A Tribute to Alan Magill

The world of tropical medicine and global health was shocked and devastated in September of 2015 to learn of Alan Magill's sudden and unexpected death at age 61 years (Figure 1Figure 1). At the time of his death Alan was serving as immediate past president of the American Society of Tropical Medicine and Hygiene (ASTMH). At the Society's annual meeting just a month later, the sense of loss was profound and raw, and felt by members from across the entire spectrum of tropical medicine, global health, travel medicine, and parasitology that Alan spanned during his remarkable career. Alan's life and accomplishments were celebrated throughout the meeting. We lost a leader who inspired us with his vision, his wisdom, his commitment to service, and his deep knowledge. We also lost a friend and colleague who was unfailingly kind and generous, a devoted family man who was known as something of a sly prankster.Figure 1Alan Magill at the Annual Meeting of the American Society of Tropical Medicine and Hygiene in 2014. Image courtesy of the American Society of Tropical Medicine and Hygiene.View Large Image | Download PowerPoint SlideProfessionally, Alan became best known as Malaria Director for the Bill & Melinda Gates Foundation, which he joined in 2012 to lead the Foundation's effort to eradicate malaria worldwide. This was Alan's starring role, to which he brought unparalleled depth and breadth of expertise in malaria research and product development, along with exceptional leadership qualities honed during his decades in the US military, which he joined as a young physician to get trained in parasitology and tropical medicine. It was in the Army, working in Peru and in the USA, with detours to places as far flung as Somalia and Iraq for field and clinical work, that Alan contributed to an impressive series of advances. Just a few of these include helping to develop diagnostic tests for leishmaniasis and malaria and advancing the development of both drugs and vaccines for malaria.The bold call that Bill and Melinda Gates made in 2007 for a renewed malaria eradication campaign was initially met with some skepticism. In the past 3 years Alan advanced the prospects for malaria eradication immeasurably. He did this in part by traveling the world as a highly effective advocate who delivered a compelling case for eradication to scientists, policymakers, and world leaders. I suspect that, more than anyone else, Alan Magill can be credited for converting eradication skeptics into believers. He was such a credible and respected figure in tropical medicine that even before considering his meticulously researched and analytically argued case for eradication, the mere fact that he had decided to take it on as his personal mission made eradication seem that much closer to reality. He advanced eradication prospects by building and guiding a talented and dedicated team at the Gates Foundation to manage a growing research and development portfolio ranging from drug discovery and diagnostics to vaccine development, mathematical modeling, surveillance, and response systems, and building political will.I first got to know Alan in the late 1990s when, after returning from a posting as head of parasitology at the Naval Medical Research Center Detachment in Lima, Peru, he was seconded to the National Institutes of Health to develop a malaria vaccine clinical testing program. In Mali, West Africa, Alan worked with scientists at the University of Bamako's Malaria Research and Training Center to establish the capacity for conducting malaria vaccine field trials. Alan had the vision, the patience, and the can-do spirit to look at a dusty village a few hours’ drive south of Bamako and see a site for a world-class clinical trials center, staffed and directed by an expert team of Malian investigators. The Malian vaccine testing unit that Alan helped to establish has now completed at least a dozen malaria vaccine trials, each led by a Malian principal investigator.In Peru, Alan's legacy includes a generation of internationally respected Peruvian scientists who for the past 4 years have hosted an ‘ASTMH Peru Annual Conference’ in Lima, where Peruvian investigators present – in Spanish, to a local audience of several hundred – scores of their talks from the previous ASTMH annual meeting. Also, of course, in the USA, Alan's professional progeny includes legions of former proteges both in and out of uniform, in parasitology, clinical tropical medicine, and military medicine.The growing recognition in recent years of Alan's rare combination of smarts and skills led to ever more demands on his time. When the Ebola epidemic exploded in 2014, Alan was called on to coordinate the Gates Foundation's response, with no diminution of his responsibilities for the malaria program. That year he was also the President of the ASTMH, which held its annual meeting in New Orleans. With everything else that was happening, Alan suddenly had to respond to dozens of press inquiries about Louisiana's ill-considered decision to quarantine any travelers arriving in the state who had recently visited Ebola-affected countries.Alan not only managed the chaos in New Orleans with skill, grace, and humor, he somehow even found time during the meeting to sit down with two senior health officials from Myanmar, the emerging democracy in Southeast Asia formerly known as Burma, which has by far the greatest malaria burden in the region. Just a month earlier, Alan had visited Myanmar for the first time and had been impressed by the government's commitment to fight malaria and by their progress in the face of limited resources and formidable political obstacles. With international sanctions in place, most development partners refused to fund the Ministry of Health directly and much of the malaria burden was in areas under the control of ethnic militias engaged in armed conflict with the government. But Alan shared a surprising vision.In his typical patient and thoughtful way, Alan first drew out the views of the Burmese visitors and then respectfully offered the suggestion that, maybe, despite its political divisions and poverty, Myanmar had the human capacity to be not the last but the first country in Southeast Asia to eliminate malaria. ‘Kind of like Nelson Mandela got South Africa to focus on winning the World Cup as a way to achieve reconciliation after apartheid,’ Alan proposed, ‘Myanmar could build a national reconciliation campaign around malaria elimination.’ Alan's inspiring words, respectfully and sincerely delivered, have been heard and are being taken up. Malaria elimination and eventual global eradication are far more achievable goals than we ever imagined, in no small part because of Alan Magill's energy, talent, wisdom, compassion, and commitment.One of my most vivid memories of Alan Magill is of a conversation we had not long after he came back from a deployment to Kuwait and Iraq, where he took care of troops during the early days of Desert Storm. I will never forget Alan describing to me how it felt when he saw and heard the massive invasion force of war machines rumbling across the desert toward Baghdad. His first reaction, he told me, was to feel ‘shock and awe’ at the immense power thundering over the horizon. This feeling was immediately followed by wistful thoughts about how much good we could do if even a fraction of the resources on display were deployed instead to fight tropical diseases.After Alan took on the job of malaria eradication, he had a coin inscribed with the Latin words ‘Malaria delenda est’, which translates to ‘Malaria must be destroyed’. In the weeks after his death, at least one malaria fighter I know had the Latin words tattoed on her body. I might just do the same. But whether we get the tattoo or not, malaria fighters and others working in tropical medicine and global health the world over have been inspired by Alan Magill's life to pick up the banner, destroy malaria, and dedicate our own lives to achieving the vision that he gave us – a world free of tropical infectious diseases.