NOTE: This post started off as 2 lists in another blog I wrote which is no longer maintained. The text has been modified from the originals, which can be read here

If you read this and raise your eyebrows at the notion that there is a long-standing society dedicated to the subject of Parasitology then I am not entirely surprised. The British Society for Parasitology has been in existence for over 50 years. It continues to supports young career scientists in particular. Despite the persistence of the BSP, 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 up 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 10 areas of research (from a potentially 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).

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.

6) Parasites modulate the immune systems of their hosts to potentiate their own survival.

So what? – This can be exploited for our benefit. Some parasite products can be used therapeutically, for example to reduce symptoms associated with inflammatory bowel diseases, or certain allergies. We need to know how to do this more effectively.

7) Parasites can manipulate host behaviour to complete their own life-cycle.

So what?  –  Parasites are drivers, and part, of the global food chain. They quite often ‘want‘ to be eaten. Their manipulation of host behaviour facilitates predator-prey relationships and helps maintain stability of wildlife populations that are connected to human activities. We need to know how best to exploit this fact to ensure sustainable ecosystems.

8) There are still no (commercially available) vaccines for any parasitic infection of humans.

So what?  – Given that drugs and other interventions are only partly effective, we still need to work on vaccinations as a strategy to remove those parasites that directly impact on the health of human populations.

9) Parasites are put under selection pressure from human activities

So what?  If parasites adapt their biology and/or ecology as a result of interventions, and/or anthropogenic environmental pressures we need to know in order to plan mitigation and adaptation strategies.

10) Hundreds of millions of people carry undiagnosed parasitic infections at any one time

So what?  If we are ever to realise universal health coverage then we need to find solutions to the lack of diagnostic capacity in health systems where the populations are affected by parasitic infections.