To mark World Malaria Day we spoke with Dr Francis Ndungu about his research into malaria immunity. Dr Ndungu completed his PhD at the National Institute for Medical Research before returning to Kenya where he is currently a Senior Research Scientist at the KEMRI/Wellcome Trust Research Programme.
Why did you choose to study malaria?
My interest in how humans develop immunity to malaria started during my undergraduate studies at Kenyatta University, Nairobi. We visited the KEMRI-Wellcome Trust Research Programme (KWTRP) in Kilifi for an academic field trip and whilst there, the Director of KWTRP, Prof Kevin Marsh, who went on to become my mentor, gave us a lecture on ‘the immunology of malaria’.
It became clear to me during that lecture, that although there was overwhelming evidence that children growing up exposed to malaria acquired immunity to clinical episodes, the mechanisms of this immunity remained unclear. This was despite decades of work in the subject.
As an undergraduate student of immunology, I was fascinated by this revelation. It seemed incredible that scientists had failed to determine exactly how people become immune to malaria. It was obvious that this lack in understanding had made the goal of designing and developing malaria vaccines a huge challenge.
Discovering this gap in knowledge sparked my interest intellectually and I knew that this solution would not only be of global public health importance, but also have direct health benefits to those living in rural Kenya, where I grew up.
What are the main aims of your research?
Interestingly, I am still pursuing answers to the same question that initially triggered my interest in malaria research over 15 years ago; what is the cellular and molecular basis for naturally acquired immunity to malaria?
What we do know is that antibodies are critical for this immunity, the strongest evidence coming from experiments conducted from the early 1960s when passively transferred antibodies from immune adults were shown to have antiparasitic and therapeutic effects in children with severe malaria.
However, immunoepidemiological studies in malarious countries have failed to narrow down the specificity of these protective antibodies to a single antigen that can be developed as a vaccine. Furthermore the majority of antibodies measured in young children appear to be short-lived. Thus the aims of my research are to understand the reasons behind the relative inefficiency of naturally acquired immunity to malaria and particularly to determine whether there are deficiencies in the generation of immunological memory.
I am also involved in a new and very exciting project that will determine whether a small proportion of children that experience more malaria than expected by chance, while others become immune after only a few clinical episodes, are immunologically unique.
What do you hope we will have achieved in 10 years’ time?
Although there has been a reduction in malaria transmission and cases of clinical malaria in Africa in the last decade, it’s estimated that nearly 60% of the population remains at risk of severe malaria as they continue to live in areas of moderate to high Plasmodium falciparum transmission (Noor et al, 2014, Lancet).
Thus despite the current push to eliminate malaria, a lot of work remains to be done to make it feasible. Whilst I would like to be optimistic and rally behind the elimination campaign, I prefer to be realistic and hope that in 10 years, we have massively reduced P. falciparum transmission to very low levels by increasing usage of tested and proven preventative measures like insecticide-treated nets, vector control, and treatments with highly effective drugs, and that we will have put in place the novel tools that we need to combine with current control methods to begin a big push towards elimination.
In the next 10 years I hope we’ll develop new effective drugs and insecticides, as the current ones are threatened by emergence of resistant parasites and mosquito-vectors, respectively. Furthermore, if the goal of elimination is to be realized, we will inevitably go through a prolonged period of increased risk among a growing population of non-immune individuals that will need these preventive methods.
Thus we need to develop and test new vaccines, vector control methods and anti-malarial drugs. As the scientific community wrestles with these challenges, I also want to see African governments, some of whose economies are now performing well, increase their budgetary allocations for medical research and disease control.
So far, the international community has done well to support these efforts but if we are going to achieve sustainable progress towards elimination of malaria and other diseases, we will need more investment in research, health systems and social-economic development. There was a good story about Tanzania aiming for the internationally recommended allocation of 1% of GDP to research, I hope they are still on track and will set a good example for the others to follow suit.
Are there benefits and challenges to working directly in a malaria endemic region?
Definitely! I feel very privileged to be able to do my research in a malaria endemic area, but of course there are many challenges to this.
For me, the greatest benefit is having access to clinical research, which undoubtedly helps formulate the most relevant questions for research. In addition, we benefit by having access to clinical data and samples.
The greatest challenge we face is inadequate funding for the research, infrastructural development and disease control. At the moment, the most successful malaria research programmes in Africa are supported from external funding from organizations like the Wellcome Trust, NIH, MRC-UK, DFID, and EDCTP (EU) amongst others. Although these programmes are very successful and provide some of the best training for research in Africa, there is still a lot to be done in terms of local capacity development.
For example, there are now a lot of PhD students and young postdocs coming through, but they struggle to make the transition to research leadership due to inadequate numbers of adequately funded positions that would give them the space and time to develop their own research programmes.
Going forward, we will need increased budgetary allocations from African governments to local research institutes in support of their own scientists and infrastructural development, and collaborations that will bring in substantial support for capacity development.
Other challenges include lack of access to strong research communities (as people are pre-occupied with their own survival owing to low pay or even funding uncertainties), technology, internet and good journals. Going forward, I would hope to see more collaboration between western-based institutions and African research institutes/universities in both the conduct of research and training, as this will impact generating research capacity and leadership in the region.
Nonetheless, such collaboration should be guided by strong leadership from the partnering institutions in order to protect either side from unfair competition, or even exploitation!
Do you feel that open access has benefited the malaria community?
Definitely YES! As you can imagine, there are a multiplicity of important journals, each charging a lot of money in subscription fees, meaning that individuals and research organizations would have to spend a lot of money to access a wide range of publications.
Owing to limitations in funding, access to both new and old publications were literally out of reach for a majority of researchers, lecturers and students in African institutions until the introduction of the open access concept by several publishers including the publishers of PLoS and Malaria Journal.
Perhaps I should also mention that one of the reasons open access has been so successful is the overwhelming support from both funders and the scientific community. Nonetheless, we still have a long way to go as not all journals are open access yet. In addition, I should also commend other initiatives like HINARI that brings together a collection of journals from many publishers to researchers in developing countries for free.
Either way, open access journals and HINARI have resulted in massive benefits with regards to acquisition of knowledge, collaboration, quality and quantity of research in Africa, and elsewhere. I can only hope that all publishers will go open access soon.