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.
方案 策略 工具都需要调整改变
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,
了解疫苗开发的人 了解蚊子研究的人 昆虫学家
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.
Sometimes they might even find a better question
that actually gets rid of the main challenge
you were trying to deal with.
There’s a famous saying that
if a problem seems intractable increase the scope of the problem.
And that actually becomes
really evident in the power of collaboration.
If you’re looking at how can we in this one domain of
say drug development, get rid of malaria.
That might be an intractable question.
But then you bring in the people
who are good at vector biology,
the people who are good at vaccines,
the people who are good at data,
information systems and computing,
and the people who are really good at health systems and logistics.
And all of a sudden, you have a bigger problem.
But one where you can actually work together and solve this.
It requires a lot of learning,
in terms of how to speak each other’s language,
and how to listen to each other,
and how to actually take the time
to build these bridges to other fields,
and to really see the advantage
and the impact of doing this well.
It’s not easy. It’s much easier to just sit in a room,
and talk to other people from your discipline,
where you all already speak the same academic research,
or operational language.
But it is very much worth
building these bridges and cross-linking.