Invest, Innovate, Implement for Zero Malaria: From Lab to Communities

Kim Ozano: 00:00:04

Hello and welcome to the Connecting Citizens to Science Podcast.

Kim Ozano: 00:00:06

A podcast about connecting people and communities to research and science so that we can join forces to catalyse sustainable global change.

Kim Ozano: 00:00:14

In this episode, we are going to celebrate World Malaria Day with our co-host and guests.

Kim Ozano: 00:00:20

This year's theme is 'Time to Deliver Zero Malaria', and it is focused on investing, innovating, and implementing tools that are available today and innovating for future tools.

Kim Ozano: 00:00:33

WHO calls to action include; prioritising funding for the most marginalised and hard to reach populations who are less able to access services

Kim Ozano: 00:00:45

To help us understand more, we have co-host, Dr.

Kim Ozano: 00:00:48

Hellen Barsosio, who is a medical Kenyan doctor who has been investigating risk factors, tools, and interventions to prevent adverse birth

Kim Ozano: 00:01:01

She is in her final year of her PhD at the Liverpool School of Tropical Medicine under the Department of Clinical Science, where her PhD focuses on new drugs to prevent malaria in pregnancy.

Kim Ozano: 00:01:12

The WHO also calls for stepping up innovation for new vector control approaches, so we have two guests with us today to help us to understand what those are.

Kim Ozano: 00:01:22

We will be speaking to reader and Wolfson Fellow, Dr.

Kim Ozano: 00:01:25

Grant Hughes, and reader, Dr.

Kim Ozano: 00:01:26

Tony Nolan from the Vector Biology and Tropical Disease Biology Department at the Liverpool School of Tropical Medicine.

Kim Ozano: 00:01:34

Tony has led the development of genetic tools to better understand the biology of mosquitoes that transmit malaria, and this has led to

Kim Ozano: 00:01:46

This is to decrease the amount of malaria transmission.

Kim Ozano: 00:01:49

Tony is also using some of these tools to understand how insecticides work, and in particular, how mosquitoes can evolve resistance to insecticides.

Kim Ozano: 00:01:57

Grant is currently focusing on novel control strategies for arboviruses and malaria, and his overarching goal is to develop approaches which will either reduce mosquito

Kim Ozano: 00:02:17

So without further ado, let's meet our uh, co-host Hellen Barsosio.

Kim Ozano: 00:02:21

Hellen, welcome to the podcast and thank you for co-hosting.

Kim Ozano: 00:02:24

Tell us a bit about yourself and the work that you've been doing as part of the IMPROVE consortium.

Hellen Barsosio: 00:02:29

Thank you, Kim.

Hellen Barsosio: 00:02:30

I'm Hellen.

Hellen Barsosio: 00:02:30

I work in Kenya as a medical doctor and a clinical research scientist, and I work with pregnant women and newborn babies, and I investigate new drugs to prevent malaria in pregnancy.

Hellen Barsosio: 00:02:40

Some of the work that we've been doing is finding alternative s for the prevention drugs.

Hellen Barsosio: 00:02:44

What we've been using are old drugs.

Hellen Barsosio: 00:02:46

Some of them were invented in the sixties and the seventies, and they're increasingly losing their efficacy.

Hellen Barsosio: 00:02:52

So we need new, better drugs, and these new better drugs we're looking at are those that can last very long, meaning they can protect a woman for at least a month.

Hellen Barsosio: 00:03:00

And why that is important is we see women every month at clinic, so once we release them and we see them a month later, we know that they're well protected.

Hellen Barsosio: 00:03:07

Some of the new drugs we are looking at is we want to see how they fit in within routine health systems.

Hellen Barsosio: 00:03:12

While you can invent a new drug and a really good drug, sometimes routine health systems might struggle with it.

Hellen Barsosio: 00:03:17

For instance, if the prescription is too complex and women will struggle to adhere to it.

Hellen Barsosio: 00:03:22

Some of our research work is looking at how do we help women adhere to the newer complex regiments that we are moving towards.

Kim Ozano: 00:03:28

Hellen, if you could set the scene for us in terms of malaria.

Kim Ozano: 00:03:33

WHO is calling for innovations and to invest more in malaria.

Kim Ozano: 00:03:37

After so many years of research in malaria, why is there still a need to continue, uh, and innovate more?

Hellen Barsosio: 00:03:44

Looking at what the WHO has been recording, let's look at the 2021 data, a little under 250 million new cases of malaria were reported

Hellen Barsosio: 00:03:56

And during the Covid Pandemic, we saw an uptake of about 13 million new cases, which means that we've reported new malaria cases and we are not making as much

Hellen Barsosio: 00:04:11

While we have a couple of tools in our arsenal to be able to prevent malaria, including vector control, such as using insecticide treated nets, and um, IRS, we

Hellen Barsosio: 00:04:26

But the malaria parasite is quite clever, it mutates quite quickly.

Hellen Barsosio: 00:04:30

In the case where drugs that you use for treatment are not working as well as they used to, and we're seeing a lot of parasite resistance against these drugs.

Hellen Barsosio: 00:04:37

And for the mosquito itself, we have vaccines now and one of the vaccine that has now been approved by the WHO, the malaria vaccine RTS,S used in children, is one of the tools that has been added.

Hellen Barsosio: 00:04:49

It's efficacy, it's about 34%, but I think we could do better.

Hellen Barsosio: 00:04:52

And we've just seen a new vaccine which has been launched, uh, R 21 in Ghana that has shown a higher efficacy than RTS,S.

Hellen Barsosio: 00:04:59

So while we can innovate and look for better tools, we really need to keep ahead of the malaria parasite, which mutates quite rapidly.

Hellen Barsosio: 00:05:05

So it's a very clever parasite and also ahead of the vector, the mosquito, which also mutates quite quickly and stays ahead, um, of our prevention arsenal.

Kim Ozano: 00:05:15

So Grant and Tony, how do we keep ahead of the vector?

Tony Nolan: 00:05:18

As Hellen alluded to, lots of the success we've had in reducing the cases of malaria year on year, has been to do with a combination of approaches.

Tony Nolan: 00:05:28

We're always trying to innovate and have a multitude of approaches because you're targeting either the parasite directly or the mosquito

Tony Nolan: 00:05:40

That's the only way the parasite can get from one human to another.

Tony Nolan: 00:05:43

So there is quite a lot of cost effective benefit in attacking the mosquito.

Tony Nolan: 00:05:49

In 2000, there was about a million deaths per year, and 15 years later that was down to 400,000, which is a significant reduction.

Tony Nolan: 00:05:56

Of course, there's still 400,000 unnecessary deaths, but all of that, or the majority of that reduction was due to control of the mosquito vector.

Tony Nolan: 00:06:05

That isn't always intuitive to people because you might think, you know, just go after the parasite, but as Hellen says, you know, both the parasite and, the vector by, by

Kim Ozano: 00:06:26

So tell us a bit about how you're doing that right now within your lab.

Tony Nolan: 00:06:31

I work on the genetics of mosquitoes, basically.

Tony Nolan: 00:06:35

Just like you and I, the number of genes we have between us will be almost exactly the same.

Tony Nolan: 00:06:41

It's just that we have different flavors of, uh, every gene that we have and mosquitoes are the same.

Tony Nolan: 00:06:47

And you know, mosquitoes can vary in the flavours of certain genes that are actually important in providing protection against some of these interventions that we're trying.

Tony Nolan: 00:06:56

For example, the insecticide treated nets that Hellen mentioned, now they have been very effective in reducing the number of malaria cases

Tony Nolan: 00:07:09

So don't give it a chance to take up a blood meal, but if the mosquito even looks for the human host and it lands on a bed net, if it's impregnated with insecticide, it's likely to die.

Tony Nolan: 00:07:18

That's been very effective, but now insecticide resistance is on the increase in the mosquitoes.

Tony Nolan: 00:07:25

The challenge is trying to find out which genes and certain flavours of those genes are underlying that resistance.

Tony Nolan: 00:07:31

If we can understand that, we can A/ detect it much earlier by using genetic observation methods, but we can also devise new interventions that won't

Tony Nolan: 00:07:46

So that's one approach.

Tony Nolan: 00:07:47

The other approach is trying to understand what genes are essential for mosquito reproduction, or what genes are essential for the mosquito successfully harboring the parasite and trying

Kim Ozano: 00:08:03

Thanks very much.

Kim Ozano: 00:08:04

Could you give us a very simplistic overview of how you interrupt that gene pathway.

Tony Nolan: 00:08:09

Yeah, sure.

Tony Nolan: 00:08:10

for example, if we look in wild mosquitoes and we see certain areas of the genome, which is the, all of their sort of genetic material, and certain flavours seem to

Tony Nolan: 00:08:28

We can prove that in the laboratory by then specifically targeting those genes and disrupting the DNA sequence that makes up those genes.

Tony Nolan: 00:08:36

Then we can see if with those specific disruptions, we get the expected outcome in terms of effects on insecticide resistance or effect on parasite transmission.

Tony Nolan: 00:08:48

The way that we do that is by a technique called genome editing.

Tony Nolan: 00:08:51

It's equivalent to sort of very precise molecular pair of scissors that can recognise any DNA sequence that you specify and cut the

Kim Ozano: 00:09:02

Thank you very much for, for that explanation.

Kim Ozano: 00:09:04

So Grant, can you add to this about the work that you are doing?

Grant Hughes: 00:09:08

Yeah, sure.

Grant Hughes: 00:09:08

We are interested in all the microbes that live within a mosquito.

Grant Hughes: 00:09:15

Just like humans and how we've got a gut microbiome and other microbiomes on our skin and other areas.

Grant Hughes: 00:09:22

So do mosquitoes and these microbiomes can benefit the mosquito.

Grant Hughes: 00:09:28

We're interested in how we could exploit these other microbes that live naturally within the mosquito.

Grant Hughes: 00:09:34

Um, these could be bacterial, they could be fungal, they could be viral, but we're mainly focusing on the bacterial side, mainly because we know the most about these other

Grant Hughes: 00:10:02

These gut microbes have other desirable traits that are advantageous for vector control in that they can be transmitted, or transferred to

Grant Hughes: 00:10:16

So the mother might pass them onto their offspring, for example.

Grant Hughes: 00:10:20

So that's one type of strategy that we're interested in pursuing.

Grant Hughes: 00:10:23

Um, the other one is looking at a particular specific bacteria, and this bacteria's name is Wolbachia and it's been investigated really for a long time, probably

Grant Hughes: 00:10:46

Most of these traits were related to the reproduction of the insect, it did things like feminise insects.

Grant Hughes: 00:10:53

So it would transfer ma males to females, and then those females would then be able to give birth.

Grant Hughes: 00:11:00

It could mean that an insect could have progeny without having sex.

Grant Hughes: 00:11:04

So you could have virgin birth or it would kill all the males.

Grant Hughes: 00:11:09

All of these traits would lead to an advantage, in that the females would have a fitness advantage.

Grant Hughes: 00:11:15

There's another trait that Wolbachia does called CI or cytoplasmic incompatibility, and that lets Wolbachia spread through an insect population.

Grant Hughes: 00:11:24

That's really desirable for control strategies because you could then, for example, release some mosquitoes and then the Wolbachia would spread through that insect population.

Grant Hughes: 00:11:35

So if you can have a desirable trait, you could spread that through the mosquito popul ation.

Kim Ozano: 00:11:40

Thank you very much.

Kim Ozano: 00:11:41

It's really useful to try to understand what happens in the lab environment.

Kim Ozano: 00:11:45

Hellen, I know you're passionate about communities and how these innovations reach them.

Kim Ozano: 00:11:51

Do you have anything to add or any questions?

Hellen Barsosio: 00:11:53

Yeah.

Hellen Barsosio: 00:11:54

It was very interesting hearing about your work, and some of the questions I have is are there concerns that you might produce, and forgive my lay question on this, are

Tony Nolan: 00:12:18

Yeah, these are concerns that that come up.

Tony Nolan: 00:12:21

In our case, I didn't go into the mechanism of how we might spread these into a population, but they're basically genetic modifications that can, um, multiply

Tony Nolan: 00:12:38

Um, and the precise changes that we make are, are exactly that.

Tony Nolan: 00:12:42

They're very precise.

Tony Nolan: 00:12:43

We modify specific sequence and we can test that there isn't any adverse effect on its susceptibility to the parasite or other traits such as that.

Tony Nolan: 00:12:54

That can all be tested prior to making it.

Hellen Barsosio: 00:12:56

How do we communicate such an intervention to a community that we are going to alter the mosquito, and how do we communicate it in a way that

Tony Nolan: 00:13:16

The challenge of explaining this type of technology is there and is real, but sometimes it's a consideration that's only made for this type of technology.

Tony Nolan: 00:13:24

You know, when we use insecticides, we don't expect, villages to understand the mechanism of action of an insecticide or exactly how it's working yet

Tony Nolan: 00:13:37

Um, and effectively changes the population because it selects for resistance.

Tony Nolan: 00:13:41

We don't have the same concern.

Tony Nolan: 00:13:42

So that's an interesting dichotomy, I think, but it is a question that comes up quite a bit.

Hellen Barsosio: 00:13:47

To hear what they can actually do with Wolbachia, I think it's the same concerns about producing super mosquitoes and how you control them in the

Grant Hughes: 00:14:11

Yeah, certainly these are things that we need to talk about and make sure that, um, everyone has a good understanding, and I think that's what some of

Grant Hughes: 00:14:27

I think one thing that's important to remember about Wolbachia, is this is a bacteria that is naturally in around 50% of insects.

Grant Hughes: 00:14:36

So if you leave your bananas on the shelf and you see some Drosophila coming around them, um, those Drosophila have Wolbachia, and that's

Grant Hughes: 00:14:49

The mosquitoes that are most available, I guess, to control are the ones that don't have Wolbachia.

Grant Hughes: 00:14:56

and by transferring that Drosophila Wolbachia into these uninfected mosquitoes, now they're the mosquitoes that are being used.

Grant Hughes: 00:15:04

These bacteria are already in the environment and they're present, uh, almost everywhere, it's not that we're adding a new bacterium, uh, to the environment, it's

Hellen Barsosio: 00:15:19

So with, with the work that you're doing, is there long-term intention to replace, um, existing mosquito species with those that have

Grant Hughes: 00:15:37

Yeah, I guess, I guess I can jump onto that question.

Grant Hughes: 00:15:40

So there's two possible strategies that you could use.

Grant Hughes: 00:15:44

So one is to suppress a population, and you can do that in the case of Wolbachia potentially by taking the Wolbachia genes and putting them into the mosquito.

Grant Hughes: 00:15:55

And so they're the genes that cause these reproductive manipulations.

Grant Hughes: 00:15:59

And this is very, it's very much in its infancy, but that's one possible strategy that you could do.

Grant Hughes: 00:16:04

And that's similar to some work that Tony does in Gene Drives.

Grant Hughes: 00:16:07

Um, another, another way you can suppress the population is actually release males that have the bacteria.

Grant Hughes: 00:16:15

And so these males would then go and mate with the females, and those females in the field don't have Wolbachia and that cross would not be viable so you can suppress the population.

Grant Hughes: 00:16:29

Um, It takes a lot of work to do that.

Grant Hughes: 00:16:31

You need to continually release the males.

Grant Hughes: 00:16:34

You need to make big factories where you are producing a lot of mosquitoes, but when you stop doing those releases, those mosquitoes would come back.

Grant Hughes: 00:16:43

Um, and so there's a way that basically you can stop the process and it would revert back to the natural state if you like, but then you'd have

Grant Hughes: 00:16:55

The other way you can do it, and you mentioned this, is to replace the population, and this would be in the case of Wolbachia, where you would release males and females and, given that

Grant Hughes: 00:17:26

And so that's been shown to work very effectively with Aedes mosquitoes that transmit arboviruses, but there's a, a few more challenges to get that working

Kim Ozano: 00:17:40

I can hear the excitement and kind of the anticipation of what's coming next, it's really nice for us to hear that.

Kim Ozano: 00:17:46

Tony, is there anything you'd like to add from this conversation?

Tony Nolan: 00:17:50

Just that different systems pose different challenges.

Tony Nolan: 00:17:52

I think it might be slightly confusing for the listeners to get the difference between Wolbachia and these other genetic control approaches like Gene Drive, but

Tony Nolan: 00:18:11

I think sometimes it's easy to forget the context and that is that what we've been doing in the past, is all about suppression of either the parasite or the, the mosquito vector and it's the

Tony Nolan: 00:18:29

And so, you know, suppression isn't bad in and of itself, we're always suppressing when we use, say, antibiotics for medical intervention or vector control or, or the rest of it.

Tony Nolan: 00:18:39

I had a question for Hellen actually though, if I, may I.

Tony Nolan: 00:18:44

Hellen, um, it's difficult to give, um, drugs or chemotherapy to all patients, so how important is it to target maternal cases of malaria or newborns?

Hellen Barsosio: 00:18:56

Thank you, Tony, for your question.

Hellen Barsosio: 00:18:58

So when you look at drugs for chemotherapy in pregnancy, it serves two purposes, really.

Hellen Barsosio: 00:19:03

One, to prevent malaria in itself and then to treat malaria.

Hellen Barsosio: 00:19:08

And the drugs that use for prevention are older drugs.

Hellen Barsosio: 00:19:11

Um, so Sulphadoxine pyrimethamine, uh, these are drugs that have been here since the sixties and the seventies, and are not very effective for treatment, but are still effective for prevention.

Hellen Barsosio: 00:19:21

Then we have the newer artemisinin combination drugs that we now use, uh, for prevention and why it's important to treat, especially in malaria, is the consequences that

Hellen Barsosio: 00:19:36

Either the mom would experience a pregnancy loss in the form of a miscarriage or stillbirth, or it creates placental malaria infection in itself creates a hostile environment, and the baby

Hellen Barsosio: 00:19:51

Small for gestational age or low birth weight, and for this particular conditions, small for gestational age or low birth weight, these

Hellen Barsosio: 00:20:02

reduces their survival in the first month of life.

Hellen Barsosio: 00:20:05

So it's very important to prevent malaria, especially in malaria endemic areas, and as well as to treat it as early as possible.

Hellen Barsosio: 00:20:12

And when you think about chemotherapy or drugs, uh, for malaria, often, when you have that patient in front of you, the first question you want

Hellen Barsosio: 00:20:24

And why that is important is when they're in first trimester, the baby's still quite small, they're being formed, which means exposure to any chemical would risk how

Hellen Barsosio: 00:20:42

And some of the work that we are doing in Western Kenya is looking at the safety of these drugs.

Hellen Barsosio: 00:20:45

Can we prescribe some of the very good anti-malarial combination drugs in first trimester?

Hellen Barsosio: 00:20:50

The second thing, when they're in second and third trimester, you want to check, are they infected?

Hellen Barsosio: 00:20:54

No.

Hellen Barsosio: 00:20:55

And if they're not infected, many, they're not positive for malaria, you want to give them a good drug for prevention.

Hellen Barsosio: 00:20:59

Where we are heading right now, um, the drugs that we've been using for prevention are not doing as well, so they're not as efficacious as they used to be, and therefore we need to find better drugs.

Hellen Barsosio: 00:21:10

Some of the work that has been going on for the last 15, 16 years, have been in malaria research, up to six trials or so looking for alternatives to this old set of

Hellen Barsosio: 00:21:28

And we are looking at products such as injectables that would be long-acting that would last for at least three months, beyond what we currently have,

Hellen Barsosio: 00:21:38

So that would be excellent if we get a drug like that.

Kim Ozano: 00:21:42

It's really interesting to listen to the work you're doing, within separate disciplines.

Kim Ozano: 00:21:46

How does the work that you're doing, how does that overlap?

Kim Ozano: 00:21:50

Does the prevention and treatment affect the behaviour and modification of mosquitoes in some way?

Kim Ozano: 00:21:57

And do you talk to each other and is that important or not?

Hellen Barsosio: 00:22:01

That's a really good question.

Hellen Barsosio: 00:22:02

So, because preventing malaria needs more than one arsenal, we need vector control.

Hellen Barsosio: 00:22:08

That means that every pregnant woman coming into antenatal clinic leaves with a bed net, at least at their first visit, and an long-acting insecticide treated net.

Hellen Barsosio: 00:22:17

And we have to catch up with what, um, Tony and Grant are doing and looking at what other entomologists are doing, which means that when WHO releases better nets,

Hellen Barsosio: 00:22:39

Vector control really is the cornerstone, in addition to that, we also give drugs.

Hellen Barsosio: 00:22:44

So at clinic, the first time we'll screen you and treat you.

Hellen Barsosio: 00:22:48

Where screening is not available, it's symptomatic treatment.

Hellen Barsosio: 00:22:51

So they'd see are you presenting with fever, and that's when they test you before they treat you.

Hellen Barsosio: 00:22:56

And if you're not sick, meaning that you don't have malaria, then you're given a prevention drug to go home with.

Hellen Barsosio: 00:23:01

So all of these three activities happen to one patient at the first centre visit.

Hellen Barsosio: 00:23:06

Then it's repeated every month.

Hellen Barsosio: 00:23:08

So screen and test.

Hellen Barsosio: 00:23:09

If you're not positive for malaria, then we give you a prevention drug.

Hellen Barsosio: 00:23:13

And we keep on doing that until the time when you deliver.

Hellen Barsosio: 00:23:15

So they would go hand in hand.

Tony Nolan: 00:23:17

Yeah, I think that's a great example.

Tony Nolan: 00:23:18

You know, the bed net that you can pick up at the clinic when you've gone for malaria treatment is, is a good example of joined up thinking.

Tony Nolan: 00:23:25

I think in general there are very few examples where one type of intervention is antagonistic or goes against the other type of intervention.

Tony Nolan: 00:23:33

So there's only really benefit to be had in terms of joining them up.

Tony Nolan: 00:23:38

Of course, if there's only limited resources, then you need to decide which is the best intervention in any one given area, but in general, they're very complimentary, and for

Tony Nolan: 00:23:50

The vector, the parasite, improve living conditions and classic things like removing breeding habitats for the mosquito and things like that.

Tony Nolan: 00:23:56

They all work together.

Tony Nolan: 00:23:58

It is a very good question though, and actually there is some interesting research, it's trying to look at, in mosquito populations, for example, where insecticide

Tony Nolan: 00:24:21

Which is a really important question because if they remaining in relatively high numbers but are not very competent to transmit malaria,

Tony Nolan: 00:24:32

And so these are quite active, active areas of research at the moment.

Grant Hughes: 00:24:36

The other thing I think that's important to point out is, certainly there's no one strategy that's going to be solely effective and responsible.

Grant Hughes: 00:24:44

Tony's pointed out how strategies can work in synergy, but we should also remember that resistance is going to emerge to any strategy.

Grant Hughes: 00:24:53

We're, we're very familiar with insecticide resistance, but we could have resistance to gene drives, we could have resistance to Wolbachia,

Grant Hughes: 00:25:03

But if we deploy all these strategies in unison or together, then we're also likely to, uh, reduce the chances of resistant emerging to one particular strategy.

Grant Hughes: 00:25:13

So I think that's, that's good to think about how we can synergise these both in an effectiveness, but also in mitigating resistance.

Kim Ozano: 00:25:20

Thank you very much.

Kim Ozano: 00:25:22

I have so many questions here, but it's getting more clear how we get from the lab to policies to communities to see impact.

Kim Ozano: 00:25:29

Hellen, a final comment and then we'll get some advice.

Hellen Barsosio: 00:25:33

My final comment is on a holistic approach to malaria prevention, and I would think about a community health worker, a volunteer who would visit a household and

Hellen Barsosio: 00:25:53

They live in this particular village where they have tall grass, pools of water that needs to be drained and also a couple of malaria programmes going on.

Hellen Barsosio: 00:26:01

This is a real example of how malaria control, for instance, is done where LSTM works in Homa Bay County.

Hellen Barsosio: 00:26:08

When you look at all those populations, first of all, they live in an environment where there's tall grass, and pools that need to be drained.

Hellen Barsosio: 00:26:14

We have seen programmes that look at larvicidal control, but the most important thing is to clear the bushes around the house and drain

Hellen Barsosio: 00:26:25

What the public health officers or the community health workers would do, they'd make sure that household has, uh, everyone has a bed net.

Hellen Barsosio: 00:26:31

You know, they've been quite good at, uh, from what we've seen with the Kenya Demographic Health Survey, is rural populations in malaria endemic areas,

Hellen Barsosio: 00:26:47

The population that we need to be concerned about are the reservoir.

Hellen Barsosio: 00:26:50

So these are school-going children.

Hellen Barsosio: 00:26:52

They'll get malaria.

Hellen Barsosio: 00:26:53

They've been living there for a very long time.

Hellen Barsosio: 00:26:54

They've acquired immunity over their childhood, and so they're not symptomatic.

Hellen Barsosio: 00:26:58

But once the mosquito bites them and transfers to the baby, their under five year old baby and their mom, they're the ones who are at risk of malaria infections,

Hellen Barsosio: 00:27:10

So we need intervention that also target them.

Hellen Barsosio: 00:27:13

And for children under the age of five, trying to treat them, but also availing malaria vaccines and you need to catch up and get, uh, malaria vaccines.

Hellen Barsosio: 00:27:21

So at a household level, at a community health volunteer will look at a book and check off, has a mom started clinic?

Hellen Barsosio: 00:27:27

Is she on any drugs?

Hellen Barsosio: 00:27:28

The child under five, have they been vaccinated?

Hellen Barsosio: 00:27:30

The school going child, are they in any prevention program and how is their household around it?

Hellen Barsosio: 00:27:35

So this, I think I'd call that the community or the holistic approach to malaria prevention.

Kim Ozano: 00:27:40

Thanks very much.

Kim Ozano: 00:27:40

I think that's really quite crucial in understanding the context and how these interventions work together.

Kim Ozano: 00:27:45

So I think that's an excellent example.

Kim Ozano: 00:27:48

So to finish the podcast, episode, one piece of advice in less than 30 seconds that you would give to anyone who's starting to work in the field of malaria.

Kim Ozano: 00:27:56

Tony, let's start with you.

Tony Nolan: 00:27:57

Well, it's a more of a general message, I think.

Tony Nolan: 00:28:00

I think whenever people are presented with a health problem, they try to intervene to suppress that problem and malaria is a problem largely

Tony Nolan: 00:28:13

So you need to see the urgency about intervening in the context that is not that your everyday context.

Tony Nolan: 00:28:20

Suppressing organisms that harmful to us is something that we've always done as a health intervention measure, and in order to do that, as it's been

Tony Nolan: 00:28:32

So that's my large message.

Grant Hughes: 00:28:33

I guess it's reiterating what Tony said and if someone's interested in to get into the malaria field, to go and do it.

Grant Hughes: 00:28:40

It doesn't particularly matter what area you're going to research.

Grant Hughes: 00:28:44

I think all of them are going to be particularly valid.

Grant Hughes: 00:28:47

We're increasing our tools that we're working with and they might range across a spectrum of technology.

Grant Hughes: 00:28:54

Going to do things like manipulating larval habitats or using insecticides or drugs or looking at different technologies with mosquitoes, but each of them has its own place and

Kim Ozano: 00:29:10

Thanks very much.

Kim Ozano: 00:29:11

And Hellen, take us home with one final message.

Hellen Barsosio: 00:29:14

We need to carry communities along with us as we invent, um, new interventions.

Hellen Barsosio: 00:29:18

They need to know why we are doing it, why it costs as much as it does, because research is quite expensive.

Hellen Barsosio: 00:29:24

And once we have good results, we need to come back and share with them.

Hellen Barsosio: 00:29:27

If we carry them along with us because, they are our patients, they're our clients, the reason why we do what we do, I think we'll go a lot further

Kim Ozano: 00:29:38

Thank you so much, and at Connecting Citizens to Science, that really is what we're passionate about as well.

Kim Ozano: 00:29:43

So thank you to our guests and my wonderful co-host Hellen, who has been magnificent at a really kind of unpicking the science behind some of the vector control.

Kim Ozano: 00:29:52

So thank you very much and thank you to our listeners.

Kim Ozano: 00:29:54

Please do like rate, share and subscribe so we can continue to bring, uh, amazing stories like this, on innovation in science.