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M. Henley/ WHO
What interests you most about working in malaria?
If you talk to any malariologist, they will say it is the most interesting disease. There must be some truth to it (laughs)! What makes it interesting is the complexity of the disease. It manifests differently in different parts of the world. In Africa, the disease occurs mostly in children and is associated with higher fatalities, while in Asia and Latin America, it tends to affect adults more. The malaria parasite goes through many phases as it develops in both its human and mosquito hosts – it’s in the liver and then the red blood cells of humans, it’s in the midgut and then the salivary glands of mosquitoes.
The parasite has also evolved over very long periods of time and has developed mechanisms that enable it to survive, such as by becoming resistant to medicines. In fact, even the evolutionary history of humans is marked by this parasite – in parts of the world, malaria has selected human populations with various genetic attributes because they provide some resistance to the parasite. From a scientific point of view, it’s a very rich disease to study.
How did you make the transition from clinician to malaria researcher?
My clinical career was actually short. I was living in Sri Lanka at a time when there was a lot of malaria, and became interested in studying the disease. I conducted research on immunology and transmission blocking vaccines for my PhD thesis in London. I had planned to continue working on vaccines in animal models when I returned to Sri Lanka, but quickly became interested in working on the immunological aspects of human malaria which was very timely, given that there were many malaria patients in the country at the time.
I established a malaria research unit in the Faculty of Medicine where I worked and I found myself leading a group of young scientists and, together, we were able to greatly enhance this work. We worked together for about 20 years and made some interesting scientific contributions to malaria during that time.
Given Sri Lanka’s recent success in eliminating malaria transmission nationwide, wasn't this a very interesting time to be doing this work?
Yes, it was. Sri Lanka had both a good malaria control programme, and a very good health system. Access to healthcare is robust, and is provided free of charge. The country was able to use the existing system to improve access to malaria diagnosis, treatment, and prevention tools. And the fact that they were able to do this during a 30-year civil war makes the accomplishment even more admirable.
The tools we have are not perfect, but they are effective. If Sri Lanka can achieve elimination, we know that many others can as well.
Dr Kamini Mendis
As a researcher in the University, I had contact with the malaria control programme and worked closely with colleagues in this programme. And in 1998, I moved to Geneva to help plan and launch the Roll Back Malaria initiative and then lead malaria treatment and elimination efforts with WHO’s Global Malaria Programme. Being able to move from working at the national level to the global level was a great experience. When I moved back to Sri Lanka 12 years later, the number of malaria cases was so low, it was clear that elimination was imminent. The last case was reported in 2012, and the country was certified as malaria-free in 2016. The experience of working with a highly prevalent disease and being a part of its elimination from the country was a rare privilege.
A word of encouragement to others: when I first started working in Sri Lanka, there was a lot of malaria. And then 30 years later, the disease was eliminated. The tools we have are not perfect, but they are effective. If Sri Lanka can achieve elimination, we know that many others can as well.
What are some of the challenges Sri Lanka and other countries that have recently eliminated malaria face?
Preventing reintroduction of the disease will be a challenge. The mosquitoes that transmit malaria are highly prevalent, and there is still a lot of malaria being brought into the country by travellers and cross-border workers. The national malaria control programme is doing a very good job of ramping up surveillance to detect and treat imported cases of the disease as well as keep a tab on the prevalence of the mosquito vector.
The country must also ensure that awareness of the disease among clinicians remains high. When malaria is eliminated, physicians become less familiar with it and are less likely to look for it, which can delay diagnosis. Every day a patient remains untreated, it threatens that patient’s life and contributes to transmission. This is one way a disease re-establishes itself. To avoid this, every new case of malaria in the country must be rapidly diagnosed and treated, carefully scrutinized, and an investigation conducted to determine if the case is imported or if local transmission is occurring. It is also necessary to intervene to ensure that the patient’s infection does not spread onwards through mosquitoes.
You’ve been working in malaria research for decades. What was it like working as a woman in science when you first started out?
Sri Lanka is a great place for professional women. The culture is very supportive and, in fact, in 1960 we became the first country in the world to elect a female prime minister. I never felt like I was at a disadvantage because of my gender. Several of my post-graduate students were women, and are now senior professors and infectious disease experts in their own right. For my own career, what has been most important is the collaborations I have had with extremely good scientists abroad. Mentorship in this field is critical.