François Nosten: Between research and humanitarian
Q: How big a problem is malaria at the Thai-Burma border?
François Nosten: In terms of the number of patients it is not a very big problem but because of the high grade of drug resistance it is a very significant problem. The parasites that causes malaria at the Thai-Burma border are the most resistant that you can find in the world. It is quite a serious problem because it can spread beyond the area, as it has done before, and then become the problem of everyone else.
Q: Why is it important to combine healthcare delivery with research there?
FN: In this context it is quite important because we can translate the result of the research directly into practice; for the people it is beneficial and for the researchers it is rewarding. Combining research and healthcare in this research unit has proven to be a very good synergy between the two activities but, of course, it is double the work. We have to do at the same time clinical trials and research, and provide healthcare to the population.
Q: Can you tell us a bit about your research?
FN: The research that we have carried out in Thailand for the last 30 years has been mainly on infectious diseases, mainly malaria, which was a major problem when we started. We’ve concentrated on prevention, epidemiology and treatment. A big bulk of the work has also been on maternal and child health because of the very high mortality and morbidity in pregnancy. We’ve concentrated on delivering safe services for safe deliveries for the pregnant woman but also we’ve done a lot of studies on the treatment of malaria, which is particularly bad in pregnancy.
Q: What are the most important lines of research that have developed in the past 5 or 10 years?
FN: In the past 5 or 10 years the most important part of research is probably that on resistance in Plasmodium falciparum to drugs. In particular, the emergence of artemisinin resistance, which is a very serious threat to the control of malaria worldwide. We’ve spent a lot of time documenting it, studying it, trying to understand it and combat it.
I would put after that the work on maternal health, the work on the treatment of malaria in pregnancy, which is very difficult because drugs are usually not used in pregnant women. There are very few places in the world where studies are being conducted on the treatment of infectious diseases in pregnancy.
Number three would be the focus on the other infectious diseases, respiratory infections in children. The bulk of the major research program studies that we have done is cohort studies, longitudinal studies, involving patients that we can follow for a certain period of time. That’s where the strength of the unit is: being able to conduct these population studies in large numbers.
Q: Why does your line of research matter, why should we put money in to it?
FN: I think that this research is important because we are in an area of high drug resistance in malaria. Whatever result we can get that contributes to improving the treatment or understanding the mechanism of the disease will be beneficial elsewhere. In terms of maternal health, the health of mothers and infants is a big priority for the developing world. By being able to study in detail and follow a large number of pregnant women throughout pregnancy we are in a position to study the effect of the diseases and how to prevent them, in a way that is rarely found in the tropics.
Q: How does your research fit in to Translational Medicine within the Department?
FN: I think that the best example of translational medicine from the work that we’ve done comes from the artemisinin combination therapy, which we pioneered in the 90’s and was finally adopted as a standard treatment worldwide in the early 2000’s. This work has provided most of the evidence that was needed to assess the efficacy and improve the safety and effect of malaria transmission in one area.
Of course, locally the translation is almost immediate because as soon as we have the result we can use the new regimen in the population. On a larger scale it has influenced the National Malaria Program in the region (in Thailand, in Vietnam and in Cambodia) and also at the global level with changes in the treatment guidelines that were developed by the WHO.