Video Transcript

Kevin Marsh

Good evening ladies and gentlemen. Thank you very much. It's great to see so many people here. We weren't sure how many people would come to this malaria day. It's fantastic!

Today, we want to talk about the current malaria situation and give a sort of snapshot of some of the work that goes on in Oxford and through Oxford on malaria.

I'm just going to show a couple of slides at the beginning to orientate us.

I presume that most people here understand that malaria is a parasitic disease spread by mosquitoes.

We often say it's a global problem, and it is a global problem. But that actually doesn't quite get the picture because if you take into account where the people are and the parasites are, this is what malaria looks like on a map. In Africa, it's a massive problem, and in Asia, particularly South Asia, it's a massive problem, and that's because the population is so large. This is a global problem, but it's not an equally distributed global problem.

Had we been having this meeting 15-16 years ago, we'd have all been terribly depressed. Many of us were terribly depressed, and we were writing articles saying that malaria was a complete disaster. And it was a disaster - it was essentially out of control. Nobody had any real sense of what to do about it; there were massive drug resistance problems, and mortality was very high. Nobody knew how many; we used to make the numbers up. But there was an absolute lack apparently of international or national will to do anything about it.

Over the last 15 years, there's been a really remarkable change. I think the change was just a surprise. It more than pleasantly surprised many of us who work in malaria because often people talk about international initiatives and such like and usually not very much comes up.

In the case of malaria, there has been a real revolution over the last 15 years. And it's partly reflected in this figure; we show global spending on malaria control. At the beginning of this century, the whole world spent only a couple of a hundred million dollars a year on malaria control. Very quickly, after a series of concerted initiatives, this rose tenfold and has now gone up to about fiftyfold. So a really massive investment in malaria control around the world. You would hope that that would have some effect, and in fact, things have changed incredibly between 2000 and 2015.

People are used to looking at these maps, so if you're not, you'll see a lot more, I think from Katherine. You get a general idea that red is bad and blue is better. So you can see over 15 years looking at Africa alone, there's been a major change, as you can just see without going down into detail in the amount of malaria in Africa. But globally, over that period, over 600 million cases have been averted compared with the numbers in 2000. And really, I think extraordinarily global malaria mortality rates have fallen by an estimated 60%, and in Africa, probably somewhat more than that.

Now, if you had asked any of us at the beginning of the century how likely this was, I don't think many of us would have put very much on this. So it looks as if everything is great. Things are good to a degree, but there are some big issues on the horizon. Firstly, drug resistance, and you're going to hear quite a lot about that - both the situation and what can be done about it - secondly, funding. It's fantastic that funding has gone up fifteenfold, but it needs to go up thirtyfold, and if it doesn't, we'll stall, and things will return to where they were. So things aren't totally rosy. In fact, what's a very interesting point in history where many people are talking about elimination and even eradication. I think everyone should aim at eradication, but everyone should be more than aiming at being realistic. Unless we solve the problems of drug resistance, insecticide resistance and funding, there's no point in talking about any of these things. And one of the key things we need is new interventions. So you'll hear quite a lot today about potential new interventions both in terms of vaccines and also the power of genomics science to contribute to our understanding of malaria. So I'm going to introduce first Katherine Battle, who is going to talk about mapping, and I should have said that we talk about malaria as if it is a single thing. Of course, many of you will know it's not – there are several species, and we tend to talk about Africa. We tend to talk about falciparum because that's important. Still, there is another massively important malaria parasite, and just to bring the changes, Katherine is going to concentrate on that.