 My name is Professor Bob Snell, I work at the Kenya Medical Research Institute Welcome Trust programme and I am a malaria epidemiologist. Well briefly to describe the history of malaria over a hundred years would require more than five minutes but in essence what's happened is that at the turn of the last century about 1900 malaria probably reached its natural extent in Africa which included all of North Africa, all the offshore islands quite a long way south in South Africa as well, Southern Africa and then in the first sort of 50 years, 50, 60 years or so I mean fantastic progress was made, I mean malaria was eliminated for all of North Africa there was no malaria in Reunion, Mauritius so control efforts had actually shrunk the map of malaria in Africa down to a section below the Sahara running all the way across and all the way down into South Africa I mean South Africa had also made progress I mean it shrunk its map of malaria further and further east to a constrained area around Kwazulunatal and Polanga but largely I mean there was a huge number of people still living under sort of intense malaria transmission from about 1970 all the way to today and the map hasn't really shrunk very much since and within there there has been a big reduction in the likelihood of being bitten by a mosquito infected with malaria so the number of people who have malaria in their blood has also dropped dramatically but it's gone in waves so the first wave was when we introduced DDT and chloroquine in the 1940s after the Second World War there was a big drop then and it remained quite low for a long time until we had the perfect storm when there was El Nino epidemics in the 90s increased rainfall, big sort of flooding and we had emerging resistance to chloroquine so then we had a massive peak I mean a huge epidemic across the whole continent and that's when the world woke up and realised that we had to do something and then big efforts made to raise more money global fund support, rollback malaria initiative, things like that and we introduced two other magic bullets insecticide treated bed nets and Artemisinin based combination therapy and malaria you saw then began to drop and we're at a stage now where it's much lower it's the lowest it's ever been for over 100 years the thing is it's probably stagnated so now what we've seen today is a sort of bubbling along at a lower level but still there and still affecting millions of people across Africa well Africa is home to 98% of all the malaria burden worldwide I mean over 90% of all the deaths occur in the entire world occur in Africa and there's been a lot to talk about eliminating malaria from the planet several people have said in their lifetimes they don't want to see malaria anymore on the sort of globe but to be fair I mean Africa still has nearly 800 million people living in sort of a belt across Africa where malaria is part of their daily lives half of them sort of 400 million people live in areas where there's one in four children walking around with malaria in their blood today and I mean it is really the cradle of the world's problem is still in Africa so you can't ignore Africa Africa has other issues other problems which allow us to be in a situation where there's still lots of malaria including poverty, poor governance, conflict lack of economic investment and things but that's why there needs to be a focus on Africa well I think we're doing everything we can currently with the tools that we have available but if I had to look to the future we need more tools one thing that we can learn from the history of malaria is that the malaria parasite and the malaria mosquitoes are incredibly clever and very adaptable so that we will and we are seeing resistance emerge to both drugs and insecticides so we need more effective insecticides more effective drugs to combat what will happen in the future which is an emerging resistance to both we need vaccines vaccines that we currently have and are currently trying are okay but they may not go to scale they may not be good enough to implement at a sort of wide population level so we need continued investment in vaccines but the two things I think that would make a biggest difference and this is from history outside of Africa is that economic development actually when you reach a point of all your female is going to school there's electricity, there are paved roads malaria does disappear and I think that's the one message that we need to fully understand that the future of malaria in Africa depends largely on how well Africa develops as a continent economically and allied to that is how well is the health system invested in so governments across the continent need to invest in a strong health system I don't believe that malaria will be eliminated from Africa in my lifetime or anybody else's lifetime but there should be no deaths from malaria that is unacceptable because children should be treated quickly, they should get access to emergency care in hospitals when they need it and no one should die so if I was to think of a future and I was to think of a future milestone it would be that no child, no individual in Africa dies of malaria and I think that's achievable I think for our group here it's been investing in mapping the risk of malaria in Kenya to begin with then across Africa and globally and I think that work has really transformed the way we think about disease think about investing in interventions so we've worked very closely with national governments and the World Health Organisation to try and identify areas where you might get the biggest bang for your buck and areas where maybe giving everyone bed nets is a waste of money so I think cartography, the geography of malaria to design control, design investment I think has been one of our biggest achievements and I think that that's a space that will continue to grow the other area that is largely the work that I'm now funded to do that I think is obviously important is the relationship between how often you get bitten by a mosquito carrying parasites is your speed of developing immunity because we really don't understand properly still to this day after hundreds of years or so of research the relationship between infection and disease outcome so how likely are you to develop severe disease given how often you are bitten by an infected mosquito and how likely you are to die that is a whole concept and a whole body of research that has been neglected for a very long period of time and to design what the future of malaria looks like we need to understand that so I think that that's an important area as well well as we said I mean malaria is still a major killer you can't neglect malaria from a research point of view there's been a massive increase even announced this week or last week in donor assistance to malaria the UK government for example increased its budget to the global fund it recognises and the world recognises how important it is to get on top of malaria there has been a shift as well which I'm really grateful to in making sure that a lot more of that investment goes into Africa for disease prevention and disease control now obviously as I said we need new tools we need a better understanding of malaria I cannot imagine why you wouldn't increase the amount of money going into malaria research if you increase the amount of money that's being spent on its control knowing that that will only last for a short period of time since about 2009 we've worked very closely with the Kenyan government to try and help it identify areas where you will increase the amount of intervention coverage and areas where you might do things differently and we've kind of shaped the Kenyan policy in that sense, I mean beginning with work in 2009 by Dr Abdeslam Hamidnor and that was very influential I think we've extended that beyond Kenya's borders we work now in Somalia, Sudan, Djibouti Tanzania, Uganda, many other countries where we provide government support for basically epidemiological intelligence is trying to understand the landscape of malaria in a country so that they can design their national strategies effectively they can actually invest in a clever way and it's again using the science of malaria cartography and understanding the epidemiology of the disease to shape that and that's been driven by us here in Kenya I mean it's now grown into an initiative called the high burden, high impact initiative run by the WHO but it really actually began here in the programme