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Trailblazers with Garry: a conversation with Marcus Lacerda
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"Trailblazers with Garry" is a series from Global Health Matters, where host Garry Aslanyan sits down with trailblazers — thinkers, leaders, and influencers shaping the future of global health — for short face-to-face conversations, available in both audio and video formats. It’s a chance to get to know the people behind the work and hear their perspectives on the current global health landscape.
For this episode, Garry sat down with Marcus Lacerda at WHO headquarters in Geneva. Marcus joined TDR as Director in March 2026 from Fiocruz Amazônia and Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Brazil. He is a Brazilian infectious diseases physician and tropical medicine researcher whose work has profoundly influenced malaria elimination strategies and the broader field of global health. Born in Taguatinga, near Brasília, Brazil, Marcus reflects on the Catholic missionaries who first took him deep into the Amazon, his insights on vivax malaria as a silent social killer — a disease that not only takes lives but also robs children of learning abilities — and what it will take to close the gap between research innovation and real-world impact.
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Welcome to Trailblazers with Gary, a serious but global health matters podcast. I'm your host Gary Aslan. In this series, I sit down with Trailblazers in Global Health for short face-to-face conversations which you can listen to in audio or watch the video. It's a chance to get to know the person behind the work, hear their stories, and gain their perspectives on current global health landscape. Join me as we explore the people, places, and ideas driving global health forward. Let's get started. For this episode, I had the pleasure of sitting down with Marcus Lacerda at TDR headquarters here in Geneva. Marcus joined as TDR director in March of 2026, bringing with him more than 25 years as an infectious disease physician and tropical medicine researcher. Most recently at Fiocruz Amazonia and the Fundação de Medicina Tropical in Brazil. He is an international leader in malaria research and a driving force behind Tefenoquine, the first single-dose radical cure for Pasmodium Vivax malaria, to be approved in 40 years. In our conversation, Marcos reflects on the missionaries who first brought him deep into the Amazon and set him firmly on the path of tropical medicine. He shares a compelling insight into Vivax malaria as a silent social killer, one that robs children of learning long before it ever takes their lives. We also explore why the world now has the tools to eliminate malaria but has struggled to hold on to the collective appetite to do it and what it will take to close the gap between research, innovation, and real-world impact. Welcome to Trailblazers with Gary, another episode. Today I have Dr. Marcus Lacerda. He's the new director of TDR, uh just a couple of months. And Marcus welcome to Geneva and welcome to TDR. I just wanted to also let people know that we are also recording for Global Health Matters first time an episode that will be in Portuguese with Marcus. So in Portuguese, procure my startup, so Marcos, let's start um by maybe discussing the really personal attributes that one needs to be a successful global health practitioner. And especially for you, and what's most important.
SPEAKER_01And I think that uh when you talk about the global health, you really have to be global. And it doesn't mean that you are not only seated in the office, but you also have to know how to talk to people in the field. You you need to talk to funders, you need to talk to your staff. Uh so you need to talk to everybody. And sometimes the challenge is how do you modulate the way we're talking to these people? So I think the the major uh attribute of those who are working in global health is that they are able to change dramatically the way they address certain people and the way they address other people. And that's probably the the the best attribute also of politicians. They have to talk to people who are electing them, they also have to talk to to other to other presidents, and and usually they have to change a little bit the tone. So I think we have to change the tone every time we talk to different people.
SPEAKER_00Okay, well, this is really uh from the beginning, clearly something that Global Health Matters comes over and over. The way we as global health people communicate. And I think that's an important one to pick. Marcus, I understand you were really influenced by your uncle and inspired, and you worked with uh Catholic missionaries to focus on neglected diseases, tropical diseases in your career. Tell us a little bit more about that experience.
SPEAKER_01Yeah, so when I was very young, uh my uncle was a physician, and um I fell in love for that profession because uh he was really passionate about what he did. So that's when I decided that I would go through medical school. Um and and later on I I got involved with some Canadian missionaires and and they were working in the Amazon. So when I met them, uh they invited me during my vacation time to come over and see what they were doing in the Amazon. So that was my first contact with the Amazon. As you know, Brazil is huge and not many people know the Amazon. Right. So it's considered like a second country inside our country. Within Brazil, because uh 90% of the population they live more in the south, and only 10% live in the Amazon. So that was the first time I I've seen with my own eyes uh how was the deep country in which I was born. So those missionaries they took me to the countryside and I fell in love for the population, I fell in love for the geography. So I was convicted that I would like to do something joining um medicine and those diseases, and that brought me immediately to tropical medicine, which I have been doing for the last 26 years.
SPEAKER_00Great. So, really, I mean, this also comes along a lot with our trailblazers. Everyone has had an experience that really shaped their their career. Maybe um since you already mentioned how you started working in Amazon and with communities there, uh was there any sort of certain experience or certain sort of situation that really made you passionate about focusing on malaria because that's where your future career was more in. Was there a situation when really it made you think I'm really gonna work on malaria?
SPEAKER_01So usually physicians they like severe diseases. They like to be in emergency rooms, they they saving lives. Saving lives. So when they come to the emergency room and they have meningitis, severe malaria, that's what they mostly like. But then I started to see that there were some diseases which were not killing people, but I I got very, very interested in understanding how the type of malaria we had in Brazil was affecting people. So one of my first uh master's students went to uh a village in the countryside close to Manaus in the Brazilian Amazon, and she has followed around 300 kids over a year.
SPEAKER_02Uh-huh.
SPEAKER_01And at the end of the year, she got their grades in Portuguese and math. And she got to the conclusion that those who have had at least one episode of Vivax malaria, they could not learn as much as the others who didn't have malaria. So that was the first time I understood that malaria sometimes kills, but sometimes it kills you in the sense of not allowing those kids to go to the university, to work on global in global health. So those are people who are being killed socially. They will never have the chance to go to study and to learn because that disease is somehow killed in them. So I I really got uh a lot of interest for the impact uh of Vivax disease in in that population. It represents almost 90% of the case of malaria we have in Brazil. In Brazil, yeah. It's it's it's decreasing over time, but it still is a huge burden for that population.
SPEAKER_00Right, right. Interesting. It's almost like one can call it like a silent killer or silent determinant.
SPEAKER_01And it's up to us researchers to show to the society the impact, the hidden impact of such diseases.
SPEAKER_00And some of that is not necessarily always health, it can also be other outcomes of the development or something.
SPEAKER_01Well, that's we call syndamies. So m vivex malaria is not there by itself. There are other parasitic diseases, there's poverty, people are hungry. So many things are together to show to the world that there's not only one disease in each specific population.
SPEAKER_00So that made you uh think of focusing on malaria. And obviously, in the last 20, 25 years, a lot has changed with malaria in terms of we have more uh ways to test, we have more ways to treat. Uh, we actually had an episode um last year with a question can we eliminate malaria? With two leaders um from Africa discussing. Uh, what do you think is still missing to really realize that what that dream or that goal to really eliminate malaria as a tropical disease?
SPEAKER_01Well, I I think it we always need to take a look at the tools we have available, how those tools are coming to the field, and also the momentum. So, in this very building here, uh the first WHO director coming from Brazil was decided to go through an elimination campaign of malaria. Oh, really? And he actually did it. Uh-huh. So there was a lot of appetite of many endemic countries to eradicate malaria. And that helped to eliminate malaria in various settings, but not in all of them. So there was kind of a feeling of frustration at the end because after that worldwide campaign, there was still some malaria in some countries and it bounced back after a while. Well, after many decades, the tools have changed because at the time the only tool they had was DDT. So they were concentrating all the efforts in spraying DDT all around. But now, decades later, we have many other tools. We have better drugs, we have better diagnostic tools, we have bad nets. So now we have the tools, but we don't have the same appetite for eradication. Because the countries they have their own priorities now, and malaria is not among those priorities anymore. So sometimes you have to merge the appetite for eradication with the tools. And I don't think that we are doing that properly now. So with all the technology, with all the advancements of the pharmaceutical industry, I think that this is time to have a very solid discussion under the countries convening again to decide if they really want to tackle that disease.
SPEAKER_00That's very interesting because that puts really things into more historical perspective. I don't think I've heard people put this so clearly before. So that's that's something to think about how these kind of waves of interest come and go and then compete with other, uh compete with other priorities. So but so you think it's possible, we just need a bit of a more push and more more sort of focus on it.
SPEAKER_01Yeah, keep in mind that malaria is also a social disease. I mean, places which have developed over time, they have no more malaria. But in areas of poverty, that's where malaria is. In Brazil, indigenous areas, indigenous population are mostly affected, and people who live in the borders with other countries. So it's not only having the tools, but also uh trying to understand that there are social problems that will block our actions.
SPEAKER_00Right, right. Other determinants. Um we and on this podcast, as also you know, we uh try to break communication barriers and have these kinds of discussions in different episodes, making really um communication in global health more simple, more personal, bringing voices that otherwise don't get to contribute to overall global health debate. And I know that you've been working, particularly during uh the pandemic, and uh are there any stories you wanted to share maybe with our listeners about communicating science or communicating um sort of your research or lessons you learned from how to engage in communication? Anything that you comes to mind you want to share?
SPEAKER_01Well, traditionally, researchers they're not trained to be good communicators. So usually what they do is that they come to a meeting, a scientific meeting, they use their own jargon and they talk to their peers. But the pandemic has taught us that you really need to talk to the population, to those who are really suffering from that infectious disease. And especially the pandemic uh made me change my mind in terms of how I communicate with people. And and uh because of fake news, which were around uh studies that we did during the pandemic in Brazil, I really had to get the help of the press and and very talented journalists with our specialized in disseminating uh research information, and I think I've learned a lot. Uh especially with social media, everybody pretends to know about how to use social media, and that's a very powerful tool, and uh we have to take advantage of that to also to disseminate true news and the training of researchers. I think we're still uh lacking the opportunity to make them to tell what they're doing in an easy language to the population who ultimately are paying for the research that we are doing.
SPEAKER_00Do you think we are making any progress in terms of that being really appreciated by those who go into health and global health and uh and and our professions? Um, and or have we made that because uh the the fake news, misinformation, disinformation is still out there. It's just changed the focus on other things. Are we making, you think, any progress in this?
SPEAKER_01I I think we are, but the thing is every time we have a new terminology and things which are created in a high level, uh we have to translate to people in the countries what does it mean. Right. Uh usually those terms they do not come from the population and reach us. So we have been discussing a lot about one health, and most of us usually don't understand what one health is. Uh so you have to translate that terminology also to the countries, to the population, and it takes a while until they understand what we are trying to do, which is connecting human health with veterinary health, climate changes. So most of the times we are changing terminology, which is to some extent advancing in understanding the needs and the challenges, but I think that that terminology needs to be very clear to the countries and to the population living there.
SPEAKER_00So by the time what it's kind of defined at a global level, we kind of miss the boat at a local level and things are not adopted on time to be then really implemented or to be considered.
SPEAKER_01Yeah, sure. I think we have to clearly show to people, for example, what's the impact of climate change. Well, it's something very vague to some extent to them, but by the time you show them that the droughs and the floods that they are living is impacting, for example, the distribution of drugs, diagnostic tests, it becomes more clear to them the practicalities of climate change.
SPEAKER_00Hold out climate change. I'm gonna come back to that. Now, if we look at infectious diseases overall, we talked about malaria, but other infectious diseases. In 2026, what do you think needs to change in terms of how we approach the uh sort of infectious diseases or the burden still uh disproportionate on some neglected diseases? What are the new ways we have to think of doing things to really achieve that?
SPEAKER_01Well, there is a paradox. When you have many cases of a lethal disease, people are a lot concerned. That's when they uh they try to manage that disease. They they're looking for more diagnostic tools, you're looking for better and safer drugs. But by the time you start to decrease the number of cases and you have a small amount of cases, usually people don't care. So the paradox is the more cases you have, the more you're trying to solve the problem. But then you reach a certain number and people are not concerned anymore. So it seems that many diseases that we are able to control, they need to be integrated with the health system so that you merge that control with the control of some other diseases which are more important, are more relevant to the population. So if you go nowadays to lots of countries, tropical countries, low and middle income countries, and you ask them, Do you think we have to eliminate sleeping sickness? Or should we do something else for sleeping sickness? They probably would say, since they have only 3,000 cases in in Congo, for example, they would say, No, we have other problems. We have opacity, we have hypertension, we have diabetes, cancer. So they're not worried anymore about those diseases. No, it's not even neglected by us, it's also neglected by the population at some point. So that's when we have to merge systems and we have to take advantage, otherwise, you will always have, for example, uh a program for sleeping sickness, a program for malaria, a program for dengue, and that way load approach. Exactly. And that way you will never reach the population. It's the same example of fibrious syndromes. Uh-huh. If you decide that you will tackle Zika virus or Shikungunia or Oropushi, that will not work because at the end everybody has to do that. You have to do it together. Yeah. So you have to have an approach in which you diagnose the syndrome and you try to diagnose, but based on the syndromic uh definition of that patient.
SPEAKER_00Yeah, and a lot I also think a lot of new things come in. Uh there's a lot of innovation, but then kind of the block is to get it to the people in the right way. Um don't you think that also needs to kind of really be uh rethought and and and this a lot more attention also needs to be put on the implementation of things? What's what do you think? Are we doing enough in helping get the things to people?
SPEAKER_01Yeah, I think that at this point uh the countries they have a a lot of talent, they have good researchers, they have good universities, and sometimes they even have a lot of of funding to the research. But are they doing the right questions? Do they have the right questions? So they will probably go to a lab and they will train their students uh with pie patting, they will teach those students how to do some immunological studies. And well, these people should not be very competitive because there are places in which they do that very fast in a high throughput way. But those countries they have full access to endemic areas, they know the field, they know the people, they know the cultural perspective of their countries. But I don't think that they're taking advantage of that expertise. Well, they should focus on the right questions. So we have new tools here, they've registered, they've been registered, they are ready to get used, but the countries are not using it. So that's to me a big gap, and the countries need to address that. And that's why I think that the the concept of implementation research has changed a lot and will change a lot, but not by the time we in WHO TDR understand that the countries need to ask that. They have to ask for more implementation research and they have to do it on their own.
SPEAKER_00So you mentioned that a lot of countries' context change and the capacities change, which is extremely Welcome, obviously, to see. And what should then change in terms of global collaboration? You know, north-south, south-south, and between countries? What kind of new ways of capacity strengthening or exchanges, or you know, those working in countries can be taking advantage of thinkings happen things happening at global level or work that TDR does. How do you think this needs to be different now?
SPEAKER_01Well, we are definitely more globalized in these days. We have been connecting with people all over the world, and we it's much easier now to get their ideas and to learn from them. So it's not like in the middle age that people were not contacting, you know, only when they came to those fairs in the small village they were talking to each other. So now we have many more people. The thing is, uh, what's the quality of that spirit experience? So you're talking to someone in your neighbor country, and how can you copy that experience? Sometimes we are copying a lot of experiences from outside, and we don't think that we need to make our own ideas and our own strategy. So sometimes copying from one country like the US, for example, it should work in the US, but it should not work in in Bolivia or Argentina. So people are afraid of making of getting new ideas to their routine lives. And of course, guidelines, and WJO is an expert in producing general guidelines, but those guidelines, they have to be adapted to the real context. And I think people are still afraid of doing that. They feel that they have to follow guidelines strictly without looking that they might be more adaptive in the sense in their context.
SPEAKER_00In their context. Okay. So we we need to work on making that more applicable and helping and working with um in that area. So um for the season five, we're actually asking all of our guests to kind of reflect on what's the future of global health in general. You mentioned climate change, and and I just want to also come back to that, how you see things uh going in terms of the future or global health. And obviously, climate is one, but also we have more conflict now, we have more kind of migration, etc. What do you think uh global health future in the future? How does uh future of global health look for you?
SPEAKER_01Well, we have uh a big population, uh and and and people now they're facing many challenges. Uh the the first one is how they move from one place to the other. The other thing is that uh probably 50 years ago when TDR was doing their first uh uh research, uh people were living in rural areas. And nowadays most of the population they live in urban areas. So we have to understand that change because with that change, the tropical diseases they're no longer in the small villages, they are in the surrounding of the big cities. Right. And in those places, someone has to understand that there is uh a change in the temperature in that area. You have violence, which does not give you access to everybody living in the surrounding uh areas of uh of a huge capital. And of course, the most obvious way of thinking about climate change is for the first time the planet is seeing an increase in temperature, and that is related to uh human beings. Right. And of course, with the increase in temperature, we have to understand better, for example, how the vectors will survive, how will they get adapted? Well, insects, vectors which transmit many parasites and viruses, they know very well to get adapted. I'm not sure that we are as well adapted as those vectors are. So I think that from the evolutionary perspective, it's very difficult to understand how those vectors will behave. But definitely we have already started to see diseases in place where they never existed because the temperature during winter was able to block their proliferation. So it's something very obvious and it comes to tropical diseases as the first impact of climate change. But I would not like to forget these agglomerations around big cities and more than that, mental health. Uh people definitely with the climate change and the impact of living in the crowds around big cities, they are also facing more and more mental issues. And that's not part of the equation when we are discussing those diseases.
SPEAKER_00Yeah, good. Thank you for that, Marcus. And obviously, a lot more kind of understanding and work needs to be done. So uh it's great that also TDR will look into this so we we can uh tackle that as a global kind of challenge in the coming years. So thank you very much for your attention. Thank you, Marcus, for joining us for this Trailblazers. So please check out our other episodes and we are here to bring you Trailblazers coming forward, going forward, so don't miss future episodes. Thank you for joining me for this episode of Trailblazers with Jerry. The audio and video versions of this episode are available wherever you get your podcast. Be sure to visit the Global Health Matters webpage for more information about my guests in this series. Don't forget to get in touch with us via social media, email, or by sharing a voice message. And be sure to subscribe or follow us. Global Health Matters is produced by TDR, a United Nations co-sponsored research program based at the World Health Organization. Thank you for listening.
