(Production: Pablo Cantudo)
At the end of March, the World Health Organization called on the countries most affected by malaria to guarantee the continuity of services to combat this disease in the context of the COVID-19 epidemic. We wanted to talk about this issue with Elena Gómez Díaz, who directs a research group on genetics and epigenetics of the parasite responsible for malaria at the López-Neyra Institute of Parasitology and Biomedicine (CSIC) in Granada.
“Indeed, right now we are very concerned about how this pandemic is going to affect current programs to combat malaria,” the researcher comments. “ The coronavirus pandemic is beginning to occur, although apparently more slowly, in many countries in Africa and Latin America that were already plagued by very important epidemics. They are also countries with very impoverished health systems: imagine the dimensions that a pandemic like the one that is hitting us can have in a context of lack of resources and infrastructure ”.
In addition to the possible catastrophic consequences of the COVID-19 explosion in these countries, there is also concern about how it will affect the burden of those other diseases that are already being fought there every day. “It is a problem both from the epidemiological point of view and that of a possible setback in all the advances that we have made so far in the monitoring and prevention programs of the disease. It must be taken into account that the malaria parasite responds very quickly to changes in the use of insecticides, drugs and vaccines. It is capable of adapting very quickly to changes, so that an interruption in these programs can lead to the rapid appearance of new strains, and this would mean a very important setback in the fight against this disease ”.
Lessons that come to us from Africa
At a time when the health systems of many Western nations have staggered due to the coronavirus pandemic, it seems necessary to look to other countries more used to dealing with health emergencies of all kinds and learn from them. “We must change the way we look at Africa,” explains Gómez-Díaz. “First of all, there are many countries, with many different cultures and realities. And, on the other hand, we must banish that image so western that we have of Africans. We look at them with sorrow and paternalism, but they are people with many potentialities and capacities, they just need more opportunities and that we stop stepping on them ”.
“One of the problems we are having in the West with this pandemic is improvisation and the lack of structures and procedures. These are things that are already implemented in Africa because they have been facing these terrible epidemics for many years that are taking away millions of people ”, reflects the scientist. “Another thing they teach us is the capacity for community involvement in the response, that is something that we are learning as we go along. We had been many years drifting toward individuality, and now with the pandemic we must return to a community, and that’s the most valuable thing they have to fight against epidemics “.
Drugs against malaria: are they effective against covid-19?
In recent weeks we have heard about chloroquines and other drugs that are commonly used to treat malaria and that have been presented as potential treatments for SARS-CoV-2. “It is very important to understand what drug repositioning consists of: this implies reusing drugs that are already used for other conditions and that, therefore, have passed all the controls to treat another disease. A priori it is a good solution because you save a lot of time, but the problem is that we have evidence of how these drugs work in other diseases, but we do not know what the effective and safe dose is, nor its effectiveness in new pathologies ”.
“Hydroxychloroquine started out with great promise, and over time it has been seen that, in human clinical studies, it does not appear to work as well as expected. It has side effects, the clinical picture of a person sick with COVID-19 is not the same as that of a person with malaria, and also the dose that is required to be effective is much higher. To this day, hydroxychloroquine is not having the results that were expected just a few weeks ago ”.
“In this sense, there are other antimalarials that are also proposed as candidates. One of them is ivermectin, which is one of the drugs that is currently being considered as a possible solution for mass administration to the entire population in Africa against malaria. If it were now used against COVID-19 (it is an assumption, it has not been proven to work either), it could lead to a shortage of this drug for the treatment of diseases for which it is already used. Furthermore, if it were suddenly used on a larger scale and with larger doses, there would be a risk that the malaria parasite would develop resistance ”.
Science has its times
In recent weeks we have been experiencing a constant rain of information related to the new disease with data that, most of the time, have not been contrasted with due scientific rigor. “ We are living in a time of total misinformation. Due to the urgency of the situation, information is being given that is not entirely truthful or faithful to reality. Society needs answers, but scientists must not rush. Evidence is being released that is not such and that it has not gone through all the filters that science has to ensure that the results are true and reliable ”, reflects the researcher. “We are in very rare times, in which many things are questioned, everything is debated and comes to light very quickly without us having time to assimilate and evaluate it from a critical point of view and with a formed opinion. That is very dangerous”.
Science matters
One of the things that seems to have become clear in this crisis is the importance of having a strong scientific system. “Like health workers, suddenly we scientists are on everyone’s lips, we are the heroes and heroines on whom the salvation of the world depends. That is dangerous, because we do our job, which is to investigate and advance knowledge. This task needs time and funding, enough people to work on it, as well as stable science infrastructures and policies ”.
“In Spain we do not have a healthy, well-funded health or scientific system, with an adequate number of people. We are in very precarious conditions, and that is why when there is an epidemic or an emergency like the current one, the answers cannot be given in the way that would be desirable. We do what we can, but the shortcomings are there, and in the face of the next emergencies and challenges we need that scientific system to be healthy and well staffed and resourced. And that society believes in it and sees the need to have it and take care of it. I hope that this perception of the need for science that we have at the moment remains there and lasts for a long time ”.
