Science and Innovation

Interview by Teresa Bau for Barcelona Science and Universities and Núvol.

Malaria is a disease caused by a parasite transmitted by female mosquitoes of the Anopheles species. A campaign to eradicate the disease was launched in the 1960s, mainly by the World Health Organisation (WHO), but was only successful in northern countries. In the South, it still causes many deaths: last year, 249 million people worldwide contracted malaria, and in Africa, a child dies of the disease every minute. One of the most prestigious scientists in international malaria research is Dr. Carlota Dobaño, who leads a line of research on immunity at the Institute for Global Health in Barcelona (ISGlobal).

Why is it that after so many years of fighting malaria there are no effective treatments, and it has not been possible to eradicate it?

There are treatments, but the parasite is becoming resistant and new ones need to be developed because there are areas of the world where patients do not respond to the available drugs. In addition, the fact that malaria is caused by a parasite, which is a more complex pathogen than a virus or bacteria, makes it more difficult to develop vaccines, and it takes a long time to develop them.

A few days ago, the first malaria vaccination programme was launched in an African country, Cameroon. Are you optimistic about the impact these campaigns can have?

There are currently two vaccines available, the RTS,S/AS01E (under the trade name Mosquirix), which is the first one recommended, and a more recent one, the R21/Matrix-M. It is a first generation of vaccines with moderate efficacy, but if we take into account that many people are infected and could die, it is already a very important first step. If we add to this other control measures, such as drugs, mosquito nets, etc. all this will be useful to control the disease, but not to eliminate it completely. We need new tools and more effective vaccines to achieve total eradication.

Although the answer seems obvious… Why hasn’t as much effort been put into eliminating malaria as other diseases, for example, COVID-19 or AIDS?

The answer is clear: it is a disease that affects the poorest countries. The fight against malaria has always been an effort of institutions that have prioritised social aspects and solidarity over profit. It is difficult for European or American institutions to focus on a disease like malaria.

Your research focuses on immunology, what are your goals?

As I said, we have vaccines, but they are not effective enough, and we need to improve them. We are working to understand why these vaccines work in some children – this group is the main recipient – while they don’t work in others. We study the immune system of people who have had the disease (their antibodies and T-lymphocytes), what differences exist at the immune level between people who respond well to the vaccine – when it protects them from the disease – and those who do not. The aim is to be able to develop new generations of vaccines that are increasingly effective.

Is there any forecast of when they will be available?

The fact that we have two vaccines – and they are recommended by the WHO – is already a big milestone. The other thing is that there is not enough for everyone to benefit. The challenge is that although the market is large, the purchasing power of the countries that need them is low. This makes it dependent on the goodwill of institutions and pharmaceutical companies investing in this area.

Why do some people have greater immunity than others?

This is the big question… When people are born, babies, that’s when they are most vulnerable because they have very little immunity. If they catch malaria in the first few weeks of life, that’s when they are most at risk of dying. If they survive, they become immune with age, but some people develop more immunity than others – some, for example, get sick again. This is what we are investigating, what makes some people have an immune system that protects them more than others. Generally, when an adult person gets malaria in a highly endemic area, they go through it like the flu, they rarely die. It is children who have a higher mortality rate. We have seen that immunity depends on age and the number of times a person has been exposed to the parasite.

Climate change is causing diseases typical of tropical countries to burst into areas where they did not exist before. Do you think malaria could reach our lands?

Malaria had existed until the civil war in the Ebre and Llobregat delta, there was a lot of it. The water of the delta is a fantastic place for mosquitoes to breed. The campaigns carried out in the 1960s eradicated it.

Malaria, like other mosquito-borne diseases – for example Dengue – is linked to climate, and we are now seeing epidemiological changes linked to rising temperatures. Maybe it is not so obvious here, but we have some examples where it is clear. In Ethiopia, which is a mountainous country, we are seeing malaria reaching higher and higher elevations where it did not exist before. In several areas of the planet where there was no malaria, there is now malaria. In Catalonia, it is more difficult to predict, there must be a series of circumstances, such as a high number of infected people. But we have surveillance programmes to stop it in time. From time to time we have some cases, but right now I don’t see it happening in the near future.

Let’s talk about your professional background. What are the experiences you have had at various research institutions in different countries that have had the greatest impact on you?

I would highlight the London School of Hygiene & Tropical Medicine, one of the world’s leading institutions in Tropical Medicine, where many networks working in this field come together. Also, the University of Edinburgh, where I did my PhD, which has a very strong malaria department. My stay at these two institutions opened many doors for me. It also marked me and opened contacts for me to be able to do my post-doc at the US Naval Medical Research Center, given that they have an important focus on tropical diseases so that the US military can travel all over the world.

You lived for a while in Africa, an experience that made you decide you wanted to focus on this disease.

When I was studying pharmacy, I volunteered in Equatorial Guinea. There I saw the impact of malaria: many children died, others got sick and could not go to school, their parents could not work…. I saw that there was no vaccine to prevent it, and that made me decide to do research in this area.

I was also impacted by a second stay in Africa during my PhD, specifically in a centre in Malawi that cared for children with cerebral malaria. These are children who end up in a coma and many dies…. We did an autopsy to determine and understand the cause of death. It was very interesting and impressive at the same time.

Finally, I worked at ISGlobal’s collaborating research centre in Manhiça, Mozambique, where I supervised the doctoral theses of a number of researchers.

In your professional career, have you encountered any specific difficulties because of being a woman?

During my time as a junior researcher, I did not notice any gender discrimination. The only time I had to face difficulties was when I became a mother. It is very hard when, in an academic career, the moment of being a mother coincides with the moment of becoming independent and becoming a group leader in the field of research. This stage demands a great deal… It is a world in which there is a lot of competition. At such a complicated time, there is no support for women, and a lot of them give up because they decide that it is not worth it. In my case, I had a strong will to go on and the good fortune of having a supportive family environment (my husband, my parents…). Without that, I couldn’t have got to where I am now. It is unfair how little support we women scientists have at this critical moment.

How do you see the state of science in Catalonia, is there enough support for research?

Here we have a lot of talent and the success rate in attracting competitive science funding compared to other nearby territories is high, but, of course, if we compare ourselves to northern European countries or the United States, we do not have enough support and the necessary investment. We do not have stable funds that allow us to continue in times of crisis, and this is a major constraint. There should be more investment in order to have more staff and to be able to finance what research costs.

What advice would you give to a girl who wants to go into science?

First of all, she should have a vocation, curiosity and a strong academic and study capacity, as it is a very demanding field. But the most important qualities are resilience, focus and perseverance: it’s a fascinating world, but you often run into obstacles – like being denied a grant or an article – and only people who are clear and persistent go ahead. I think this is an issue that today’s generations need to work on…. In fact, the number of vocations is decreasing.