For a decade, the ethos of the University of Pretoria (UP) Institute for Sustainable Malaria Control (UP ISMC) has been to transcend disciplines to allow for transdisciplinary collaborations and translational applications towards malaria elimination, as outlined in a paper published in Malaria Journal in 2012.
In order for research to make an impact on the drive towards malaria elimination, researchers must collaborate in a transdisciplinary manner and ensure that their research translates into tangible outcomes to save lives. But the disease is not making things easy.
Despite significant reductions in the global malaria burden since the upscaling of control strategies in the early 2000s, the disease remains a major public health concern.
Malaria elimination is the strategic disruption of local malaria transmission in a specific geographical region. Continuous or sustainable control measures are required to prevent re-establishment of transmission in a region.
Many factors have contributed to the increase in malaria cases in recent years, and control programmes face several challenges to merely control the disease sustainably.
The main difficulty is that the malaria “lifecycle” is made up of three biological components – human, parasite and mosquito – each with its own complexities, and a complex interaction between them.
The disease is caused by Plasmodium parasites, which are transmitted to humans when bitten by infected female Anopheles mosquito vectors.
This situation is further exacerbated by a combination of challenges. Resistance of vectors against vector control insecticides, and of parasites against many of the antimalarials used as treatment has resulted in major disruptions to control practices.
Furthermore, the movement of people, either within a country or across borders, introduces new parasite strains to different areas. Climate plays an important role in the malaria lifecycle too: changes in climate conditions have been linked to an increase in malaria transmission.
In tropical countries, warm, wet climates create favourable breeding conditions for mosquitoes, and malaria may be reintroduced to areas that were previously declared malaria-free.
Another concern is the change in vector biting behaviour, where mosquitoes that previously fed indoors now feed on humans when they are still active in the evenings or when sleeping outside to avoid the stifling heat in their homes.
Then there are the challenges in implementing malaria policies or control strategies, control programme operational errors, the discontinuation of vector control programmes, limited funding and budget constraints… the list continues.
Throughout history, malaria has been known to drastically impede social and economic growth and development, especially in the poorest countries.
Many of today’s more affluent nations would not have been able to achieve their level of advancement and prosperity if it was not for their successful elimination of malaria. Sub-Saharan Africa sees the co-occurrence of major malaria mosquito vectors and parasites, and the ideal warm, wet climate for continuous transmission.
As a disease of poverty, malaria impacts adversely on the existent poor quality of life in malaria-endemic communities in Africa. These communities are often based in large rural settlements where living conditions are poor, malnutrition is rife and there is inadequate access to healthcare.
Malaria exacerbates the situation by impacting on community and household income, shortening people’s lives and playing a role in the development of chronic medical conditions.
Global movements to end malaria
Malaria elimination campaigns in the late 1940s were conducted regionally, laying the foundation for the World Health Organisation’s (WHO) Global Malaria Eradication Programme in 1955.
By 1969, the ambition to eradicate malaria globally was abandoned despite the successful elimination of the disease from entire continents. At that time, the exercise was unsuccessful in sub-Saharan Africa, which today accounts for more than 90% of the remaining malaria burden.
Africa’s malaria challenges were just too different to those confronted anywhere else. From 1969 to 1991, focus was placed on lessons learnt by addressing the technical issues experienced prior to 1969.
There was an uptick in research and development to find new tools for malaria control, and the importance of social, economic and cultural aspects to achieve elimination was highlighted. However, during this time, global support towards establishing health systems and healthcare in various African states was practically non-existent.
The declaration garnered strong support to push towards eliminating malaria on the African continent, but noted that this could be achieved only by strengthening local health systems.
During its 31st summit in July 2018, the African Union Commission along with RBM launched a campaign called Zero Malaria Starts with Me. The pan-African movement was initiated after 10 African countries reported 3.5 million more malaria cases in 2017 compared to 2016.
The campaign aims to mobilise and empower those affected by malaria to take ownership of their health in fighting the disease, while highlighting the need to fast-track the prevention and treatment of malaria.
An important realisation is that no single, currently available control tool or strategy alone will achieve elimination, especially not in Africa. Novel, sustainable, and more innovative tools and strategies are needed; these can be strategically added to various control programmes and health systems, and implemented as part of an integrated approach to target elimination.
Transdisciplinary research to make a tangible difference
Controlling malaria parasites and preventing mosquito bites have and most likely will always remain the first line of defence against malaria transmission, and thus remains the main strategy of malaria control programmes.
But these methods are becoming ineffective, and the approach needs to change.
Every renewed global effort to eliminate malaria is accompanied by an increase in basic research. To identify new, innovative ideas to gain the upper hand in the battle against malaria, researchers need to think beyond their own expertise. Their research should transcend disciplines and become transdisciplinary to have impact.
By combining basic biomedical sciences and public health efforts, together with the management of malaria through policymaking and education, a transdisciplinary perspective with a targeted focus is achieved.
Basic science (fundamental) research should also be translated into tangible interventions, written into policy and implemented in practice, for real-life scenarios with outcomes that will improve human health and well-being.
The successful integration of transdisciplinary research approaches has potential for translatable applications, which in turn, will benefit malaria-endemic communities and achieve eventual sustained malaria control and elimination.
UP ISMC takes a holistic approach to make a difference in the ongoing war against malaria. For a better understanding of transdisciplinarity in action, read the UP ISMC case study published in UP’s 2019 Sustainable Development Report.
*Professor Tiaan de Jager, is Dean of the Faculty of Health Sciences at the University of Pretoria (UP), Director of the University of Pretoria Institute for Sustainable Malaria Control (UP ISMC) and Dr Taneshka Kruger, Project manager and coordinator of the UP ISMC