Behind the microscope: advances in malaria research

Q&A with Dr Neena Valecha, Director, National Institute of Malaria Research, India

20 April 2018

This interview has been edited and condensed from the audio version (Duration 13:31 [mp3 9.5 Mb])

Research is an often overlooked but essential part of the advances in global health. From anti-malaria medicines to the very systems that deliver treatment, research provides the foundation of evidence that is needed to make headway in tackling disease. In this interview, Dr Neena Valecha shares her thoughts on malaria research and the progress achieved in this dynamic field.

Today's malaria tools have been made possible through vital investments in research (animated illustration)

Dr Valecha, you’re speaking to us from your office in India. Can you tell us about your role at the institute?

I am heading the National Institute of Malaria Research, which is one of the institutes of the Indian Council of Medical Research. Our mandate is to give technical support to the national malaria programme by doing operational and implementation research in addition to basic research.

Somebody who is not following malaria closely might think that we know everything we need to know about the disease. Why is research still so important?

Malaria involves the interaction between a host, parasite, vector and environmental conditions, and there are continuous changes in the dynamics of all of these, which makes research mandatory to keep pace with changing scenarios for all these elements. We also need basic research to understand the pathogenesis of the disease – or the mechanisms – for many phenomena we are observing, like resistance to medicines and insecticides.

We need to develop new tools like diagnostics and new medicines, for which research is needed. To implement these tools, we need to have operational or implementation research, which will help us know the best way to use them and ensure acceptability by communities. One size doesn’t fit all, so in different scenarios in a country, or in different situations, we need to understand which tools will be the best in terms of safety and efficacy. Ultimately, we have to have continuous research if we want to achieve the elimination of malaria.

Can you give an example of what you’ve just explained: that research has to keep pace with the disease?

I have been in this field for 30 years and we have moved from the chloroquine era to artemisinin-based combination therapy (ACT), from DDT to long-lasting insecticidal nets (LLINs). Diagnosis was previously based on microscopy and now we have tools which can be used at the point of care. You need to have evidence on how to move forward.

Tell me about a game-changing moment in your career, when there was a sudden change rather than a slow development, perhaps when a new tool came out?

The most important change I have seen, and which has made a real difference, is the introduction of ACTs: the way it improved treatment outcomes, the fast recovery of patients, and decreased transmission of malaria. Also, the number of deaths decreased because we could diagnose and treat patients immediately. This was in 2005 when ACT was introduced in India and then implemented in the whole country in 2011.

What should the world learn from India’s experience in fighting malaria?

India is a huge country with 29 states, seven union territories and about 700 districts. All over India, the epidemiology of malaria is variable; different species of the parasite and vectors and different environmental conditions. In some places, it is seasonal malaria transmission, while in others transmission is throughout the year. Because of these variations, one strategy or approach cannot work.

What gives you hope that we can reach elimination one day in India and elsewhere in the world?

If other diseases have been eliminated in India, like polio, why not malaria? Although the disease is more complex, there is political commitment. Our Prime Minister has given that commitment, and the national framework for malaria elimination has been launched. But we have to keep that momentum. It can be done.

Dr Valecha was interviewed by WHO Communications Officer, Nyka Alexander, from the Organization’s headquarters in Geneva.