MANUFACTURED DUPREUILH: What are the most common and worrying infectious diseases in the world today? FRANCINE NTOUMI: The most prevalent infectious diseases in the world are, without surprise, malaria, HIV/AIDS and tuberculosis. HIV/AIDS now accounts for 40 million infected people worldwide and 630,000 people have died of HIV/AIDS-related diseases; malaria: 268 million cases worldwide have been affected by this disease and resulted in 638.000 deaths. 94 per cent of malaria cases in 2024 occurred in the tropical areas of Africa. And for tuberculosis, the number of people living with the disease is 10.8 million and 1.3 million deaths. So it's the diseases that kill the most on the planet. In September 2021, the Executive Director of the Global Fund had stated that Covid-19 had had a "destroying impact" on the fight against HIV/AIDS, malaria and tuberculosis. Would you say that Covid-19 has actually slowed down the work that has been done and should be done on all three diseases? Covid-19 had a significant negative impact on all three diseases. Covid-19 has severely disrupted access to health systems, screening/diagnostic testing and treatment in many countries. The supply of reagents in health centres was difficult, as many reagents are imported and, of course, access to antiretrovirals, anti-tuberculosis and antimalarial drugs is difficult due to the limited local movements. We have therefore seen in the fight against these three diseases a certain reduction in its impact in all countries of the world in general, and much more in Africa in particular. Has the work done for Covid-19 helped in a positive way in the field of research on other diseases? Absolutely. I smiled because in 2020, when I saw all the funding that was available in Covid-19 research and I had never seen such a mobilization in my career, I had a blow of blues. I then wrote a provocative article in the prestigious journal "Nature" entitled: "What if tropical diseases get as much attention as VOCID?". But what are the impacts of the research on Covid-19? MRNA vaccines have made a breakthrough not only for Covid-19, but also for other diseases such as malaria where there is a mRNA vaccine pathway. Funding to improve technical platforms as part of the VOCID work has been used for tuberculosis, and other diseases such as sequencing pathogens. I forgot the benefits and the multiplication of scientific exchanges through virtual platforms (Zoom, Skype, Teams, ...). The research had been boosted to an unprecedented level. Have you learned from this work that has already been done? As I just said, during the VOCID, scientists have never spoken so much. We have never shared our knowledge so much without any restrictions, without any frontiers. And for me, it was a very great lesson: knowledge sharing and, above all, data sharing. Effective. Is the fight against HIV/AIDS and infectious diseases a thing of the past? We imagine that the answer is certainly, no. We know that much progress has been made in recent years, particularly in the fight against these diseases, especially for HIV/AIDS. Do you today have a positive and optimistic message about these diseases? Science is progressing. Thanks to numerous clinical trials also conducted in Africa, the understanding of these three infectious diseases is much more important today and allows to imagine targeted and original solutions or interventions. For example, for HIV/AIDS in PrEP (Pre-exposure prophylaxis), namely HIV exposure prevention, advances such as injectable treatment (twice a year), but with 100% protection is a great tool. But for the moment, this preventive treatment is still too expensive. We hope that generics will be available soon so that our populations can benefit from them. This is a good example. And in there are also advances in insecticides, etc. Speaking of PrEP, we have the impression that these advances represent a kind of danger to a population that would ultimately feel that it is now protected and that it no longer needs protection for these diseases? It is true that today, unfortunately, the media speak much less about HIV/AIDS. We have the impression that this disease is commonplace. And younger generations think this disease is no longer a problem. The latest UNAIDS report shows that the rate of new infections is increasing. And so, we need to completely renew prevention messages. Make it clear that condoms and PrEPs for those who are more exposed should be implemented. The WHO report published at the end of 2024 shows that condom use among sexually active young people has decreased significantly since 2014, and unprotected sex rates have been worrying especially in Europe for the past 10 years. The report indicates a decrease in condom use between 2014 and 2022. The proportion of sexually active adolescents who used condoms during their last sexual intercourse increased from 70 to 61 per cent in boys and from 63 to 57 per cent in girls. What is the work to be done today in terms of prevention? Who should be approached for these prevention campaigns? Who should they really be targeted to? In the Congo, with 4.5 per cent prevalence, girls and women are much more infected than men. The most affected age group is between 15 and 25. Today we are in the era of the internet and social networks. These are tools that young people commonly use. They must therefore be used to communicate better. Unfortunately, in this struggle, we have remained in the old tools that are no longer suitable. So we need to renew the messages and adapt them to mobilize this age group so that they preserve themselves, because we can live a long time with this infection, what HIV/AIDS is or other diseases that can be prevented. Prevention is worth prevention. Let's talk a little about malaria, an area in which you work a lot. For those who know the disease, how are malaria parasites transmitted? Malaria is one of the oldest diseases in the world. How is this parasite transmitted? By mosquitoes. Infected female anophele mosquitoes are the route of transmission of the disease to humans. In fact, female anophele stings to feed. She needs blood for her eggs. In return for our blood gain, she pays us by injecting us some small parasites, plasmodia. These parasites go straight into the liver. When parasites are in the liver, you are not sick and you do not know that you are infected. Then, after a liver multiplication, the parasites are released into the bloodstream and will enter the red blood cells where they will multiply for about two days then the red blood cells burst and release thousands of parasites into the bloodstream. And the red blood cell re-infection cycle continues (input-multiplication-explosion of red blood cells and release of new parasites). The infected individual then has the symptoms of the disease. The first most common symptoms of malaria are fever, headache and chills. They usually appear within 7 to 10 days of the bite of an infected mosquito. Can the development of malaria vaccines enable Africa to eliminate the disease by 2030? What can be expected from the two WHO  pre-qualified vaccines?? Malaria is one of the world's most serious health threats, with about 268 million malaria cases and 638,000 malaria-related deaths worldwide, 95 per cent in Africa. On this continent, malaria is among the leading causes of infant mortality, with half a million children under the age of five losing their lives each year. The RTS, S malaria vaccine, also known as Mosquirix and R21 vaccine, the second vaccine recommended by the WHO, both target the parasite Plasmodium falciparum, which is the parasite more deadly. The fact that there are now two vaccines should make an interesting contribution to progress in combating this disease. WHO states: "To date, there is no evidence that one vaccine is more effective than the other. The choice of product to be used in a country should be based on programmatic characteristics, vaccine availability and financial accessibility." Even if we must celebrate this major breakthrough, these two vaccines do not yet represent the expected "miracle" solution. Because of its low long-term effectiveness, mothers will have to keep sleeping their children under an insecticide-treated net, by far the most effective tool to date. These vaccines add to the arsenal of control alongside impregnated nets, insecticides, rapid diagnostic tests and medicines. As for its deployment to Africa, it is in progress. Donald Trump's second term as President of the United States opens a period of upheaval in international relations that has few precedents. Global health is one of the areas that have already begun to suffer terribly from the new US policy. The decisions taken with regard to the United States Agency for International Development (USAID) and WHO are only one aspect of the tragedy that is predicted for millions of people around the world. The country finances the institution with at least 20% of its budget, not to mention the decision to temporarily suspend the financing of the PEPFAR (Presidential Emergency Plan to Combat AIDS). These disruptions will cost lives and destroy years of progress in the fight against the AIDS virus. In terms of funding, are there any real reasons to worry about this today? This question is very interesting. I recently read an article in Nature by a South African researcher who said that cuts in the US budget are an opportunity to review and reimaginate global health. I fully agree with him and his reflection. Why? I believe that this is an opportunity for the countries that receive this support, including many countries in Africa to review their health financing priorities. But was it planned that the US would permanently support us? I don't think so. In Africa, an expression that says that the hand that gives is always above the hand that receives. So when you give, it's for a while and you have to be aware of it. As an African scientist, I mainly work with funding from outside the continent (extra-mural) because unfortunately our countries do not provide the necessary budgets to conduct research that is necessary and appropriate for countries. I regret it, but my profession, my passion, is to be scientific, I am happy to receive international grants. But I would be much happier if I could have those subsidies from my country or African governments. It's really time we took care of our health problems.           Among the priority challenges is the production of medicines on the continent? I know it's a subject you care about... Indeed, the VOCID-19 pandemic has brought us a lot of information. Countries have shown that solidarity has limits, and countries have had to rely on their own human and material resources to meet the needs of people. When 98% of your needs are imported, closed borders leave you with a bitter taste. The convict's. It is necessary to develop the pharmaceutical industry on the continent in order to be able to produce affordable pharmaceutical and diagnostic products and to facilitate access to these products. A word about young people who would like to follow your steps, Professor... To young people in general, we are in a period of great economic, financial, cultural transformation, participate in this transformation by training you. To women, be ambitious regardless of the disciplines in which you work. Make the sky the limit of your ambitions. On your Facebook page, you once wrote: "Don't put yourself on limits. You can accomplish everything, just want it." Who are you calling? And that will be the end word... to all young people, regardless of gender or race, dream is the first step towards success.