As I mentioned at our class last week, I am now attending a large meeting of people interested In the control of malaria, organized by the Multilateral Initiative on Malaria.   MIM is the outgrowth of a meeting that I helped to organize in this city twenty one years ago.  The goal (as explained more fully in my memoir) was to explore the potential for forming a coalition of funders, policy experts, and working scientists from Europe, the United States, and many African (and a few Asian) countries to work more effectively together against this major cause of morbidity and mortality in many developing countries, especially in sub-Saharan Africa.

In the intervening years, several good things have happened.   Many other organizations, in addition to MIM, have taken up the cause, the use of insecticide-impregnated bed nets (to reduce transmission by mosquito bites at night) has expanded dramatically, diagnostic methods to detect the malaria-causing parasite have improved, and new medicines (mostly combinations with the best single drug class, the artimesinins) have been made cheaply available through public- private partnerships.  As a result, the incidence of cases and death rates from malaria have declined very significantly in many places, though not all, and there is widespread discussion of the once far fetched goal of eliminating clinical malaria.

However, despite these gains, many speakers have noted that the declines in incidence have recently stalled or even reversed course in some places, that the Anopheles mosquito often shows resistance to the usual insecticides, that no radically new drugs have appeared, that attention to malaria has subsided as chronic, non-communicable diseases become more prominent in the developing world, and that novel approaches to vector control ( including “gene drive” generated by the use of CRISPR/Cas9) are still at least a decade away from implementation.

Despite these concerns, there is a feeling of optimism and progress here.  Some of that can be attributed to the substantial growth of the scientific enterprise in Africa.  This meeting is ten times larger than the first one here in 1997, and most of the attendees are African.   Many are students and postdocs who speak well and authoritatively, work in strong institutions, and complain about many of the same things I hear about from American trainees: a shortage of jobs, inadequate mentorship, defects in peer review, grants that are hard to get and too small to be effective, and the difficulties of publishing.   To the last point, I was able to say, during my own talk in the opening session, that the African Academy of Sciences was launching this week a new publishing platform that posts preprints on line, oversees open review, and makes papers officially published without undue delays.

I would be happy to say more about this meeting, my forthcoming side trip to a longstanding malaria laboratory, founded by the British, in The Gambia, and some of the interesting people I have met at our next class, on April 25, when we will talk about problems confronting young scientists in the U.S.  I hope you all enjoy hearing from Jon Weiner this evening.

Best, HV