impaginato piccolo - Società Italiana di Parassitologia (SoIPa)

Parassitologia 50: 141-141, 2008
The role of research in the fight against malaria: the Italian
contribution to malaria research in the frame of north-south
cooperation in the last 25 years
F. Esposito 1, G. Majori 2, M. Coluzzi 3
1 Department of Experimental Medicine and Public Health, University of Camerino, 62032 Camerino (MC), Italy; 2 Department
of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Roma, Italy; 3 Department of Public Health
Sciences, University of Rome “La Sapienza”, Italy
Italy has an extraordinary tradition in malaria research,
from the Grassi discovery of the parasite life cycle, to
the Coluzzi breakthrough into the species problem of
the anopheline vectors. Furthermore, Italy was a malaria
endemic country until the first half of the XXth century
and therefore has been the theatre of large scale
‘experiments’ aimed at controlling the disease and its
transmission. Undoubtedly, these experiments and their
successful outcomes guided, sometimes with exceedingly
optimistic foresights, control programmes in various
areas of the world. A deeper insight into the determinants
of the successful malaria eradication in Italy
allowed the roots of that success to be tracked and
wiped off many illusions. Thus, over the years, Italy has
remained a reservoir of expertise, and Italian scientists
have been involved in malaria research and control programmes
funded by international agencies, from the
‘Garki Project’ in Nigeria, to the most recent programmes
devoted to counteract malaria resurgence in
problem areas bordering the south-eastern fringe of
Europe.
Interestingly, in the late 70’s of last century, when the
big draught hit the sahel area south of Sahara, there
was in Italy a renewed rise of interest for tropical diseases,
especially malaria. Then, the Italian Department
for Co-operation in Development supported the idea
of a malaria control programme in Burkina Faso,
which actually started in 1983. Although specific
results in terms of reduction of the malaria burden are
just in the process of becoming reality 25 years later, it
has to be recognised that the programme gave enormous
contributions to a better understanding of
malaria under extremely high transmission conditions.
New and innovative methods for malaria epidemiology
were established, which allowed previously unthinkable
levels of transmission to be detected. A complexity
within the vector populations which was before
only guessed was definitely demonstrated. The very
special characteristics of the immune response against
the malaria parasites - of paramount importance in
view of a malaria vaccine development - were elucidated,
together with an unexpected heterogeneity in the
susceptibility to malaria in individuals belonging to
different ethnic groups. Various vector control tools,
including insecticide treated nets, were challenged
with the most unfavourable conditions which can be
imagined, and the obtained results led to the adoption
of the strategy within the national control programmes
in Africa. Home management of malaria cases was
extensively tested, and also in this case the positive
results induced its incorporation within control programmes.
In conclusion, the Italian Programme in
Burkina Faso, with the participation of various
research groups from Italian and international institutions
represented an exceptional blend of curiosity
driven and translational research which paradigmatically
demonstrated the need for both components for
a significant advancement of knowledge. The empowerment
of the National scientists constitutes the most
relevant strength of the Programme. The Italian
research institutions provided a similar contribution in
other African countries and in particular in
Madagascar when, at the end of the ‘80s, malaria
transmission reappeared on the Central Highlands
with deadly epidemics. In that dramatic situation, the
Italian malariologists, with funds made available by
the Italian health cooperation, were able to assure
technical assistance and leading operational research
to the National Malaria Control Program since the
resurgence of malaria. The international funding agencies
strengthened in the following years the fundamental
role of the applied research to the success of malaria
control campaigns.
The most recent years showed unfortunately a decrease
of interest by the Italian public donors, a surprising
event, in view of the opposite attitude by public and
private donors worldwide. Hopefully, the Italian
Malaria Network may be instrumental to reverse the
situation and renew the brilliant tradition of the Italian
School of Malariology.