MY association with Dr V.P. Sharma (V.P. to friends), who passed away recently, lasted 45 years, starting in June 1970, when we joined as Senior Scientists at the newly started World Health Organisation (WHO)/ Indian Council of Medical Research’s (ICMR) Genetic Control of Mosquitoes Unit (GCMU). We worked together for five years. Following the closing down of this research unit, two research centres were created on July 1, 1975—the Malaria Research Centre (MRC) in Delhi and the Vector Control Research Centre (VCRC) in Puducherry. V.P. became the Director of the MRC. He had the unenviable task of building up a research organisation from scratch, and with scientists with no experience at a time when India was at the crossroads as far as malaria was concerned.
That the MRC became a pioneering centre, recognised by the international community, speaks volumes about the outstanding contribution of V.P. to malaria research. Having worked on mosquitoes during his stint with the GCMU, he paid particular attention to research on vectors. Since the VCRC was also working on vector research, we naturally came together to discuss many vector-related problems. His qualities and achievements as a scientist have been written about in the excellent obituary note published recently in Current Science . His demise is a loss to the science of malariology in general and vector science in particular.
Malarial epidemiology
The post-1960 history of malaria research in India can be described as tragic. Malaria epidemiology abounds in instances where even a few gametocyte carriers present in a locality can become a focus (a micro-focus perhaps) for transmission. While the occurrence of one or two cases of malaria in a population of 10,000 may appear to be a low figure, even these, if they occur in a small circumscribed locality, say an isolated cluster of huts with 100 people (for example, a tribal settlement), can be a serious matter. I am aware of several instances where active transmission of malaria is going on even now in practically closed cycles in small outlying hamlets consisting of a few huts, while the main village itself, not more than a kilometre away, is considered to be in a satisfactory position.
These insignificant-looking foci become centres for focal outbreaks and sources for the spread of the disease if the vectors are not brought under control. Many such focal outbreaks occur even now in our country.
Malaria control at the national level was an operational programme with the motto “Spray and Pray”. Deficiencies in the control operations resulted in mosquitoes developing resistance to DDT and some other insecticides. This serious problem could have been corrected in time if there had been constant entomological surveillance and research. To overcome this situation, V.P. started many Integrated Disease Vector Control (IDVC) units in several places all over India. This was his greatest contribution to malaria control in India. There was a special emphasis on environmental control. The units were started on an ad hoc basis, but were encouraged by the then Director General of the ICMR. Many of the IDVCs became centres of excellence not only in controlling malaria in their areas but also in training young malaria entomologists. They were all headed by brilliant young entomologists. Thus, V.P. contributed greatly to the development of scientific manpower in an important area.
Unfortunately, in the 1980s, total “molecularisation and computerisation” of research took place in almost all institutions dealing with vector-borne diseases. This followed the WHO example in Geneva, where the famous Vector Biology and Control (VBC) division was converted into the Molecular Entomology Division. What is the connection between molecules and entomological work in the field? Fieldwork went out of fashion. Apron-clad laboratory “scientists” replaced hard-core fieldworkers. Easy solutions to complicated epidemiological and ecological situations were sought in computers. Applied research remained only on paper.
Over the years, particularly after he retired from the ICMR, V.P. became disillusioned with many aspects of the research on vectors and vector-borne diseases. There is a multiplicity of factors involved in vector-borne diseases—the human host, the etiological agent, the transmitting agent (vectors) and, most important of all, the environment. No one seems to be interested these days in carrying out long-term studies on these factors.
A few years ago, V.P. did write a “commentary” on the challenges in malaria control which was published in Current Science . It was an excellent summary of the problems in the field. At the Indian Science Congress in 1978, Dr T.R. Rao gave the Sisir Kumar Mitra Lecture about the dismal malaria situation. I also wrote a few articles on Japanese encephalitis, ecology, and so on, which Frontline published. I had sent copies to many scientists in India, including V.P. This is what V.P. wrote after reading them:
“Your excellent articles on vector-borne diseases need to be seen by the powers in health. But I have no faith in the Ministry of Health and the ICMR. They continue to mislead the people of India regarding the real situation of vector-borne diseases. ICMR set up a vector science forum and it was raised to an important scientific body. ICMR has not invited me for any meetings for over two years. The forum is closed for all practical purposes. If scientific bodies are run by sycophants, this is invariably the outcome. The credit or discredit goes to the head of the institution. Vector control and the situation of malaria is so bad that in malaria patients, dengue and typhoid are being reported. But all the information is suppressed for self–preservation, and who cares for the society or the poor? I had written to Health Minister when he took over, but the letter was not even acknowledged. The fact remains that they want to live in the make-believe world, far removed from the realities of a common man.”
We should realise that it is not possible to eradicate vector-borne diseases. At best, they can be kept at manageable levels. The vector population should be kept below the “critical” level. To do this, we must study all aspects of vector populations and their build-up, their drivers, the environment and human ecology. This is not happening. The role of medical entomologists/vector ecologists is thus crucial. Many vector-borne diseases are of zoonotic origin. Long-term sustained research work is necessary in the field. In the case of Kyasanur forest disease (KFD), a field team worked for 17 years staying in the forest.
Importance of fieldwork
V.P. was highly critical of assessing the performance of scientists on the basis of the number of publications and their citations. He used to say that current research was all on paper. He felt people went on publishing more and more papers without checking whether their research contributed to disease control or not. Present-day malaria research is skewed. It neglects sustained fieldwork.
The emphasis now seems to be on futuristic research in the laboratory. But the problem is “here and now” because thousands of malaria cases occur year after year in many pockets in India. And we depend on foreign funding for new projects (euphemistically called sponsored research), trying to test new drugs, new insecticides, chromosomal research, vaccine production, and so on. These are necessary, but nothing is being done to improve operational efficiency.
The epidemiology of malaria is complex. The malaria parasite, the mosquito, man and his environment are all intimately interwoven. Involved in it are four or five species of human plasmodia with very different biologies; numerous vector anophelines, each with its own peculiar bionomics and ecology; and people with varied social habits and susceptibility to the disease; and, finally, the constantly changing environment. How many of the present-day researchers are aware of these?
Sidelined
Unfortunately, though V.P. had the stature, he was too polite a person to express his views forcefully. He and several others of his stature were sidelined. His own institute, which he built up from scratch, ignored him. I used to tell him that we were in the company of our mentor, the late T. Ramachandra Rao, the greatest malaria entomologist, who openly asked for an international malaria commission but was rebuffed.
I end by quoting a paragraph from an obituary to Fred Soper, chief of the Pan American Sanitary Bureau, and a great scientist whose work in fighting malaria and yellow fever in Europe and the Americas is widely acknowledged.
“Toward the end of his life, Soper, who died in 1975, met with an old colleague, M.A. Farid (another famous malariologist), with whom he had fought Anopheles gambiae in Egypt years before. ‘How do things go?’ Soper began. ‘Bad!’ Farid replied, for this was in the years when everyone had turned against Soper’s vision. ‘Who will be our ally?’ Soper asked. And Farid said simply, ‘Malaria’, and Soper, he remembered, almost hugged him, because it was clear what Farid meant: Someday, when DDT is dead and buried, and the West wakes up to a world engulfed by malaria, we will think back on Fred Soper and wish we had another to take his place.”
P.K. Rajagopalan is a former Director of the Vector Control Research Centre in Puducherry, an institute of the Indian Council of Medical Research.
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