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About the Author

Bart Knols
Medical Entomologist (Dodewaard, Netherlands)

Bart G.J. Knols (1965) is the Managing Director of MalariaWorld, the world's first scientific and social network for malaria professionals. He is a malariologist with a Masters degree in Biology and a PhD in Medical Entomology from Wageningen University, the Netherlands. He also obtained an MBA degree from the Open University (UK) in 2006, for which he won the prestigious international ‘MBA Student of the Year 2007 Award’ as well as the Alumnus of the Year Award from the Open University. With 11 years of working experience in Africa he has managed large-scale research and vector control programmes on malaria for ministries, international or national research institutions. He has worked for the UN (IAEA) as a programme manager for three years, has served as a consultant for the World Health Organization, and is currently a Board Member of the UBS Optimus Foundation, the second largest charity in Switzerland. He has published over 130 peer-reviewed research articles, has written 16 book chapters, and has served as senior editor on a WHO/IAEA sponsored book on implementation research. In 2007 he co-edited a best-selling book titled 'Emerging Pests and Vector-Borne Diseases in Europe'. He received an Ig Nobel Prize (2006), an IAEA Special Service Award (2006), and in 2007 he became a laureate of the Eijkman medal (the highest award in the field of tropical medicine in the Netherlands). He has been a member of the Royal Dutch Academy of Arts and Sciences since 2004. Bart held an Assistant Professorship at Wageningen University until April '09 with projects across Africa. He currently directs K&S Consulting, a firm he founded in the beginning of 2007.

Post

Malaria: Can science cripple development?

Published 11th April 2010 - 26 comments - 17849 views -

Surely not, right? Being a scientist my first response is ‘Of course not!’. Hasn’t Flemming’s discovery of penicillin saved millions of lives around the globe? What would our healthcare look like without centuries of scientific endeavour? There is, regretfully, another angle to this…

Science for science’s sake

Nobel‘They will then quickly run to collect their Nobel Prize before the whole system collapses’ uttered the late Professor Chris Curtis of the London School of Hygiene and Tropical Medicine cynically. He used these words during a talk I attended in 2005, in which he described the possible ill fate of genetically-engineered malaria mosquitoes. Mosquitoes to which genes have been added to ward off an infection with the deadly Plasmodium malaria parasite. Science turning bad mosquitoes into good ones. But a simple mutation could spoil the victory over malaria and the disease would return after a short period of success. But perhaps long enough to receive the prize of the prizes in science.

His words shocked me. Could anyone doing research on malaria be in it for personal gain and not for solving the misery of millions around the globe? Or at least not have both goals in life?

The same Prof. Curtis published an article back in 1999 with the title ‘Can molecular biology contribute usefully to vector control?’. In it he argued that scientists around the world are too much focused on using the latest technologies and new research methods on the malaria system. And score publications in the world’s leading scientific journals, rather than working on practical solutions that can save the lives of millions of children. He frequently talked about ‘NPS’, or ‘Nature Paper Synthetase’ to describe experimental studies that yielded results that Nature or Science might publish but meant nothing in terms of solving malaria in the real world.

Is this true? Surely any piece of scientific research, basic or applied, will contribute something, right? This question is worth considering. After all, billions of dollars are spent on research annually…

Massive output, marginal impact

More than 3000 scientific articles on malaria are published each year. We know this, because we conscientiously list them all in our weekly e-bulletin at MalariaWorld. But how many of these pieces of published research really make a difference in the way we control malaria?

Few. Very few indeed. 

Why? Here’s ten points worth considering:

1) Academic malaria researchers have a mandate to generate new knowledge. Not to control malaria…

2) They therefore publish research findings so that the world can learn from these, but the appropriation (i.e. the actual use) of that knowledge remains up to others. Thousands of pieces of malaria research end up in libraries and never get used afterwards.

3) If you work in academics, your career depends on publishing in high-impact journals. ‘You publish or perish’ is a well-known statement in academic circles.science

4) High-impact journals (like Nature or Science) are not interested in malaria in Africa but in things like ‘…omics’ (e.g. metabolomics), high-tech molecular stuff (e.g. RNAi), etc.

5) So researchers that want to build a career focus on this ‘hot’ science and not on implementation research…

6) The net result of points 1-5 above is that more and more the focus is diverting from valorisation of research to hard-core fundamental science.

7) Next, publishing in Nature or Science will dramatically increase your chances for funding…

8) Which is needed to build your lab (and feed your family) and employ PhD students and post-docs…

9) Who follow in your footsteps because they also want a lab of their own (and start a family)…

10) So they seek out even more sexy science to work on. All of this results in an ever-increasing gap between the focus of science and the science that the real world of malaria in Africa needs.

 

These observations were nicely graphed by Kenyan malariologist Dr. Clifford Mutero:

science cripples

There is an overwhelming amount of malaria research that is upstream, basic and lab-based. That’s where most researchers are found. Those that work with communities and researchers in developing countries to seek applied and sustainable solutions for malaria are few and far in between.

Can it be concluded that modern science is crippling malaria control? I talked to three University professors about this recently (from the USA, The Netherlands, and the UK) and they all agreed. The focus of much of contemporary malaria research is wrong. That is worrying, to say the least.

DDT: A good example

1874: The insecticide DDT first synthesised…DDT spraying

1935: DDT’s potency as an insecticide discovered…

1955-1962: DDT responsible for saving countless lives around the world…

1962: Rachel Carson’s book ‘Silent spring' condemns DDT…

1972: USA bans the use of DDT, Europe follows…

1972-2000: Countless people die in the developing world because of the ban on DDT…

2000: Persistent Organic Pollutants treaty (POPs treaty) underway…

2004: DDT back on the agenda for malaria control…

2006: WHO backs the use of DDT for indoor use against malaria…

2010: 4-5 million kg of DDT used for malaria control.

Seventy-five years since the discovery of this potent yet highly controversial insecticide, it is back in the mainstay of malaria control. This week, in the Wall Street Journal, Richard Tren and Don Roberts condemned the efforts of politicians in Washington and Brussels to enforce a new ban on this insecticide. Apparently Tren and Roberts also believe that nothing has come out of the science box that matches the power of this pesticide. More food for thought.

Seventy-five years of malaria research has brought us back to where we were in 1935. 

Tens of thousands of research papers, billions of dollars, and all we have come up with is to fill our knapsack sprayers once again with ‘good-old’ DDT.

Is science crippling development? 

 

 


Category: Health | Tags: development, science, ddt, publishing,


Comments

  • Maria Kuecken on 11th April 2010:

    Hi, Bart.  Really interesting topic.  I imagine the same type of bias holds for academics in other disciples as well.  The DDT example is extremely telling. Just curious—how much more does it cost to run applied, participatory research compared with the other options?  And also, do you have any thoughts about how the incentive structure for research could be realistically changed to encourage more applied studies?


  • Bart Knols on 11th April 2010:

    @Maria. Thanks - and you raise two important points. First, applied and field-based research is normally one or several orders of magnitude cheaper than high-tech lab-based science. Besides the costs of machinery and consumables that can be extremely high, staff salaries and overheads at academic institutions in the North are also very much higher than those in developing countries.All the more reasons to empower scientists and research institutions in the South…

    Your second point is intriguing. One way in which this could be done is when funding agencies and universities no longer base the success of their research on the number of high-impact publications but on the impact that research has on solving problems like malaria. I would be a strong advocate of introducing the ‘relevance factor’ besides the impact factor, so that peers can rank a scientific contribution on its true merits in terms of actually aiding the fight against malaria. Expectedly, I don’t see much support for this idea around me…


  • Yvonne Machira on 12th April 2010:

    Very insightful; food for thought. Nonetheless, perhaps governments should play a bigger role in determining and providing incentives for a specific research agenda that would/could contribute to practical solutions.


  • Maria Kuecken on 12th April 2010:

    Thanks for your insight, Bart.  I don’t know much about scientific research, but are independent funding agencies usually public, private, or both?  I am all for the relevance factor, but as you say, there doesn’t seem to be much backing for that, unfortunately…


  • Bart Knols on 12th April 2010:

    @Yvonne. Thanks for comment. Indeed there is a role for governments. Beyond this, I often talk about a second wave of independence, the scientific independence. Today the vast majority of funds flow North-South in malaria research, and the North therefore not only holds the purse but also sets the agenda…


  • Bart Knols on 12th April 2010:

    @Maria. Funding can come through any of the options you list. Although I have no figures, I think that funding through the private sector is much more geared towards product or process development, and less tolerable towards science for science’s sake.

    It will all start with developing countries setting their own research agenda, which funding agencies (up North) would have to abide with. This is where the issue gets really sensitive…


  • Yvonne Machira on 12th April 2010:

    True, direction of funds and the research agenda is North-South.  I’m a researcher living and working in Nairobi and sadly coordinated research efforts by the government not only in malaria but also other health issues are literally non-existent.  I truly support a ‘free market’ research arena, but in a country like ours with pressing problems for urgent solutions, more stringent control could be placed more so in bi/multi-lateral research agreements with the government seeking to skew funds where most needed.

    The flip side of all this, perhaps we as researchers have not been as innovative and as aggressive as we should be in highligting pertinent research problems and seeking to attract funding for them.  We tend to take what’s available or pursue what’s of interest.  A philanthropic perspective to research is thoroughly needed.


  • Bart Knols on 12th April 2010:

    @Yvonne. Having worked in Kenya for 5 years myself, I have a reasonable feel for the situation you are in. I fully support the seconf part of your comment. Change should come from the bottom up - from researchers, not from the negotiations high-up. ‘Taking what is available’ is absolutely true. The institute I worked in in Kenya was desperate for funding. Almost anyone, with whatever research they had in mind, was welcome, as long as they brought a big bag of cash. I know for a fact that most other large research organisations in Nairobi function in exactly the same way. The interest of southern institutions is the interest of the donor with the largest wallet. That is intinsically wrong…


  • Aija Vanaga on 12th April 2010:

    After this post it feels that not only governments are going in the wrong direction.


  • Bart Knols on 12th April 2010:

    @Aija. Indeed, but as discussed with Yvonne above, it is only the researchers that have the ultimate responsibility for directing the science they believe in. Once researchers take this responsibility, they may have a chance of contributing to the focus and direction governments take.


  • Roger on 14th April 2010:

    Bart, you described the loop very well!

    Research Scientists are paid to search, not to Find! wink

    Okay, that’s a bit cinical, but careers are built on publication number and journal ranking, not on the impact of the work done.
    This however is changing (see http://bit.ly/bNLZfA), and research projects will now have to include an impact plan. Thought this is somewhat obvious, it was not compulsory before. Not that I completely agree with it because of the clear danger of the impact plan actually impacting the kind or research done…


  • Yvonne Machira on 15th April 2010:

    @Roger, thanks for the link.  We adopt a similar strategy in the organisation I work for, having all research proposals (prior to approval) indicate intended plans for communication, dissemination and policy.  The challenge however is that beyond a workshop or two, the researchers have no motivation, or mandate for that matter to follow it through.  I sense the need to involve ‘advocates’ from the start, they’re experienced in policy advocacy and that way, researchers remain as such, doing research.  It’s not easy I know, a rather convoluted process but one worth thinking about.


  • Bart Knols on 15th April 2010:

    @Roger. Maybe you consider your comment cynical, but is that really so I wonder. There may indeed be too much searching and too little finding. I like you way of putting it.

    Thanks also for this very useful link. I had a look at it and it certainly appears to be a move in the right direction. With societal impact as the ultimate goal whilst safeguarding the role of basic science…


  • Rune Bosselmann on 15th April 2010:

    Hi Bart, do academic scientists necessarily have to solve any problems as a direct consequence of the academic output? I would argue that few companies have put out more applications for vector control than our little outfit over the past 8years. And that by sampling from both applied and academic research.

    It s hard to predict exactly academic research will result in real world impact. Eg when designing a mosquito control campaign using a larvicide in an urban area, you may need input on mosquito population dynamics, flight pattern etc in order to plan properly. This input may be found in eg from your “genetically engineered mosquito” study.

    I can easily appreciate your (10) point(s) - as well as vanity as a motivator of scientists. But should academia necessarily be those who sought the valorisation of research? Private outfits have a system of incentives already, the market, and it may work still.

    The DDT story to me is not one of failed science but wrong policy. If only applications that can be applied globally are endorsed for funding by the authorities (on malaria), such as spraying and nets, it doesnt really matter if you as an academic scientist can demonstrate a new wonderful but specialized tool. It will still remain in obscurity. It is (WIN) policy that only tools that can be applied universally will be endorsed for funding. Hence, no lavicide is recommended for funding as its scope of application is limited.

    If policy was changed away from silver bullet type interventions to interventions based observations on biological and sociological etc context (more “science like”) maybe then science would have a greater change of actually making an impact.

    DDT is great as it is cheap and it can be applied everywhere - or so people think. Of course, it will recieve heavy endorsement by policy makers and influencers (like AEI). So maybe politics crippled “malaria science”?


  • Bart Knols on 16th April 2010:

    @Rune. Thanks for your insightful comments. It can be debated whether or not scientists should be ‘problem-solving’. My personal opinion when it gets to scientists working on diseases like malaria, dengue, trypanosomiasis and a whole scala of other poverty-related diseases, they should. But I do agree that more progress in terms of applicable solutions has orignated from the business world than the academic world.

    But isn’t that in itself food for thought. Should more R&D be based in entrpreneurial and business-like environments?

    I am not sure if only tools that can be used in a blanket approach reach the forefront in vector control. If indeed these are considered by global entities like WHO, The Global Fund etc., then this signals ignorance of the heterogeneity encountered across the continent.

    Please let me know what you think,


  • Rune Bosselmann on 16th April 2010:

    Bart, it’s hard to tell if the total of (malaria) academic research should be shifted, by degree, from basic research to applied research or if we have a good balance today. My own (academic) background is in business so my view is that of an outsider (to natural sciences). What I can see is that the concepts we develop for market are not really based in one work of research but the total body of research that is available to us by sampling here and there - and not just in malaria research but also polymer science, chemistry etc. That is great for us because our base becomes rather wide while response time, from concept to market, becomes rather short. We then use academics again in testing the ideas and writing academic (eg sociology) reports on the use of the product or concept, which again may spur further improvements. See our urban mosquito control ‘article series’ as an example.
    Academic science thus become a resource. If academic science was to work all the way from a to z and were rewarded only on the basis they arrived at z, you would need to re-organize the entire world around science as well. Take one of posters at MIM last year on vector control based on spores. Maybe scientists involved did a great job in developing a technical solution but would fail if you asked them to take it all the way an application that was optimized for ease of use, special mechanisms of delivery and other aspects involving other aspects of science. If the same people were to do all this they might either fail or not start in the first place.
    We on the other hand would probably not start from such a basic point of research as the time span from start to finish is too great - esp for a policy driven field like malaria control. We wouldnt start on something basically new that was expected to become a beta of an applicable product in 5 years - as our criteria for doing this is a proper ROI. Science on the other hand can live off of vanity and publications so they can and they dont even have to deliver something they think has a good chance of being a dominant product.

    In regards universal applicability being a criteria for endorsement by WIN (now VCWG) for use in campaigns (and therefore funding) this is really the case. At the AMP meeting in Feb as well as Friends of the Global Fund meeting last year in Paris, the WIN chair explicitly said interventions such as larvicide will not receive endorsement because it cannot be applied universally or even nationally. It is a criteria that an application can be mass distributed in order to achieve any serious funding.
    This is the very reason why we have left otherwise excellent, in terms of efficacy, cost and sustainability, solutions on the shelf for a long time.
    To me it is clear that vector control is likely best when adapted to circumstance but this is not very compatible with the political goal of scaling up at the massive rate we have seen over the past 7years - in order to reach 2010 goals of universal coverage.  But I wouldnt label this ignorant but political prioritizing. If this is wise policy we ll see when the dust settles.


  • Roger Tatoud on 16th April 2010:

    There is two kinds of research, applied, and not yet applied… (said someone I can’t remember the name)


  • Bart Knols on 16th April 2010:

    @Yvonne. I guess that communication and dissemination of results (you have to fill these in most grant application these days) will mostly be dealt with by saying: We will present our results at international meetings and will publish our findings in open-access peer-reviewed journals. That’s not the impact I am talking about. Perhaps better is the word ‘change’ that I am after. Change in the way we control malaria based on scientific outcome… It’s that change that is so hard to see, particularly in vector control. Do you agree?


  • Bart Knols on 17th April 2010:

    @Rune. Thanks for this elaborate view. I am not proposing to shift the entire field of science in malaria towards applied research. Basic research will always be the starting point for new interventions against both the parasite and mosquito. But what I do propose is to shift the balance more towards science directly in aid of interventions close to or already being implemented.

    It is beyond any doubt that most science in malaria does not leave the library following publication and this is the situation we have to change. That’s a challenge for the reasons outlined above.

    Or perhaps, there should be more open innovation and crowd sourcing rather than conventional models of research primarily based in the academic environment.

    It is interesting that you mention the poster at MIM on fungal spores. Spores that kill malaria mosquitoes - a biopesticide. This is a great example, because the whole future of this great new interventions is hinging on the absence of an entrepreneurial entity picking it up and developing it into a product.

    Aren’t there too few intermediates between the field and upstream applied research? Is this what is needed more? Curious to see how you view this…


  • Yvonne Machira on 19th April 2010:

    @Bart, I definitely agree.  Change is a tricky output/outcome to follow through.  I’m unable to think of practical solutions to this dilemma.  At this point, what can we as researchers (practically) do in context of our being boxed in with regard to funds and research agenda?


  • Bart Knols on 19th April 2010:

    @Yvonne - this is the critical question. I personally believe that you being Kenyan working within a Kenyan institution, that you and colleagues could first focus on the issues that YOU would like to research, irrespective of the availability of funding for those ideas.

    Far too often (and I have been guilty of that many times myself) scientists look for calls for proposals and then bend over to submit something that fits the criteria stipulated in the call. Very often, therefore, the research that needs doing doesn’t get done, because organizations holding the wallet simply may not be aware of YOUR needs.

    If Kenyan scientists would draft their own research agenda and float this in front of funding organisations, what would happen?


  • Tullu on 19th April 2010:

    I am in Kenya, these days, for a very small straight forward trial of a larvicide. In just a months time, that I have been here, I have seen a girl and a boy (above 10 years of age) developing malaria. Both of them are very close relatives (sister in one case and a son in the other) of two persons, actually working in the field of malaria research. In both cases the medication started with painkillers at home. In one case, latter, it even involved over dosage ( based on a docter’s prescription) of malaria medicine. Here, I am mentioning people who are educated and have the means to reach a docter within an hour. Imagine what the situation is when that is not the case.
    On the other hand, I am taking malarone every day, use DEET and a bednet, everything I learned from a course “Health risks and prevention of tropical diseases” offered by my university. I am doing all this while I wait for the clearance to start my trial. Maybe I will go for a safari too while I wait. Question is why I didn’t get the clearance before. The answer is I didn’t know I need a clearance and even my supervisors who apparently have years of experience in malaria research in tropical countries they didn’t know too. They describe it to me as a learning experience. I call it, the malaria researcher lifestyle. Spending money on flight tickets, accommodation, food and research material with nothing in mind except for a publication.
    There maybe many reasons for this attitude, which in one way or another fit into the ten points Bart has identified.  The main reason however is dishonesty, with our profession, in what we write down in research proposals and above all how we value a human life.


  • Bart Knols on 19th April 2010:

    @Tullu. Many thanks for this comment and frank opinion of someone actually undertaking malaria research in a developing country. It is precisely as you describe. The focus is on the science, not on getting a grip on malaria in the real world, where children die every day - needless. Best of luck with your research! Let us hope that one day it will be of direct good use and help to avoid the situation you describe ref these 2 children…


  • Marit on 20th April 2010:

    Hi Bart. Thanks for posting this interesting topic. I am a malaria researcher based in the Netherlands and have had first hand experience with the “Science for Science sake” attitude in my former work environment. This was not only the case for the University I worked for, where my field work plans and collaborations with potential industrial partners got shot down and even the phrase “valorisation” had to be removed from my PhD thesis title, but also for the large group of collaborating institutions, where in meetings the project’s progress was emphasized by the number of publications in high impact journals and even the two African partners did not undertake any real field experiments in 4 years time.

    Though I agree with the point that researchers themselves have the ultimate responsibility, I would also like to emphasize that for young researchers it can be very difficult to hold on to their initial good intentions. Especially at the start of your career, a person is highly influenced by supervisors, peers and work environment. It can be, in my opinion, very tempting to just go with the flow and end up using the typical “Malaria kills more than 1 million people each year” in the introduction of your papers, while describing pure fundamental scientific results that are nowhere near translation into something useful. I was very disappointed and demotivated by the way many researchers I encountered pretend to do real important malaria research, and selling it this way to the public and funding agencies, whilst staying far away from actual valorisation and not giving their young, enthousiastic employees a chance to pursue more practical approaches. Personally, I was lucky to work with someone that inspired me to think big and be bold, and I got out of the “science for science” system just in time.

    I think that the actual development of malaria control tools is better off at (commercial) institutions in malaria-endemic countries, where the need to achieve good impact is a real driving force. That’s where the money should go Mr Gates!


  • Bart Knols on 20th April 2010:

    @Marit. This is a very telling story - and does very much stress the ‘10-point problems of academic malaria researchers’ outlined above. Thank you for being so frank about this issue. I certainly hope that more researchers will come forward and express their opinion on this matter…


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