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M. Henley/ WHO
One of the things your research has focused on is malaria treatment. What do you find most interesting about this topic?
Not all diseases have a specific diagnosis and treatment, but for malaria we are fortunate to have both. The treatment for malaria is affordable and the benefit is perceived by the patient immediately. What is interesting to me is that even though it is a serious disease and can sometimes be fatal, a very simple treatment, if administered in a timely manner, can cure the patient and prevent adverse outcomes – even at community level.
How has malaria treatment research evolved over the 20 years you’ve been in the field?
The malaria treatment as such has been totally revolutionized in the last 2 decades, and so has the research related to this topic. Point of care diagnostics are now being used, as confirmed diagnosis is considered essential for treatment with antimalarials. Diagnostics with high sensitivity and stability are being developed. Research for treatment is directed towards new combination therapies with improved dose schedules and safety.
Drug resistance monitoring is informing the evidence-based modification of existing treatment guidelines. In addition, implementation research is gaining importance to improve our understanding, on the one hand, of community diagnosis and treatment and on the other hand, the availability of best management of critical cases at state level. Issues like poor treatment practices and the availability of substandard medicines also need more attention.
You led the introduction of artemisinin combination therapy as the first-line treatment for India. Can you talk a little bit about what some of the challenges were, and how the country overcame them?
Yes, there were lot of challenges, including acceptance of artesminin-based combination therapies (ACTs) by the national programme, regulatory issues, implementation, and generating evidence to justify this change in first-line treatment.
The malaria treatment as such has been totally revolutionized in the last 2 decades, and so has the research related to this topic.
Neena Valecha
India is a huge country with diverse epidemiology of malaria. In the era when chloroquine (CQ) was widely used as first-line treatment for malaria, the change to second-line treatment with sulfadoxine pyrimethamine (SP), when resistance to CQ emerged, was patchy leading to even further CQ resistance across the whole country. In 2005, India introduced ACTs in areas showing CQ or SP resistance.
From 2009, India started systematically monitoring drug resistance to first-line antimalarial medicines. Based on these studies, India’s National Malaria Control Programme scaled up the use of ACTs nationwide in a phased manner. We managed the complete changeover to ACT only in 2010. However, since CQ is effective for treating P. vivax malaria, it was retained for this purpose.
In addition, we managed to get 5 ACTs registered for marketing by completing regulatory trials. Now we are considering a change to a fixed dose ACT which is effective in both malaria parasite species (P. falciparum and P. vivax).
Can you briefly explain what pharmacovigilance of antimalarials is and why it is important?
Pharmacovigilance is the detection, assessment, understanding and prevention of adverse effects of medical drugs. All new medicines are introduced after phase III trials which are done in a limited number of patients. When the same medicines are used in larger populations, some of the less frequent adverse reactions will be detected. Since there can be different responses in different populations, data on adverse responses needs to be collected from each country.
Which female scientist inspires you the most and why?
Dr Soumya Swaminathan. I have seen her working in different and diverse capacities in both India and abroad. She has expertise as a clinician, scientist and administrator. The most impressive part is that although she has to deal with critical issues every day, she is always calm and cool. She is a big proponent of teamwork, both at the national or international level.
What advice would you give to young/aspiring female scientists?
For female scientists, especially in developing countries, there can be a disruption in studies at PhD or doctorate level since it coincides with the time when parents want to get them married. That is a turning point of their life. Some sustain the pressure and strike a balance, but others leave science for some duration or even permanently.
In India, the percentage of women in undergraduate science courses is approximately 40 % but that decreases to 15% at the scientist/ faculty level. So many will obtain a degree, but will not go on to use it in a professional capacity. I feel that if these women could use their skills and will power to stay committed to their career development during that phase of life, the rest of the journey is not that difficult.