Vivax malaria in Western Indonesia

To learn most about a disease, you need to go to the area where the burden of that disease is greatest. For that reason Dr Kevin Baird, director of the Eijkman-Oxford Clinical Research Unit in Jakarta, Indonesia, regularly makes a flight to the island of Sumba in the remote eastern part of the Indonesian archipelago. There and at other study sites, he and his Indonesian colleagues evaluate the impact of malaria, and the effectiveness of various tools in combating it.

'Indonesia is the fourth largest nation in terms of population', says Dr Baird, 'and it has very substantial infectious disease burdens of malaria, TB, dengue and other tropical diseases.' Malaria is caused by parasites that are carried by mosquitoes. Worldwide, the forms of malaria that are most often life-threatening are caused by a parasite called Plasmodium falciparum. Plasmodium vivax is also common, but until recently it was thought to be less of a problem. Dr Baird's studies at Sumba and elsewhere are showing that this view is mistaken.

'Vivax malaria causes people to be very sick very often', he says. 'We are finding that it kills people far more frequently than has been recognised historically. We focus on this infection because it has been neglected, and consequently the tools for dealing with it are poor.'

Much of the work involves training local doctors and scientists. 'Bringing safe and effective drugs to bear is priority number one', says Dr Baird. For example, there is only one drug, primaquine, that is effective against relapses of vivax malaria. However, in people who have an inherited enzyme deficiency, primaquine is toxic. This condition, G6PD deficiency, is relatively common in malaria-endemic areas because it provides some protection against disease caused by malaria parasites. Because doctors do not know how to diagnose this deficiency, they are afraid of causing harm by using the drug.

EOCRU is based within the Eijkman Institute of Molecular Biology. 'We recognise that local research capacity is the key to progressing health agendas', says Dr Baird. 'We are able to buy relatively sophisticated equipment that supports competitive biomedical research, which we aim to put to work in the labs of our local partners.' This approach fulfils the aim of building local research capacity as well as respecting Indonesia's reluctance, like that of many developing nations, to see biological research material exported.

'We seek to bring the technical expertise here, both people and equipment', says Dr Baird. 'This is the clear win-win.'