to finish.

On a problem like malaria eradication, disease eradication in general, and getting rid of infectious diseases, it is very fundamentally an interdisciplinary problem. There will be people from the medical side of things. There will be people from health systems and operations. People who know immunology, drug development, vaccine development, and mosquito science, such as entomologists.

At the same time, there’s also a really good role for people who are good at mathematics, people who are good at software, and people who are good at data systems. The interesting thing is that when you have a question that’s really core to your part of the problem and you bounce it off someone from one of these other disciplines, often they will come up with a better way of actually framing and looking at your specific question.

Sometimes, they might even find a better question that actually addresses the main challenge you were trying to deal with. There’s a famous saying that if a problem seems intractable, increase the scope of the problem, and that actually becomes really evident in the power of collaboration.

If you’re looking at how we, in this one domain of say drug development, can get rid of malaria, that might be an intractable question. But then you bring in the people who are good at vector biology, the people who are good at vaccines, the people who are good at data information systems and computing, and the people who are really good at health systems and logistics.

All of a sudden, you have a bigger problem but one where you can actually work together and solve this. It requires a lot of learning in terms of how to speak each other’s language and how to listen to each other. It’s about actually taking the time to build these bridges to other fields and to really see the advantage and the impact of doing this well.

It’s not easy. It’s much easier to just sit in a room and talk to other people from your discipline where you all already speak the same academic, research, or operational language. But it is very much worth building these bridges and cross-linking.