Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

Multidrug resistant P. falciparum malaria is now established in parts of Thailand, Laos and Cambodia, causing high treatment failure rates for artemisinin combination therapies, the main falciparum malaria medicines.

My name is Lorenz von Seidlein and I am based in Bangkok, Thailand; I coordinate malaria elimination efforts for the Unit. My field of work includes Vietnam, Cambodia, Laos, Thailand, Myanmar.

The focus of my work is malaria elimination. What we are trying to do is find the best and the most cost efficient way to eliminate malaria. We are living in a time of historical very, very low malaria prevalence. I don't think it has ever been so low as it is now. So, there is a real chance to get rid of the parasite once and for all.

The threat is that if you have this really low prevalence and incidence of malaria, you have cornered the parasite. The parasites that can survive under these circumstances are the ones that are the strongest, that have completely adapted to this environment. These are parasites that are resistant to the traditional anti-malarial drugs.
The fear, of course, for an epidemiologist is that this population is going to expand again. And if these parasites expand, we have at the moment no good treatment for them. We need 2 or 3 anti-malarial drugs at once to get rid of malaria in these patients. It has become very expensive and complicated to treat people who have these resistant parasites.

And our fear is that if these parasite populations expand in Southeast Asia, the same thing will happen that happened before with sulfadoxine/pyrimethamine and with chloroquine even earlier: resistant parasites which arise from western Cambodian spread throughout the Greater Mekong sub-region, then make it through India. There has always been lively commerce between India and East Africa, and ultimately the parasites will arrive on the African continent.

Q: the main focus of your work is malaria elimination. What are the challenges in that work?

Lorenz von Seidlein: Malaria elimination has been going on for at least 50 years. In 1963 there was a strong drive to eliminate and eradicate malaria. They were perhaps even more optimistic than people are today. When they weren't successful, there was a resurgence of malaria.
I started working on malaria in 1995 in West Africa. We went to villages in The Gambia where every single person was parasitaemic, and that was not sub-microscopic parasitaemia: if you drew their blood and looked at the microscope, you would find parasites during the malaria season in the entire population.

Q: You are trying a lot of community engagement?

LvS: Yes, that's what it is called. Community engagement is the overarching umbrella term, but what does that mean? The one stream is having these technical solutions, but we are also very interested in finding approaches to engage whole communities. What would we have to do to make you interested in malaria elimination?

From what we have learned over the last years, the most successful way is to provide healthcare through the village healthcare worker; that builds trust. The village health care worker can be a villager who is interested in health care and wants to be trained and become better at it. We support this person with training, medication and basic diagnostic tests. As soon as there is one person stationed in a village who can take care of most fevers, malaria incidents drop very quickly. It is a very effective intervention. Building trust is not a very sophisticated technological approach. It doesn't get you into fancy journals and it doesn't give you a high impact factor, but it is absolutely essential if you want to be successful in malaria elimination.

Q: What are the benefits for you of working at MORU?

LvS: I am based here in the Mahidol-Oxford Research Unit in Bangkok. The advantages are that I am in the zone, in the area, in the region: Vietnam, Cambodia, Laos, Thailand, Myanmar. Being based here in Bangkok, I can fly to any one of these sites within half a day and start visiting field sites. If I would be based in Europe, I would have to fly first from London to Bangkok and then from Bangkok to these places, which would make it much more difficult if not impossible. And the second thing is that you get a different perspective. If you live in Washington, London or wherever, you have a little bit of a different view than if you are here, being immersed in the Asian area. I think I have a little bit better understanding here in Bangkok than if I were in another place.

Q: If you had one thing to say to governments about malaria elimination, what would it be?
LvS: As a Minister of Health, you look around and ask: where is most disease? What is the biggest problem that my nurses from the district hospitals are busy with? What are the hospital managers most concerned about? It is probably not malaria at the moment because we have it at very low levels of incidence. But it is myopic to stop the funding at this stage instead of saying: "OK, we must continue to do this and keep it at very low levels, then try to do the last push to get rid of malaria."

Lorenz von Seidlein

Targeted Malaria Elimination

Dr Lorenz von Seidlein coordinates MORU's Targeted Malaria Elimination (TME) study, which seeks to eliminate artemisinin resistant falciparum malaria by treating entire communities that have significant levels of subclinical malaria parasite infections and transmission with the antimalarial Dihydroartemisinin-piperaquine (DHA-PIP).

Malaria elimination in the Greater Mekong sub-region

A further spread from Myanmar to India then sub-Saharan Africa would be a global public health disaster. TME seeks the best ways to eliminate drug-resistant malaria, using both technical solutions and novel ways that engage entire communities.

More podcasts related to Malaria

Bob Taylor: Primaquine for vivax and falciparum malaria

Malaria

Primaquine can be used both to treat vivax malaria and to prevent the transmission of falciparum malaria from human to mosquito. A shorter and age-based primaquine regimen would reduce the burden of vivax malaria. It would also allow primaquine to be used more widely to block the transmission of falciparum malaria.

Lisa White: Mathematical modelling for tropical diseases

Malaria

Mathematical modelling, particularly when combined with economical modelling, allows researchers and policy makers to determine the most effective interventions to fight infectious diseases such as malaria. We can use those models to explore ‘what ifs’ scenarios, at country or province level, save more lives and limit costs.

Ric Price: Curing Plasmodium vivax malaria

Malaria

Vivax malaria used to be considered benign but is now recognised as an important cause of morbidity and mortality. Resistance to chloroquine (given to treat the parasite blood stage) is growing and ACT (artemisinin-based combination therapy) is becoming common treatment for vivax malaria. New drugs and better public health strategies can help elimination targets, anticipated for 2030.

Olivo Miotto: Genomics and global health

Malaria

Genomics is the study of the complete DNA sequence, for example of a particular parasite, allowing us to analyse its evolution and the impact of human interventions. Alongside clinical date, we use genomics to identify mutations that are markers for drug resistance. Mapping out drug resistance then helps inform elimination programmes.

Frank Smithuis: Fighting malaria in Myanmar

Malaria

Although malaria is decreasing in Myanmar, resistance to anti-malarials is on the rise in the region and the focus is now to treat people early, particularly in remote communities. MOCRU has set up a network of community health workers, trained and supplied with diagnostics, bednets and treatments, to help improve access to healthcare as well as produce the evidence to encourage policy changes.

Andrea Ruecker: Blocking malaria transmission

Malaria

In the falciparum malaria parasite cycle, the gametocyte stages are responsible for the transmission from person to mosquito, then to other persons. A better understanding of how gametocytes respond to malaria treatments would help us block transmission and ultimately eliminate malaria.

Rob van der Pluijm: Tracking antimalarial resistance and treatment of malaria using Triple ACTs

Malaria

Anti-malaria drug resistance is spreading throughout Southeast Asia and we need to find new treatments. Our researchers at MORU use a combination of artemisinin and two partner drugs instead of one. If confirmed safe and tolerable, triple artemisinin combination therapies might be a good option to treat multi-drug resistant malaria, as well as slow down the emergence and spread of anti-malarial resistance.

James Watson: Primaquine and vivax malaria

Malaria

Primaquine is a drug used to eliminate vivax malaria from the liver and prevent relapses. However, it causes anaemia in patients with G6PD deficiency. A new, slightly longer regimen with increasing doses of primaquine could allow to safely treat all patients with vivax malaria.

Xin Hui Chan: Using big data to eliminate malaria

Malaria

Malaria is the most important parasitic infection to still affect humans, and a safe use of antimalarial drugs is paramount. The current explosion of clinical data is causing a jungle of data; making sense of all this data will greatly help us in our fight to eliminate malaria.

Bob Snow: Malaria control in Africa

Malaria

Quality data is vital to design better malaria control programmes. This project helps various African countries gather epidemiological evidence to better control malaria. Professor Bob Snow showed how sub-regional, evidence-based platforms can effectively change malaria treatment policies.

Translational Medicine

From Bench to Bedside

Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.