Dr. Jobin has been a very active member of MalariaWorld over the last seven months. Time to interview him and get some feedback on his views regarding malaria control and elimination in Africa.
Q: You have just published a book titled: 'A realistic strategy for fighting malaria in Africa'. What's the key message of this book?
A: The key message in my book is that malaria should be fought in Africa now, because of the renewed global support and enthusiasm, by expanding public health programmes, but not by the current uncoordinated series of sporadic donor projects. We should be careful students of history before we start anywhere on a new attack against this disease. For example, the first indoor spray program by the US and WHO against malaria was in Liberia in 1945. They thought they could finish in a few years, but they failed. With help from the US Presidential Malaria Initiative (PMI), they are going to try again, 65 years later. If they study their history they can repeat the successes, not the failures. I tried to stress positive ideas in my book, but have to admit that I wrote it because I was angry about the mess being made by WHO, UN agencies, bi-lateral aid programmes and well-meaning NGO’s. The current efforts will not endure; we need to get realistic. And the places to start are the several stable, democratic countries which have large numbers of competent and experienced people, already working in malaria control or relevant field research.
Q: In the book you argue that lessons should be learned from past malaria control/elimination campaigns. Can you summarise the key lessons here?
A: The key lessons are: First - we must be in this for the long haul. Second – we should use all available methods, emphasizing the permanent and sustainable ones, in a rationally integrated strategy. Incidentally, remember that indoor spraying and drugs and bednets are not sustainable, they must be continually renewed. Third – we should concentrate now on the most stable and democratic countries so that our investments of time and resources will endure. Fourth – because of the rapidity of transmission in Africa, eradication is not likely. Instead, we should plan for control at a low, tolerable level, sustainable by the countries resources. Fifth – it is important to understand past attempts before starting any new programs. However we should always be open to pleasant surprises, such as the Inter-faith movement in Mozambique; Together Against Malaria. Muslims, Jews and Christians have joined in this effort, with help and guidance from people in Washington DC at the National Cathedral and Georgetown University. In Mozambique they are also supported by Hindu and Bahai congregations. This is the kind of stability and coverage that the fight against malaria desperately needs. To his great credit, Tim Ziemer of the US PMI supports them.
Q: Suppose you would be given a blank cheque and be asked to go somewhere in Africa to eliminate malaria, where would this be and how would you do it?
A: Bart, that is a really hard question. The three most promising countries in Africa for malaria control are Senegal, Mozambique and South Africa. All three have a core of competent people with decades of experience in control and field research. They also cover the three most common languages, French, Portuguese and English, so what they know can be spread to the rest of the continent. But you are only letting me go to one country, so I would start in South Africa with their mature and competent national malaria control programme (NMCP), and help them develop a regional malaria control center, giving training in English. In the center, I would help them train more people for their malaria diagnostic labs, the epidemiologists who organize malaria monitoring and evaluation, and the directors in the national malaria control programme. It would be vitally important that the people trained would then be placed by the NMCP in permanent jobs, with career paths forward. This would be for people in the NMCP in South Africa, and then it could spread to Zambia, Malawi, Tanzania and Ghana, the most stable and democratic English-speaking countries.
Q: Optimism reigns that malaria will one day be eliminated in Africa, but you hold a different opinion. Why is this, and what is therefore your long-term vision of tackling the malaria problem in Africa?
A: Africa is one of the most beautiful but complex continents on our beloved planet, so fighting malaria there is incredibly complex too. Mostly because it is the ancestral home of the anopheline mosquito, and the ecological nursery for the malaria parasite. Plus, there are deserts and rain forests, savannahs and mountains. The people comprise multiple ethnic groups and speak myriad languages. Violent dictators hold sway, wars rage, droughts recur, and massive flooding is frequent. A sustainable fight against malaria has to deal with all of these issues. With rational and modern methods in an integrated strategy they can bring malaria transmission to a low and acceptable level. But the uncertainty of the ecology and the political situations make it unlikely that a country can be maintained free of malaria for long. So yes, we shall overcome, but we need to develop permanent programs for suppressing transmission. Eradication will not happen in our lifetimes, nor in those of our children, nor our grandchildren. Outside donors can help a little, but Africans already have the capacity to successfully fight this disease, so they must be aware of getting distracted by rich donors.
Q: You have decades of malaria control experience under your belt. If there would be one key message for young scientists just starting their career, what would it be?
A: Despite the joy I have found in scientific research, I am more of an engineer who tries to apply science, rather than a true scientist. So I cannot speak to those who are dedicated to Science in the abstract. But I can speak to those who want to help friends in need. If you are a malaria scientist it means that you are intelligent and educated. Thus I would give you the same advice that I gave my youngest daughter last year when she returned from several months in southern India. Laura is graduating from a good college in the US, and is a top student. She asked, “Dad, why I am so blessed, when people all over the world suffer?” I told her that she is blessed with all these advantages so that she can share them with people in need. So my advice to young malaria scientists is similar. Use your talents, education, and good fortune to help people suffering from this scourge. That will make it all worthwhile, no matter what you do. And do it now! Don’t wait for the mythical vaccine, we have the tools we need, let’s use them.
Thank you, Bill.
Attached below the book review published in Parasites & Vectors.