The Status of Research and Developments in Advancing Tropical Medicine in Malaysia

 

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The Status of Research and Development in Advancing Tropical Medicine in Malaysia ASM Advisory Report 1/2012 Academy of Sciences Malaysia 2012 Report-Text.indd 1 8/7/12 2:11:10 PM

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©Akademi Sains Malaysia 2012 All rights reserved. No part of this publication may be produced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise without the prior permission of the Copyright owner. The views and opinions expressed or implied in this publication are those of the author and do not necessarily reflect the views of the Academy of Sciences Malaysia. Perpustakaan Negara Malaysia Cataloguing-in-Publication Data The Status of Research and Development in Advancing Tropical Medicine in Malaysia (ASM Advisory Report 1/2012) ISBN 978-983-9445-87-9 Tropical Medicine—Research—Malaysia. 2. Medical Climatology. I. Akademi Sains Malaysia. 616. 9883 Report-Text.indd 2 8/7/12 2:11:10 PM

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Foreword I would like to convey my congratulations to the ASM Tropical Medicine Task Force for producing this Advisory Report, entitled “The Status of Research and Development in Advancing Tropical Medicine in Malaysia”. We believe that this Advisory Report is most timely in view of the growing new areas of study, such covering “Medicine in the Tropics” as functional genomics, tissue engineering, and bioinformatics, among many others, which are being pursued with increasingly powerful techniques and instruments. The need to translate these multidisciplinary efforts to the clinical setting is becoming increasingly urgent. A number of recommendations, arising from both the earlier Workshop and the Forum, to enhance research in medicine in the tropics are proposed as follows: 1. Create a task force/advisory role in the enhancing of research in medicine in the tropics in ASM to sustain interest 2. Development of human resource in research field of medicine in the tropics 3. Create a research culture in medicine 4. Career development in medical research 5. Training of researchers 6. Enhancement of research infrastructure/support 7. Funding and Evaluation; and 8. Research policy on medicine in the tropics. The publication of this Advisory Report is in fulfillment of the Academy’s many functions, among which are to provide independent advice to the Government through dissemination of ideas and suggestions amongst decision- and policy-makers, scientists, engineers and technologists through identifying where the innovative use of science, engineering and technology can provide solutions to particular national problems towards sustained national development. Tan Sri Dr Ahmad Tajuddin Ali, FASc. President Academy of Sciences Malaysia iii Report-Text.indd 3 8/7/12 2:11:10 PM

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Preface The desire for a healthier and better world in which to live our lives, and raise our children is common to all people and all generations. As we enter the 21st century, our past achievements and technological advances make us more optimistic about our future than perhaps any stage in recent history. However, infectious tropical diseases are still the world’s biggest killers of children and young adults. For those living in developing countries, among the poorest of the poor no matter what their age, the risk of death and disability is always many times higher than those living in the developed world. Over 500 million people on earth, that is one living person in ten, suffer from one or more of the major infectious tropical diseases. While health globally has steadily improved over the years, on the other hand many people living in poorer countries have seen little, if any, improvement at all. The gaps between the health status of rich and poor are at least as wide as they were half a century ago, and are becoming wider still. Despite this, the most important pattern of progress now emerging in general globally is an unmistakable trend towards healthier, longer life. More people than ever before now have access to at least minimum health care, to safe water supplies and sanitation facilities. The spectacular unveiling of the human genome in 1999 and subsequent mapping has totally revolutionized our thoughts and understanding of disease and treatment. The neglected tropical diseases are a group of 13 major disabling conditions that are among the most common chronic infections in the world’s poorest people. If new resources are made available, as has been recommended by the Commission for Africa, a scaled-up approach to simple interventions could lead to sustainable decreases in poverty in some of the world’s poorest countries. These decreases would represent a major success story for the United Nation’s Millennium Declaration. This Report is the final product arising from a stakeholders’ consultative approach with inputs from collaborators such as the Institute for Medical Research (IMR), including the strong support from the Ministry of Science, Technology and Innovation (MOSTI), and the Ministry of Health (MOH), to convene the one-day forum on the “Status of R&D in Tropical Medicine in Malaysia”. This forum provided a platform for experts, health players, relevant government agencies and non-government organisations, and other key stakeholders to undertake a situational analysis of the current status of research in tropical medicine in the country. We have had a decade or two of unprecedented scientific progress in medicine and there is great promise of more. But we cannot rest on our laurels. The infectious tropical diseases are in danger of being forgotten by a rich world that has forgotten its poor, and they will be forgotten, unless we take an aggressive and entrepreneurial approach, to grasp the scientific, political and economic opportunities that arise, and set in place good defense against the evolution of our biological enemies. iv Report-Text.indd 4 8/7/12 2:11:10 PM

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It is the task of all of us to make sure that infectious tropical diseases will not fall back into the darkness of middle-ages. Academician Prof Emeritus Dato’ C.P. Ramachandran, FASc. Chairman ASM Task Force on Tropical Medicine v Report-Text.indd 5 8/7/12 2:11:10 PM

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ASM Task Force on Tropical Medicine The Members of the ASM Task Force on Tropical Medicine are as follows: Prof Emeritus Dato’ C.P. Ramachandran, FASc. (Chairman) Academician Tan Sri Dr. M. Jegathesan, FASc. Prof Emeritus Dato’ Lam Sai Kit, FASc. Prof Dato’ Khalid Yusoff, FASc. Prof Mak Joon Wah, FASc. Prof Abu Hassan Ahmad Prof Osman Ali, UMS Dr Shahnaz Murad, IMR Dr Lee Han Lim, IMR Associate Prof Stephen Periathamby Ambu, IMU Dr Sha’ari Ngadiman, MOH Prof Norlijah Othman, UPM Associate Prof Zairi Jaal, USM Dr Adznan Abdul Karim, WILDLIFE The Academy of Sciences Malaysia would like to acknowledge the following for their contribution as Rapporteurs to the Tropical Medicine Forum held on 21st June 2011 at the Medical Academies of Malaysia: Dr Nazni Wasi Ahmad, IMR Dr Yvonne Lim Ai Lian, UM Ms Adela Ida Jiram, IMR Ms Jeyanthi Suppiah, IMR The Advisory Report was prepared and compiled by Dr Yvonne Lim Ai Lian, UM, and P. Loganathan, ASM. vi Report-Text.indd 6 8/7/12 2:11:10 PM

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Contents Foreword Preface ASM Task Force on Tropical Medicine Executive Summary Introduction Create Task Force/Advisory Role Towards Facilitating the Enhancing of Research in Medicine in the Tropics in ASM to Sustain Interest Development of Human Resource in Research Field of Medicine in the Tropics Create a Research Culture in Medicine Career Development in Medical Research Training of Researchers Enhancement of Research Infrastructure/Support Research Funding and Evaluation Research Policy on Medicine in the Tropics Conclusion Appendix 1. Workshop on “Enhancing the Environment for Medical Research” Appendix 2. Report: ASM Forum on Tropical Diseases Page iii v vii 1 5 7 7 8 9 10 10 11 11 12 13 17 vii Report-Text.indd 7 8/7/12 2:11:10 PM

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The Status of Research and Development in Advancing Tropical Medicine in Malaysia Executive Summary The infectious tropical diseases are still the world’s biggest killers of children and young adults. The risk of morbidity and mortality related to disability and death is many times higher in economically disadvantaged communities in developing countries compared to those living in the developed countries. It is reported that over 500 million people on earth, that is one living person in ten, suffer from one or more of the major infectious tropical diseases. While health globally has steadily improved over the years due to better access to minimum health care to safe water supplies and sanitation facilities, on the other hand many people living in poorer countries have seen little, if any, improvement at all. The gaps between the health status of the rich and poor remain as wide as they were half a century ago, and in some cases becoming wider still. Neglected tropical diseases (NTD) are amongst some of the most common infections in the estimated 2.7 billion people who live on less than USD2 per day (the poorest of the poor). These diseases which occur primarily in rural areas and in some poor urban settings of lowincome countries in sub-Saharan Africa, Asia-Pacific, and Latin America, lead to long-term disability and poverty. In aggregate, NTD cause approximately 534 000 deaths annually. Since the establishment of the Institute for Medical Research (IMR) in Kuala Lumpur in 1900, IMR has played significant global role in enhancing research in tropical diseases, towards their treatment, control and prevention. Some of the basic and fundamental discoveries in tropical diseases were evident in diseases such as malaria, lymphatic filariasis, scrub typhus, leprosy and other parasitic and bacterial infections. The IMR today is more than 110 years old and stands as a Malaysian major global player in the fight against NTD. IMR has in the past 40 years played a significant role in the region and contributed to SEAMEO – TROPMED. Till today, the IMR houses the WHO Regional Centre for Research and Training in tropical diseases. The Malaysian Ministry of Health (MOH) has had a leading role in health research policy, which is rarely seen in Western countries. This has been due to the foresight of a number of its leader who had, in seeing the importance of Health Research as a tool in development, taken steps to integrate it into the organizational and operational framework of its programmes. The IMR, while being a separate federal department at its time of founding, was very shortly afterwards placed under MOH as its research arm, a function it executes till this day. But the recognition that research goes beyond biomedical research and also that it should be an integral part of every health professional work led to the addition of “Research” as a separate programme to the Ministry’s other programmes in1986. Report-Text.indd 1 8/7/12 2:11:10 PM

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ASM Advisory Report 1/2012 Over 100 years, Malaysia was among the leaders in tropical diseases research. However, in this recent past, we have fallen back on our lead — reasons perhaps many changing pattern of diseases, lack of support, limited financial and human resources, and other reasons. Surely we should not allow this to happen. We need to continue to play a pivotal role and strategic role in tropical disease research in the country and the region. We have the resources; we have the talents and the technical know-how. Our younger generation of scientists, doctors, public health workers and researchers should be motivated to embark on tropical disease research on all aspects of biomedical, lab-based, field-based as well as clinical research to accelerate new knowledge towards the control and elimination of tropical diseases in this region. At an earlier one-day workshop entitled Enhancing the Environment for Medical Research, held on 3 November 2007 and at the one-day forum on the Status of R&D in Tropical Medicine in Malaysia, held on 21 June 2011, and both organised by the Academy of Sciences Malaysia (ASM), it was generally agreed that the success of tropical diseases research should be further enhanced by developing inter- and intra-collaborations between the research institutions and the universities. By advocating such collaboration, research output will be of high standards and quality, leading to a further reduction in the duplication and repetition of research projects and resources. A number of recommendations, arising from both the earlier Workshop and the Forum, to enhance research in medicine in the tropics are proposed as follows: 1. Create a task force/advisory role in the enhancing of research in medicine in the tropics in ASM to sustain interest 2. Development of human resource in research field of medicine in the tropics 3. Create a research culture in medicine 4. Career development in medical research 5. Training of researchers 6. Enhancement of research infrastructure/support 7. Funding and evaluation; and 8. Research policy on medicine in the tropics. 2 Report-Text.indd 2 8/7/12 2:11:11 PM

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The Status of Research and Development in Advancing Tropical Medicine in Malaysia Global Picture Malaria • 300 – 500 Million Clinical cases per year (90% in Africa) • 1.5 – 2.7 Million deaths a year (1 Million among African Children) Africa, in India; Brazil; Sri Lanka; Afghanistan; Thailand; Vietnam; Colombia • Incidence of major clinical cases outside Lymphatic filariasis 3 Report-Text.indd 3 8/7/12 2:11:11 PM

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ASM Advisory Report 1/2012 DENGUE Dengue Vectors Aedes albopictus Aedes aegypti 4 Report-Text.indd 4 8/7/12 2:11:12 PM

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The Status of Research and Development in Advancing Tropical Medicine in Malaysia Introduction It has been more than a decade when the promise of a revolution in human health was announced. The spectacular unveiling of the human genome unfold many secrets of human life and revolutionized the diagnosis, prevention and treatment of many human diseases. Indeed, the genomic age has produced significant medical advances. Technological advances have made us more optimistic about our future now than perhaps at any stage in recent history. The infectious tropical diseases are still the world’s biggest killers of children and young adults. The risk of morbidity and mortality related to disability and death is many times higher in economically disadvantaged communities in developing countries compared to those living in the developed countries. It is reported that over 500 million people on earth, that is one living person in ten, suffer from one or more of the major infectious tropical diseases. While health globally has steadily improved over the years due to better access to minimum health care to safe water supplies and sanitation facilities, on the other hand many people living in poorer countries have seen little, if any, improvement at all. The gaps between the health status of the rich and poor remain as wide as they were half a century ago, and in some cases becoming wider still. The Millennium Declaration, adopted by world leaders at the United Nations in September 2000, establishes an ambitious set of eight millennium development goals to eliminate extreme poverty, hunger and diseases by 2015. Thirteen major disabling parasitic and bacterial infections were identified as being neglected and are comprised three soil-transmitted helminth infections (i.e. ascariasis, hookworm infection, and trichuriasis), lymphatic filariasis, onchocerciasis, drancunculiasis, schistosomiasis, Chagas disease, human African trypanosomiasis, leishmaniasis, Burundi ulcer, leprosy, and trachoma. An expanded list includes dengue, the treponematoses, leptospirosis, strongyloidiasis, food-borne trematodiases, neurocysticercosis and scabies, as well as other tropical diseases. Neglected tropical diseases (NTD) are amongst some of the most common infections in the estimated 2.7 billion people who live on less than USD2 per day (the poorest of the poor). These diseases, which occur primarily in rural areas and in some poor urban settings of lowincome countries in sub-Saharan Africa, Asia-Pacific, and Latin America, lead to long-term disability and poverty. In aggregate, NTD cause approximately 534 000 deaths annually. Since the establishment of the Institute for Medical Research (IMR) in Kuala Lumpur in 1900, IMR has played significant global role in enhancing research in tropical diseases, towards their treatment, control and prevention. Some of the basic and fundamental discoveries in tropical diseases were evident in diseases such as malaria, lymphatic filariasis, scrub typhus, leprosy and other parasitic and bacterial infections. The IMR today is more than 110 years old and stands as a Malaysian major global player in the fight against NTD. IMR has in the past 40 years played a significant role in the region and contributed to SEAMEO – TROPMED. Till today, the IMR houses the WHO Regional Centre for Research and Training in tropical diseases. 5 Report-Text.indd 5 8/7/12 2:11:12 PM

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ASM Advisory Report 1/2012 The Malaysian Ministry of Health (MOH) has had a leading role in health research policy, which is rarely seen in Western countries. This has been due to the foresight of a number of its leader who had, in seeing the importance of Health Research as a tool in development, taken steps to integrate it into the organizational and operational framework of its programmes. The IMR, while being a separate federal department at its time of founding, was very shortly afterwards placed under MOH as its research arm, a function it executes till this day. But the recognition that research goes beyond biomedical research and also that it should be an integral part of every health professional work led to the addition of “Research” as a separate programme to the Ministry’s other programmes in1986. Over 100 years, Malaysia was among the leaders in tropical diseases research. However, in this recent past, we have fallen back on our lead — reasons perhaps many changing pattern of diseases, lack of support, limited financial and human resources, and other reasons. Surely we should not allow this to happen. We need to continue to play a pivotal role and strategic role in tropical disease research in the country and the region. We have the resources; we have the talents and the technical know-how. Our younger generation of scientists, doctors, public health workers and researchers should be motivated to embark on tropical disease research on all aspects of biomedical, lab-based, field-based as well as clinical research to accelerate new knowledge towards the control and elimination of tropical diseases in this region. At an earlier one-day workshop entitled Enhancing the Environment for Medical Research, held on 3 November 2007 (Appendix 1) and at the one-day forum on the Status of R&D in Tropical Medicine in Malaysia, held on 21 June 2011 (Appendix 2), and both organised by the Academy of Sciences Malaysia (ASM), it was generally agreed that the success of tropical diseases research should be further enhanced by developing inter- and intra-collaborations between the research institutions and the universities. By advocating such collaboration, research output will be of high standards and quality, leading to a further reduction in the duplication and repetition of research projects and resources. With the fast pace of globalisation and importance of healthcare, tropical diseases per se may not be the threat in the future. As more and more countries reach developed nation status, among the many of the diseases which are apparent in developing countries, the noncommunicable diseases are also becoming a major problem in this part of the world. In view of the increasing numbers of mortality and morbidity due to non-communicable diseases (NCDs) in Malaysia as well as in this region — the future of Preventive Medicine lies in addressing issues related to “Medicine in the Tropics” and not Tropical Diseases per se. Accordingly, the words “tropical medicine” may be a misnomer in the near future and a better way of addressing this would be as “Medicine in the Tropics”. A number of recommendations, arising from both the earlier Workshop and the Forum, to enhance research in medicine in the tropics are proposed as follows: 1. Create a task force/advisory role in the enhancing of research in medicine in the tropics in ASM to sustain interest 2. Development of human resource in research field of medicine in the tropics 6 Report-Text.indd 6 8/7/12 2:11:12 PM

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