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

Nearly 500,000 people die every year from malaria – an awful amount, but one that has come down from one million deaths per year. Philip Eckhoff, Senior Director of Research at the Institute for Disease Modeling, explains what is involved in total global eradication of malaria and how interdisciplinary collaboration is the key to out-thinking and out-maneuvering this disease.

Philip Eckhoff is a Hertz Foundation fellow and recipient of the prestigious Hertz Foundation Grant for graduate study in the applications of the physical, biological and engineering sciences. With the support of the Fannie and John Hertz Foundation, he pursued a PhD in computational neuroscience and biophysics-motivated models of decision making at Princeton University.

The Hertz Foundation mission is to provide unique financial and fellowship support to the nation’s most remarkable PhD students in the hard sciences. Hertz Fellowships are among the most prestigious in the world, and the foundation has invested over $200 million in Hertz Fellows since 1963 (present value) and supported over 1,100 brilliant and creative young scientists, who have gone on to become Nobel laureates, high-ranking military personnel, astronauts, inventors, Silicon Valley leaders, and tenured university professors. For more information, visit http://hertzfoundation.org

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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. And 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.

Then 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.

And then 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. So 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. Fundamental aspects of health systems end up becoming really important from start to finish.

On a problem like malaria eradication, disease eradication in general, 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, mosquito science, 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, people who are good at data systems. And the interesting thing is 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… [transcript truncated]

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