The Road to Conquer Malaria: What Lies Ahead

In 1980, one of the most devastating disease smallpox was wiped out from the face of the earth. What made eradication possible was contributed to good management, innovations in research and strong disease surveillance control. Malaria in contrast, an equally deadly disease not only has persisted across several continents, but also “thrived” in some poorest countries in the world, perpetuating human suffering by robbing those nations’ productivity and opportunities for economic growth. The question is why?

Eradicate malaria is no simple task

Technically speaking, eliminating malaria is possible by a multifaceted approach:
•    Interrupting local malaria transmission using vector control measures such as indoor spraying and insecticide-treated nets;
•    Managing existing malaria cases using effective diagnostic and treatment interventions;
•    Eradicating parasite reservoirs by sustaining high-coverage malaria control over a period of time until all parasites die out.
In reality, those management strategies are difficult to implement for the following reasons.

Drug resistance is a big problem which continues to put pressure on drug research and development. Emerging drug resistance of P. falciparum in sub-Saharan Africa has rendered anti-malarial drugs such as chloroquine and pyrimethamine-sulfadoxine less effective.

What’s more, eliminating the second deadly malaria species P. vivax is very difficult because of the parasite’s long dormant period in human liver.

Malaria influx is another big headache for the WHO when infected mosquitos were carried into regions such as Egypt and Brazil where malaria was once eliminated.

Operational challenges

Achieving global eradication of malaria means malaria control programmes need to be implemented across every region of malaria infestation. This is currently out of the question at least in Africa where infrastructures and health systems are often critically inadequate.

In addition, a range of malaria initiatives such as the Roll Back Malaria partnership (RBM), the US President’s Malaria Initiative (PMI), the World Bank Malaria Booster Programme have emerged in recent years, posting significant challenges to campaign managers’ capability of coordination, reporting and resource allocation.

At last, geographical isolation of some remote communities makes them almost inaccessible. Just to illustrate the point, previous eradication programmes never even reached the far-west region of Nepal where malaria was present.

Financial challenges

The biggest obstacle in the global effort of eradicating malaria is no doubt money. It has been estimated that a comprehensive malaria control effort requires roughly $3 per person each year. Given the large population within high-risk areas of malaria, it can add up to a substantial amount of financial resources. Based on the estimate of the Global Malaria Action Plan, the costs of implementing high-coverage malaria control strategies was $5.3 billion between 2009 and 2010. The figure of implementing elimination strategies was even more staggering, reaching a massive $6.2 billion USD.

Unfortunately, the current financial resources allocated to fight malaria is nowhere near the estimate target amount.

The situation is not getting better. Since the majority of the funds needed for malaria control comes from countries such as the United States where malaria is no longer an issue, there is no guarantee that the usual donors will continue their support. History has already proved this point: at the end of the Global Malaria Eradication Programme (GMEP), interest on malaria waned. On top of that, the economic crisis in the early 70s further dwindled the money supply to malaria control.

Inequality

Malaria treatment in the United States versus malaria treatment in Africa

Image sources: https://www.cdc.gov/malaria/diagnosis_treatment/diagnosis.html

and http://www.theniles.org/en/articles/society/1307/

Keen observers can easily spot the obvious: malaria is a disease of poverty. Poor health infrastructures and lack of funding equate a tragic reality of inequality on this planet. On one hand, well-developed countries like the USA and Australia “enjoy” a relative malaria free environment, while on the other hand, people in poor sub-Saharan nations suffering from malaria has no immediate end. It has been estimated the total economic burden of malaria in Africa reach $1.1 billion US dollars. Poor African nations were neglected to the extent that the sub-Saharan Africa was not even included in the global programme.

I hope you can see that eradicating malaria is unlikely to happen in the immediate future because of the reasons mentioned previously. Does it give an excuse to suspend the effort and support? Obviously not, the reason is simple: as long as Malaria still exists on this planet, you are never completely safe, no matter where you live.

References

1.    Tucker JB. Scourge. Grove Press; 2002. 1 p.
2.    Kappe, Shi, Vaughan, Am, Boddey, Ja, Cowman, Af, Kappe, Shi ; Vaughan, Am ; Boddey, Ja ; Cowman, Af. That Was Then But This Is Now: Malaria Research in the Time of an Eradication Agenda. Science. AMER ASSOC ADVANCEMENT SCIENCE; 2010;328(5980):862–6.
3.    Breman, Joel G., Brandling-Bennett, A. David, Breman A David JGB-B. The challenge of malaria eradication in the twenty-first century: Research linked to operations is the key. Elsevier Ltd; 2011;29:D97–D103.
4.    Miller LH. The Challenge of Malaria. Science. 1992 Jul;257(5):36–7.
5.    Tatem, Andrew, Smith, David, Gething, Peter, Kabaria, Caroline, Snow, Robert, Hay, Simon, et al. Malaria Elimination 2: Ranking of elimination feasibility between malaria-endemic countries. London: Elsevier Limited; 2010;376(9752):1579–91.
6.    Mills A, Lubell Y, Hanson K. Malaria eradication: the economic, financial and institutional challenge. Malar J. BioMed Central; 2008 Dec 11;7(1):S11.

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