Recently, hundreds of research scientists gathered at Imperial College in London (my alma mater) to share knowledge and discuss research outputs, ideas and opportunities. Yes, it was time for the Annual Spring Meeting of the British Society for Parasitology*. For the duration of the conference, each person identified themselves with the discipline of parasitology, and many would have declared themselves as parasitologists.
If you read this and raise your eyebrows at the notion that there is actually a long-standing society dedicated to the subject then I am not entirely surprised. My own observations suggest that the discipline of parasitology is becoming increasingly rarified, at least in the UK higher-education context.
So what?, you might say. The language of research changes over time; we cannot remain fixed on one term indefinitely by default. There has to be a reason to maintain the notion of parasitology as a standalone discipline.If developments in global health mean that parasites other than Guinea worm are somehow eliminated from the world, then it is likely that parasitology will be eventually subsumed into other domains, and at least some parasitologists will move away from the discipline all together as research funds become diverted and the students of tomorrow focus on other health issues.
I agree to a point with this view, providing that we can be certain about plans to deliver on parasite control targets, ensure universal health care etc. But wait, hang on a second. What’s that coming over the hill? Can you see it, just there, just a few years ahead? No of course you can’t. No one can draw data down from the future. It is inherently uncertain.
It is this uncertainty that means we need to keep up basic, applied, operational and implementation research in the field of parasitology. Here are just 5 areas of research (from a much longer list) that are linked to future uncertainties and which, if addressed, could help us reach our shared goal of sustainable health (each point links to an exemplar publication). Research similar to that highlighted below is being undertaken by BSP members.
Note to parasite-control programme managers: each of the points raised below can be considered in the context of how they might confound or modify expectations associated with control programmes. They may be used to generate discussion around addressing points of departure from expectations within your own programmes, or developing decision support tools to plan for future sustainability.
1) Widely used broad-spectrum drugs have different levels of effectiveness depending on the species of parasite against which they are targeted.
So what? Parasite ecology is shaped by the selective removal of certain species, leading potentially to new demographic and spatio-temporal patterns of infection and morbidity attributable to infection. Not all treated individuals will receive the same benefit from treatment, depending on their mix of infections.
2) Individuals mount different immune response to infection depending on genetic background, presence of co-infections, previous exposure, age etc
So what? Not everyone will benefit in the same way from treatment, or respond in an identical way to any putative vaccine.
3) Signs and symptoms associated with worm infections are also caused by other types of pathogen including some viruses and bacterial pathogens
So what? The benefits of chemotherapy on reducing morbidity may not be easily estimated due to imprecise or biased estimates of attributable morbidity.
4) No currently available medicine prevents re-infection. Re-infection can occur rapidly, slowly or not at all after treatment depending on behavioural, ecological parasite life history traits, human genetic traits, demographic and socio-cultural factors
So what? Repeated treatments are required to keep infections at sufficiently low levels until the environment no longer supports the free-living stages and/or vectors. Drug resistance, lack of engagement etc are militating factors that increase over time.
5) Environmental change over space and/or time affects the natural history of vectors, intermediate hosts and free- living parasite stages in different ways depending on species and location.
So what? Risk maps drawn up at one particular time point based on underlying hazards may become less informative over time.
*The BSP, more than 50 years old, has been at the forefront of encouraging early career scientists in particular to engage with each other on basic and applied aspects of the discipline. I have been a member since my days as a PhD student, and served for several years as Honorary Communications Secretary.
I am an epidemiologist based at a UK Higher Education establishment (Durham University, if you are interested). My research interests are primarily within the domain of Neglected Tropical Diseases (NTDs). I believe that the only way we can effectively tackle complex problems affecting populations living in tropics and sub-tropics is through trans-disciplinary collaboration. My working definition of transdisciplinary is undertaking research alongside so-called 'stakeholders' - groups and individuals who do not call themselves 'researchers' but whose experiences and knowledge can be used to great effect when combined with the experiences and knowledge of the research community. You can read my online CV at the link below.