Half of the world’s population is at risk of malaria. There were 216 million cases of malaria in 2010, 81% of these were in the WHO African. (WHO 2011)
Since the mid-2000s, the treatment of choice against malaria, a mosquito-borne infectious disease, is based on the artemisinin derivative, artesunate. This in addition to environmental control measures like:,insecticide treated bed nets, insect repellents, and indoor residual sprays of insecticides. Environmental management including the removal or treatment of standing water (where mosquitoes breed) have been shown to reduce and even eliminate malaria.
But an increasing number of reports now signal the spread of artemisinin-resistant malaria, most recently in Thailand as published in The Lancet. Malaria professionals are not surprised by this and warn of an impending public health disaster. In the Malaria Treatment & Prevention community on GHDonline.org, they call out the experiences of Malaysia, Burma, Rwanda, and China in the fight against malaria.
“The mess in Burma [Myanmar] is due to the chemical dependency of the malaria strategy of WHO and Burma, which is simply: drugs, drugs and biocides,” commented William Jobin, a malaria expert with more than 45 years of field work. “Now the 2011 solution proposed by WHO, he continued, “is more of the same – drugs. What do you call it when you keep doing the same thing, and expect different results?” Jobin calls for a realistic strategy against malaria, with, for example, an integrated vector management program adapted to each country.
GHDonline member Charles Llewellyn, former office director of Health and President’s Malaria Initiative (PMI) manager at USAID/Tanzania from 2005 to 2010 and currently consultant to USAID/Angola, summed up the situation: “Recently we have had a wonderful coincidence of: Affordable tools that work: nets, artemisinin and pyrethroids; Political will: which sets priorities and funding; External funding from Global Fund, PMI, Gates and others. Together these factors offer the world an opportunity to control and possibly eliminate malaria forever. However, we see that the parasites are developing resistance to artemisinin, as they have to all other drugs, the mosquitoes are developing resistance to insecticides, as they have before, and mosquitoes are even changing behaviors, feeding earlier and later, and outside houses, making nets less effective.”
There are also encouraging signs. Rene Kabera, MD, Family Medicine, in Rwanda, noted that in his District Hospital, there used to admit hundreds of patients with Malaria, but can now spend 6 months without a single case. Members say these success have one thing in common: integrated and context-relevant, with a big emphasis on prevention.
Much less talked about, vector suppression researchers like Michael Reddy, Ph.D. candidate at Yale University, points to the rise of insecticides resistance as well as delivery challenges: cost, sustainability, efficacy, and toxicity among others. Clearly there is no silver bullet for malaria. Only integrated interventions which have proven effective should be pursued.
Michael Reddy M.Phil MPH, Doctoral Candidate, Yale University; Depts of Epidemiology and Public Health & Ecology and Evolutionary Biology, contributed to this blog post.