‘Zero malaria starts with me’ and ‘Zero Malaria – Draw the Line Against Malaria’ are the rallying slogans for World Malaria Day 2021 on 25 April. For Associate Research Leader at the Institute for Glycomics Dr Danielle Stanisic, these goals drive her research to eliminate malaria.
In this Q&A, Dr Danielle Stanisic talks about the global impact of malaria, her work around preventative measures, such as vaccines and malaria education, as well as her advice for researchers.
‘The elimination of malaria truly is a global concern.’
Is raising awareness around the impact of malaria on communities and economies a challenge in Australia?
Awareness and education are our biggest challenges. Whilst scientists researching the malaria parasite are very aware of the morbidity and mortality statistics associated with malaria infection—up to half a million deaths and over 200 million clinical cases each year—it is hard for people in Western countries, who aren’t exposed to malaria and its impact, to relate to it.
During my undergraduate degree, I discovered parasites and in particular the malaria parasite and I was completely intrigued. It is a parasite that is incredibly complex and clever and continues to evolve so that it can escape whatever we throw at it, like our immune response or antimalarial drugs.
Five years into my work on malaria, I went to Papua New Guinea and came back with a far different opinion. I always knew that malaria was important but living and working in a country where the malaria parasite is endemic—seeing people (especially young children) in hospital, hearing of relatives who had died of it or had left work to become carers and hearing of pregnant mothers losing their baby to it—really helped me to understand and appreciate the impact that malaria has on people day to day. Living in Papua New Guinea—a country coping with malaria every day—and working at their Institute of Medical Research for four years, solidified for me the importance of eliminating the malaria parasite.
As a result, I always tell people who are working on a particular disease to meet and talk to people who live with it and/or have it so they can really understand the impact—that really motivates you to do the work. If the impact is so far removed from the research it becomes a different, more academic motivation.
In Australia, many don’t realise that the malaria parasite does have an impact on our Defence Force and on Australian tourists who travel to malaria endemic countries. The northern part of Australia has the right kind of mosquito to transmit the malaria parasite so an outbreak could be triggered by an infected traveller who returns to that area. Papua New Guinea, to the north of us, is a highly malarious country and all through the South Pacific there are a lot of little islands with the malaria parasite.
Interestingly, one thing that did promote awareness in Australia was the 2018 Commonwealth Games at the Gold Coast. During the Games, a number of athletes from African countries were diagnosed with malaria whilst here and had to go into hospital for treatment.
The elimination of malaria truly is a global concern.
Does the lack of direct connection between Australia and malaria impact your pre-clinical and clinical evaluations of malaria vaccines?
Whilst our research is very exciting, one of our biggest challenges is recruiting people to participate in our clinical trials to evaluate the effectiveness of malaria vaccine candidates. It is difficult to ask someone, who may never be affected by malaria, to participate in a trial where we may infect them with malaria parasites, following vaccination, to see if they are protected. But it is all very safe—we have hospital clinicians involved who monitor and assess and clinically manage our patients to make sure they don’t get sick and we can easily administer antimalarial drugs if that is needed. But it is a lot to try and explain to and expect from someone for a disease that may not impact them at all in their lifetime. It is a big ask.
Many clinical trials are for diseases that people actively have like cancer and Alzheimer’s so there is more buy–in from volunteers. We really are asking volunteers to be altruistic. To look beyond and to help for the greater good—to contribute to the development of something that will help many people around the world but not necessarily them.
Has COVID-19 helped or hindered with raising awareness around vaccines and their development?
There has been an increased awareness around the whole vaccine process; however, the ‘quick’ development of the COVID-19 vaccine has probably given people the wrong impression of how long it takes to make a vaccine. This is not the norm and really the reason the COVID-19 vaccine has progressed so quickly is that there were many groups who put their other research on hold and worked on it. Also, a lot of funding was made available for them to do that.
Ultimately, the scientific community is learning much from the COVID–19 pipeline and vaccine development program and, going forward, a lot of the resulting technology that has been developed will be applied to other diseases. The insights gained into vaccine research and development will hopefully generate heightened interest and financial support for the development of vaccines in other areas, such as malaria.
In terms of clinical trials to test the COVID-19 vaccines, it was heartening to see the number of people volunteering for the trials in Brisbane and Australia. It’s understandable as COVID-19 has had a much greater impact on people in Australia than other diseases like malaria.
Why is your partnership with Rotary District 9640 so important?
In 2016 Rotary District 9640 formed a fundraising partnership with the Institute for Glycomics, initially to raise money for a much-needed piece of equipment for our Laboratory to manufacture the vaccine. Since then, through their passion to be part of the quest to eliminate malaria from our world, Rotarians have directly raised over $650,000 and indirectly helped leverage another half a million dollars from the Australian government. This has helped to fund our clinical trials so far.
Rotary have formed a committee of eight people who look at different fundraising opportunities and, with the Institute, publish a quarterly Malaria Vaccine newsletter and manage malaria vaccine project donations. Through Rotary channels we also raise awareness of malaria and our research by speaking at Rotary Clubs and conferences.
It is a vital partnership for the success of our malaria vaccine program.
Is the elimination of malaria by 2030 an achievable goal?
Ultimately, the goal is to develop a malaria vaccine and that is where we are heading.
Since 2010 there had been an approximately 50% decrease in the number of deaths and cases world–wide due to increased usage of bed nets and the prompt diagnosis and treatment of infections. But in 2018 the World Health Organization (WHO) reported for the first time in over a decade that there was no longer a decrease in the number of malaria–related deaths and cases worldwide—that these numbers were stalling and in some malaria endemic countries the number of cases were in fact going up. The reasons for this are varied. For example, sometimes for cultural or social reasons, bed nets are not used at all or are not used correctly. The smell of the insecticide treated nets may be off-putting or they may be given to visitors to use or be used for other purposes, such as fishing. Also, in many countries, the malaria parasite has developed genetic mutations which makes it resistant to anti-malarial drugs currently used clinically in the field so that they are less effective or not effective at all, and this drug resistance is spreading. Incredibly, in some places in the South Pacific, it also has been shown that mosquitos are modifying their behaviour—so instead of just biting at night they are starting to bite at other times when people aren’t under bed nets.
Of course, COVID-19 has now been thrown into the mix and, early in the pandemic, WHO predicted the potential for a doubling of deaths and cases for diseases like malaria, HIV and tuberculosis over the next year or so. In many malaria endemic countries, COVID-19 has disrupted health infrastructure and health systems—people aren’t spraying for mosquitos, the hospitals are overwhelmed, people can’t get access to medications and, significantly, there is an increased potential of misdiagnoses as COVID-19 and malaria present very similarly in the early stages of infection. I believe that has probably set us back.
So, whilst we need a target to move toward, such as the elimination of the malaria epidemic by 2030 under United Nations Sustainable Development Goal 3, the end line may need to be adjusted unless we can get on top of this current pandemic quickly.
‘Your career path isn’t always what you envisage at the outset, so you need to be able to adapt and the best way to do that is to have passion, a diverse skill set and good network connections.’
What advice would you give to somebody interested in a researcher career?
Find your passion, something you love to work on—research can be both incredibly rewarding and challenging. You need the passion to keep you going through the challenging times.
Diversify early—if you have a good diversification of skills, it will really help you with employment and career opportunities.
Network—I personally don’t find it easy to just go up and talk to somebody I don’t know, but it sometimes is really a case of not what-you-know but who-you-know. You never know what career opportunities may present themselves via your network.
Seek out industry placements and industry mentors—there is a lot of opportunity in industry. A focus of Griffith is to give students the opportunity to have both research and industry placements. This enables students to see how they can have other experiences after their PhD that are different to the basic academic path.
I completed an industry placement during my PhD and I was glad I did as it gave me some additional skills specific for clinical trials that I have ended up using now and allowed me to confirm my interests.
Your career path isn’t always what you envisage at the outset, so you need to be able to adapt and the best way to do that is to have passion, a diverse skill set and good network connections.
Interested in learning more?
Read Dr Danielle Stanisic’s research and learn more about malaria on Griffith Research Online.