Grant Dorsey, University of California
Professor Dorsey is an expert and prolific author on the clinical and molecular aspects of antimalarial drug resistance, epidemiology and the relationship between HIV and malaria. He is an Associate Professor in Infectious Disease at the University of California in San Francisco. Grant has over 18 years’ experience in medicine and public health and has spent several years doing antimalarial research in Uganda.
1. What sparked your interest in malaria?
In 1997 an opportunity arose to help start a new collaboration in Uganda initially looking at chloroquine resistance. It was established by my mentors, Philip Rosenthal of the University of California San Francisco and Moses Kamya of Makerere University, Uganda. Spending the first nine months working in Uganda I was immediately fascinated by the disease and the tremendous impact it has on the people affected. I was also shocked at how bad the situation was at the time, where over 50% of patients failed treatment with chloroquine despite the fact that this was the recommended first line regimen.
Until recently, malaria research in developing countries was severely limited by a lack of resources, funding, and infrastructure. What was not lacking in Uganda was the number of talented and hard-working young scientists. With increased attention on malaria and the funding to do quality research, the tide has turned and it is exciting to see the improvements being made. Meaningful and sustainable improvements in malaria control and eventual elimination are only possible if endemic country scientists play a major role. I have been very fortunate to work in an environment with such a strong local presence.
2. You have been a champion of WWARN from the start. Why did you feel this project was so important?
Because of my own first-hand experience of the negative impact of antimalarial drug resistance in Uganda. When I started working there, chloroquine was first line therapy despite widespread resistance. This policy persisted because of a lack of data and availability of alternative drugs. Uganda eventually abandoned chloroquine monotherapy, but for a few years adopted a policy of chloroquine plus sulfadoxine-pyrimethamine, a regimen that was subsequently found to also be poorly efficacious. It was only through quality research using standardized methodology that Uganda was able to adopt an effective antimalarial drug policy based on evidence. Much of the work done in Uganda was based on international collaboration to help standardize approaches to antimalarial drug efficacy surveillance. To be able to create a global and comprehensive database of antimalarial drug resistance provides a potential means of avoiding the same mistakes made in the past and better preserving the lifespan of newly-developed, highly effective, artemisinin-based combination therapies.
Professor Grant Dorsey
3. In your experience working in Africa, what do you think are the biggest barriers to contributing data?
The extra time ─ perceived or real ─ it takes to contribute data, questions surrounding how the data are going to be used and who will be given credit, and the question of how people will benefit from doing this. Some African researchers lack the technical capacity and infrastructure to deal with large databases, and the regulatory support that can help deal with some of the associated legal, professional, and ethical issues.
4. What can WWARN do to help?
By providing support to make data sharing easy, rewarding, and efficient. Resources, such as standardized computing tools to audit, clean, and analyse data, will go a long way in encouraging researchers to contribute their data. Template protocols, case record forms, and data dictionaries may also help with the actual process of collecting quality primary data. WWARN should ensure that the data contributed are being used in a way that is transparent, inclusive, and benefits the entire malaria community. Ultimately those contributing data must feel the sacrifices they are making are being done for a greater good.