Malaria Control: Past Successes and Failure

Many attempts have been initiated in the past with huge financial and human resources invested in order to eradicate malaria globally. Unfortunately, it didn’t work out. At least it wasn’t as well as many have hoped. Why is it so?

Past campaigns on malaria

The first ever national effort aimed to control malaria was launched at the turn of the last century by Italy, which resulted in the eradication of malaria in Western Europe just before the second World War.

Then there was the Global Malaria Eradication Program (GMEP) launched by the WHO in 1955 aiming to eradicate malaria from the world. It was a significant effort which covered nearly half of the world population at the time. The campaign lasted for 14 years and costed about $20.33 million US dollars with the United States contributing over 85% of the total amount.

The GMEP was discontinued because it became apparent that the goal to eradicate malaria at a global level was not possible with existing means. As a result of the termination of this campaign, mortality rates caused by malaria sky-rocketed with Africa bearing the brunt of this human scourge.

In 1997, the WHO launched another program for accelerated implementation of malaria control in Africa.

In 1998, a new initiative called “Roll Back Malaria” (RBM) was launched with the main focus set to Africa. Four strategies were established which include:

  1. The access to treatment;
  2. Vector control;
  3. Prevention and malaria in pregnant women;
  4. Response to malaria epidemics.
fa_689_ddtspraying970http://www.whale.to/vaccines/ddt_spraying.html

Past successes

The various attempts to eradicate malaria either at a regional or global level have made some ground towards the ulmate goal.

Early efforts of vector control, diagnosis of malaria using microscopes and using a then-effective anti-malaria drug quinine helped reach the early milestone of eliminating malaria from Western European countries.

The discovery of DDT or Chlor- Diphenyl- Trichloroethane was another major success in the past. The residual effect of this insecticide led to the development of the indoor residual spraying technique (IRS) which reduced the application to twice or three times each year.

The control of the indoor adult mosquitos was the cause of a drastic reduction in malaria transmission in many parts of the world including Latin America, the Middle East and Asia.

New drugs were developed such as chloroquine, made available by the US Army World War II Drug Development program in the 1940s. It was the first synthetic antimalarial drug that could be mass produced.

Even though global malaria eradication has not been achieved, some regional success is worth mentioning.

China has eradicated malaria from almost the entirety of its territory by adopting a multifaceted strategy which focuses on case detection, management by politically supported epidemiological services, and well-organised response measures to eliminate malaria foci.

Another good example is the island of Bioko, Equatorial Guinea. Within four years since the launch of an integrated malaria control program in 2003, The small West African island experienced a massive reduction in the rate of malaria infection and malaria-associated mortality, especially among children under the age of five.

Past failures

So why did the GMEP fail to achieve its goal after 14 years of collective efforts and millions of dollar invested?

The campaign was based on the false assumption that DDT alone was sufficient to eradicate malaria as long as a centrally defined plan was carried out rigidly.

The consequences were disastrous:

  • DDT gradually lost its effectiveness due to its soaring prices and vector resistance as a result of the widespread application.
  • Traditional control methods of destroying mosquito breeding ground and prevention of mosquito bites were abandoned.
  • Existing knowledge of malaria was deemed sufficient and future research was considered unnecessary.
  • Social and cultural barriers prevented the campaign activities from being carried out in many regions.
  • Reports of treatment failure due to chloroquine resistance were ignored as the campaign organiser still hoped to interrupt malaria transmission by spraying alone.

At the end of the GMEP, major financial contributors such as UNICEF shifted their focus to other general health programmes withdrawing financial support to malaria control programmes. On top of that, oil shortages sent DDT prices soaring; the economic crisis at the time further diminished the financial resources allocated to malaria control. By that time, the all-out war against malaria was well and truly over.

References

1. Nájera JA. Malaria control: achievements, problems and strategies. Parassitologia. 2001 Jun;43(1-2):1–89.

2. Livadas GA, Georgopoulos G. Development of resistance to DDT by Anopheles sacharovi in Greece. Bull World Health Organ. World Health Organization; 1953;8(4):497–511.

3. Yaro, Abubakar, Yaro, Abubakar. Journey through the World of Malaria. Hauppauge: Nova Science Publishers Inc; 2014.

4. Nájera JA, González-Silva M, Alonso PL. Some Lessons for the Future from the Global Malaria Eradication Programme (1955-1969). PLoS Medicine. Public Library of Science; 2011 Jan 1;8(1):1–7.

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