Sunday, April 27, 2008

It is long past time for the world to control malaria

Friday was World Malaria Day, and fortunately that day was marked by expressions of re-dedication to the fight against malaria. The disease causes an estimated 500,000,000 cases of illness per year and a million deaths per year. While once it was an important health problem in the United States and southern Europe, it has long been controlled in the rich areas of the world, and it really only seen when someone with malaria travels to one of these countries.

The geography of the disease is important. There are areas where mosquitoes capable of carrying the disease are much more common than they are in the temperate zones where malaria has been controlled, areas where the costs of controlling mosquitoes are harder to bear, countries with grave difficulties of managing the campaigns needed to control malaria, and countries with very high levels of prevalence of the disease meaning that there are many more people to treat and many more new cases per year (since each person with the disease is a threat to others around him/her). The fact that some forms of the disease can persist for a very long time means that even when there are no reported cases for years, there remain sources that can reinfect the population when control efforts are relaxed.

Half a century ago, the World Health Organization managed an ambitious world wide campaign against malaria. The eradication of malaria in Italy before World War II showed the world that it was possible to control the disease. Unfortunately, the effort was billed as a global effort to eradicate malaria, and when public health officials came to believe that they could not eradicate malaria worldwide, the efforts to control the disease were cut back. Poor countries felt that they could not afford the required campaigns, and rich countries suffered donor fatigue.

There are many tools available for the control of malaria. Engineering works can drain areas where standing water allows mosquitoes to breed. Direct efforts can clear up refuse in which mosquitoes can breed, and larvacides can keep water larva free. There are varieties of fish that can be stocked that will eat mosquito larva and thus reduce mosquito density. Ultra low volume spraying with a number of environmentally acceptable pesticides can keep mosquito density low in areas in which people are out of doors. DDT spraying on the walls of houses and pesticide impregnated bed nets can keep mosquitoes away from people at night, and kill them when the rest after the blood meals that infect them. A variety of medications can cure people when they become infected, and the relatively new combination therapies seem to retain efficacy.

There are new technologies including remote sensing technologies, telecommunications technologies, and computer technologies that can be used to improve the management of campaigns. Advances in biotechnology are leading to improved understanding of the disease, and eventually there will almost certainly be effective vaccines to provide some degree of immunity and/or resistance to the disease. The capacities of developing nations to manage public health programs have improved in most of the world.

A million kids dying a year from a disease we can control is not acceptable. 500 million cases of the disease cause human and economic losses that are not acceptable! It is just a matter of mobilizing our will to control malaria, and eventually we will eradicate the disease. Rich countries should revitalize their support, and encourage poor countries to renew and redouble their efforts to control malaria!

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