In 2019, Dr George Busby and his team of medical experts travelled around Africa, on a mission to learn and gather data about Malaria from the most remote parts of the continent. As we approach World Malaria Day (April 25th), we though we'd catch up with him a year on to discuss his legacy, and what’s next for the Mobile Malaria Project.
It’s been a properly fascinating and superbly positive project for us, watching from the outside. For you guys it must have been doubly so. What were the main findings of your trip?
Over the seven weeks of the trip we travelled from the warm, dry deserts of western Namibia to Mombasa on the rainy Kenyan coast. With the exception of the very beginning of the trip, despite the diversity of landscape and environment, malaria and the mosquitoes that carry it were present throughout.
Our main finding was that it is possible to generate genetic data with the kit and equipment that can be carried in the back of a Land Rover. We proved that large labs are not necessary to generate the sorts of data that had previously only been produced in such large centralised facilities.
So what can be done with this data?
This was a much softer finding for us, but understanding why anyone would want to generate genetic sequence data in the field was an important take home. We had our ideas before the trip, for example the tests we conducted showed that it was possible to identify parasites that are resistant to antimalarial drugs and mosquitoes that are resistant to insecticides, but an obvious area for us to explore was to understand what researchers and malaria control programs could do with this sort of data.
There were a number of use cases, like monitoring the effectiveness of interventions like mass drug administration, when everyone in a village or town is given antimalarial drugs, regardless of whether they are sick. This blanket coverage is thought to stop the spread of malaria through asymptomatic people (those individuals who have parasites in their blood, but who don’t appear sick), but there’s also the potential that this speeds up the evolution of resistance. Having a cheap way of assessing the population for the presence of resistance is an important step to ensuring that mass drug administration doesn’t inadvertently cause a super-resistant parasite to evolve.
Understanding which species of mosquitoes inhabit an area is another use case that genetics can help to understand. Several different species of similar looking mosquito transmit malaria, and although they look the same, they can behave quite differently. In Kenya we learnt that a species of mosquito called Anopheles funestus is becoming more prevalent. This mosquito bites during the day, which renders bednets, the single best strategy for controlling malaria, far less useful.
So we learnt a lot about how genetics might be used by people in-country. However, we also found that the skills required to analyse genetic data were lacking across the continent. Although the technology we trialled to generate genetic data is small, the data it generates is big. Gigabytes of data are generated from these little machines, and it requires computational skills in coding and data science to understand and translate. So if we’re serious about getting genetic data into use in Africa, then we need to think about ways in which we can upskill local researchers to enable them to exploit the full potential of the data.
We also learnt how to ask the right questions; how to engage with local researchers and people and to understand what was important for them when it comes to malaria research and control.
Have there been any developments or changes in how malaria is being tackled as a result? Are there plans to introduce changes?
We very much see the Mobile Malaria Project as a proof of principle for two things. The first is that genetic data can be generated with minimal equipment. The second is that people in-country were excited and motivated to take on learning and using it. After our return we have concentrated on trying to secure funding to develop these foundations further. Working with our colleagues in Zambia, we’re hoping to optimise the technology so that it’s cheap to use and the results are easy to understand. A key consideration for this is to work with our colleagues from the outset and to develop approaches together. We’re confident that some money will come our way.
There is a growing appreciation that data of many different types (including genetics) is needed to help us down the road to malaria elimination. Whilst it would be crazy to suggest that our project has changed anything in the short term, it has shown that locally driven science can contribute to the global effort, should sufficient funding and training be targeted in the right places.
What next? Same project, focused on genetic sequencing, or something different?
We’re in the late stages of negotiations for further funding for two projects, one in Zambia to work on malaria parasite genetics and one in Kenya to work on mosquito sequencing. We hope to train up some of our partners to use the technology and share some of our skills with them so that they can use it for their own research. We hope that this will lead to many more trips to Africa to help build capacity. Watch this space!
Where have you been with your Haskells since? Any further adventures?
It’s been a busy time since we returned. Isaac, a medical doctor, moved to Chicago to work as a government epidemiologist. His Haskell is with him in the US. Jason has worked tirelessly to finish his PhD research and has a trip to South East Asia planned. Apart from a few days walking in the Welsh Mountains, I haven’t travelled far. I wear my Haskell every day; as a constant reminder of the opportunity given to me through the Land Rover Bursary, and as inspiration and motivation to get planning for the next big adventure.
Thank you to George Busby and his team for the incredible updates, stories and photography.
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