Nick Day: Infectious diseases in South East Asia
The Mahidol Oxford Tropical Medicine Research Unit (MORU) is a collaboration between the University of Oxford and Mahidol University, and was established with the Wellcome Trust in 1979. MORU aims to fight the infectious tropical diseases affecting rural communities in Asia and elsewhere in the developing world. MORU's malaria research aims to directly improve the treatment of the disease globally. It's researchers focus on the treatment of severe malaria, the spread of antimalarial drug resistance, and the pathophysiology of falciparum and vivax malaria. These studies are used to formulate novel adjuvant therapies, and have been translated into recommendations for the use of artemisinin based combination therapies.
From Mahidol University in Thailand, Professor Nick Day talks about rural populations in Thailand and the challenges they face when confronted with infectious diseases.
ND: The Mahidol Oxford Tropical Medicine Unit (MORU) is a collaboration between the University of Oxford and Mahidol University, funded mainly by the Wellcome Trust. It is more than 30 years old now; the MoU was signed between the three organisations in 1978, the unit opened in 1979 and we have been working here, and in the region, ever since. The major health challenges in this region are those of the whole world. Within 2,000 miles of Bangkok, a 4-hour flight, you have half the world’s population. You have very rich countries, such as Singapore and Hong Kong, you have densely populated countries which are developing fast like India and China, and in South-East Asia you have both very poor countries like Myanmar, Lao and Cambodia, and up and coming middle income countries, particularly Thailand but also Vietnam. You have the problems of tropical diseases in rural, poor, malnourished populations, but increasingly you have urbanisation and the problems associated with urbanisation and the diseases of the rich are increasingly a problem. We traditionally concentrate on tropical diseases - they tend to be infectious diseases but also some nutritional deficiencies. Malaria, for example, in particular has been a problem for a long time in this region.
Q: What are the major lines of research that have developed in the last five years?
ND: Approximately half of what we do is malaria research. And over the past 25 years we have worked on the artemisinin group of drugs. These are very powerful antimalarials which are derived from plants and were discovered from research into Chinese traditional medicine. The Unit has been very active in developing artemisinin based combination therapies and getting them accepted as the standard first line treatment for malaria throughout the world. In the last five years we have shown that the intravenous form of artemisinin, artesunate, saves lives in severe malaria when compared with the traditional intravenous quinine. This is associated with about a 30% reduction in mortality both in South-East Asian adults and also in African children. That is one of the major findings of the last five years. In the last five years we have also seen the emergence of artemisinin resistance on the Thai Cambodian border for the first time. It has probably been present for ten or fifteen years, but now it has got such prevalence that we are able to detect it clinically and it is beginning to cause a public health problem.
Q: Why does your research matter and why should we put money into it?
ND: We only do research that has a direct impact on health or is possibly going to have a direct impact on health; we don’t do blue sky research for example. The laboratory research we do is to support clinical research. In general we look at the illnesses in the populations that we work with and we let the patients ask the questions; that is what drives our research. Looking further afield our malaria research is particularly important because we want to try and stop, or at least provide some tools for stopping, the spread of artemisinin resistant malaria parasites from South-East Asia, where they are now, to Africa where the great burden of malaria is because that will then translate into a major problem for malaria control.
Q: How does your research fit into translational medicine within the Department?
ND: I think most of what we do is translational. Increasingly we don’t just look to see what treatments are more effective or what diagnostics have more diagnostic utility, we also look at the practical implementation of new therapies and we look at the health economics of that. Our health economics team look at the whether it is cost effective to deploy a new treatment, vaccine or diagnostic for example. In that way what we do is practical. Hopefully we will make a difference in terms of health.
Q: Are there any unique challenges to working in an overseas environment?
ND: I think there are challenges to working in any environment and a lot of the challenges that we face here are the same as those that researchers face in Europe or North America. The unique challenges are the wide variety of cultures that we work with, although of course this is increasingly the case in places like Oxford with globalisation. We also have to do a lot of travelling as many of our thirty sites are quite widely dispersed.