Malaria – one of the world’s oldest killers – continues to plague large parts of the globe despite decades of effort to wipe it out.
Sadly, as the World Malaria Report published by the World Health Organization today makes clear, progress on eliminating it has stagnated, with the number of cases and deaths unchanged for the past three years.
This is a disease that still results in the death of a child every 2 minutes, despite effective treatment costing roughly the same as a cup of coffee in London.
During the 20th century, several attempts were made to eliminate malaria. In some parts of the world, notably Europe and the US, they worked. But in other areas progress stalled as the tools available to tackle it began to fail and financial and political commitment wavered.
One of the most effective means to combat infection has been the use of bed nets. These protect those sleeping under them from being bitten, while at the same time a coating of chemical insecticide kills malaria-carrying mosquitoes that touch them.
The development of simple finger-prick tests that can immediately detect whether a child has malaria parasites in their blood has allowed quick diagnosis. Coupled with an increased supply of the cheap but highly effective drugs needed to cure it, these have reduced the complications associated with infection. So why has progress stalled?
As the WHO report makes clear, perhaps most important is the fact that the financial commitment to fight malaria is insufficient. Global funding has hovered around $2.7 billion per year since 2010, well below the $6.5 billion needed to meet the WHO’s global goals of reducing cases and deaths by 90 per cent by 2030 and eliminating malaria in at least 35 countries. With populations in affected nations growing more than 3 per cent a year, financial stagnation is the same as a reduction in the funding per person at risk.
The result is that many malaria-affected countries are now struggling to ensure universal coverage of proven interventions. It is often the poorest and most marginalised who miss out.
Secondly, resistance to anti-malaria drugs has emerged in the parasite that causes the disease, Plasmodium. It is notoriously adaptable and hence able to evolve strategies to evade control efforts. The parasite has developed resistance to the new artemisinin-based medicines and other drugs used in combination with them in five countries in South-East Asia: Cambodia, Laos, Myanmar, Thailand and Vietnam.
While the drugs remain effective in Africa, which harbours the greatest burden of the disease, history shows that it is only a matter of time before resistance becomes a problem here too. Equally concerning, Plasmodium appears to have evolved to evade detection by new diagnostic tests.
Moreover, the mosquito that transmits the parasite to people is developing resistance to many of the chemicals used to kill it – including those used to treat bed nets. How, then, can we get malaria eradication back on track?
It is critical that the gains made so far are sustained. Any reduction in the number of people with access to proven prevention methods could lead to resurgent epidemics due to the loss of immunity in the affected populations. This was seen following the collapse of the global eradication programme in the 20th century.
Central to preventing this is continued investment in the research and development of drugs, diagnostics and insecticides, as well as ensuring that all those at risk of infection have access to these. However, we need to do more to ensure that both the funding is available and tools are developed to eradicate the parasite rather than just contain it.
Early next year, a new campaign to try to ensure just this will be launched by charities, health groups and NGOs dedicated to fighting malaria. It will culminate with a call to action to governments, business and scientists at the Commonwealth Heads of Government Meeting in the UK in April 2018.
The global battle against this disease is at a turning point. Only by ensuring commitments are made and sustained will we end malaria for good.
Source : New Scientist