‘It occurred to me that malaria was a genocide. How was it that we had a disease that killed a million-plus people a year, and we let it happen? This was a genocide of apathy.’ (Ray Chambers, Lifeblood, page 70)
Malaria kills a million people a year, and infects up to 500 million more. It is calculated that in lost work days, expenses and wasted potential it costs Africa $30-40 billion a year (A. Perry, Lifeblood, page 11) .This expense could be spared as malaria is a preventable and curable disease. Malaria is caused by a protist parasite, of which there are 4 species that can infect humans. Of all the types of malaria, Plasmodium falciparum is the most serious, and accounts for the majority of the life-threatening cases of malaria each year. Malaria attacks the human body through entry via an Anopheles female mosquito, and goes on to destroy red blood cells and affects many vital organs include the liver, kidneys and spleen. Malaria is mainly present in Africa, Asia, the Middle East and South and Central America. Due to the nature of the parasite, it is the leading infectious killer in the world and therefore an important global health issue. Malaria is counted as the world’s most contagious disease; its reproductive number ranges from 10-3000, compared to that of H1N1 with a reproductive number of 3 (A. Perry, Lifeblood, page 12).
One way of trying to prevent the spread of malaria is to shorten the life cycle of the mosquito, so that they cannot ingest and infect other organisms with the parasite. This is currently being done through environmental methods, as by removing the mosquito’s breeding grounds or not allowing the mosquitoes long enough to develop the parasite the spread of malaria can be slowed. This can involve drainage (the mosquitoes breeding ground is stagnant water), levelling the land, and filling depressions in the ground. It has been claimed that:
“An estimated 42% of the global malaria burden (or around 500,000 deaths) could be prevented by environmental management”. (‘Preventing Disease through Healthy Environments’)
In the past, in 1950s America, oil was used to stop the growth of mosquitoes by removing their breeding ground. This suggests that if a wealthy country can eradicate malaria then there is no reason why all countries can’t eradicate it.
Another way to try and prevent the spread of malaria is use of insecticides. Indoor residual spraying (IRS) is recommended by the WHO, (WHO Malaria Report 2010, Page 17) an insecticide is sprayed on indoor walls, meaning that as the mosquito comes to rest after feeding it is killed by the uptake of insecticide through its feet. The most effective IRS spray is DDT, which can last for over 6 months. DDT is a low cost solution and an easy way to reduce mosquito numbers. However some mosquitoes have become resistant to DDT after the use of it in the previous decades.
Another way that the WHO is trying to prevent the spread of malaria is with ‘long-lasting insecticide-treated mosquito nets’, which they believe should be supplied to malaria prevalent areas either free or at a subsidised charge. These nets hang above a bed at night time, preventing the mosquito from feeding and therefore infecting people. This is especially important as the main time for mosquitoes to feed is during the night. The number of nets delivered by manufacturers increased from 5.6 million in 2005 to 88.5 million in 2009 in sub Saharan Africa, showing a dramatic increase in the use and availability of these nets. However still only 42% of households were estimated to have owned one of these nets in 2010, and only 35% of children were thought to be sleeping under one (WHO Malaria Report 2010, page 20) This shows that although the increase in nets has been dramatic, there are still not enough for each person in a malaria ridden area to sleep under one, or the people who have been provided with nets are not using them. This indicates that although effort is being put in, it is not enough for the scale of the problem.
For control by drugs; malaria was originally treated by Chloroquine, however due to widespread use, many strains of malaria are now resistant to the drug. The WHO recommends the use of one of 5 ACTs (artemisinin-based combination therapy) and primaquine. Unfortunately in many countries these drugs are either scarce or too expensive for the general population to be able to afford. Only 65% of patients who visited a public health facility with malaria got the treatment they needed, (WHO Malaria report 2010, page 31) and many people would not have access to a public health facility. This problem is being worked on by the AMFm (Affordable Medicine Facility – malaria). It aims to increase the availability of high quality and affordable ATCs by either negotiating a lower price for them, or by subsidising the cost of them on behalf of the patients. This is being trialled in a small group of countries inside and outside Africa for 24 months. (WHO Malaria Report 2010, page 32)
For travellers visiting areas where malaria is prevalent, there are prophylactic drugs that can be taken before and during the time spent in a malaria-ridden country. However these are not practical for people who live in malaria infested areas due to the cost and the negative side effects of taking these drugs for extended periods of time. Also the use of these drugs for a longer time may encourage the development of partial immunity, leading to a bigger malaria problem in the following years. This indicates that the malaria problem is not an issue in wealthier countries due to negligible risks, which could suggest why funding for the developing countries for malaria is lower than it needs to be.
There is no current vaccine for malaria, although the development of RTS,S could be heading in the right direction. The vaccine is still in trial stages and combines a protein on the parasites surface with one from a hepatitis B vaccine, which then triggers an immune response which can fight off the parasites. The vaccine has been tested on children in sub Saharan Africa in the worst malaria infested areas, and it was proven to have reduced the risk of malaria by 56% (The Economist, 22 Oct 2011).
There are drugs still in the experimental stage that may help with the reduction of numbers infected by malaria. The first of these is a genetically engineered recombinant tobacco mosaic virus, with surface proteins of P. virax. The P. virax proteins promote a response from the immune system in humans that would fight off the malaria before it reached the life-threatening stage. The recombinant virus could be used to manufacture a cheap malaria vaccine in large amount, all that is needed to do is harvest infected tobacco or tomato plants and process them for immunogenic proteins. Another drug still in the experimental stage is NITD609, which although so far has only been tested on mice, has promising results. The drug is said to be able to fight the parasites that cause malaria, as the mice injected with the drug were free from malaria after just one dose. Costs in the USA for malaria research come in at $612 million, showing that substantial efforts and funding is being put in (The Economist, 22 Oct 2011). However this could be used for funding the preventative methods and cures that we already have for malaria, controlling it before a new vaccine is even needed.
A treatment that has shown to work already is Intermittent Preventative Treatment (IPT). IPT is the dispensation of a course of an anti-malarial treatment to a certain amount of the population, whether they currently have malaria or not. The purpose of this is to reduce the malaria burden in the specified population. This is especially important for children and pregnant women. While this has been set out in the WHO’s Malaria Report 2010, it still needs wide scale implementation to work, and there is not enough funding for this.
The first thing that is stopping malaria from being a disease of the past is that eliminating malaria in a stable country is a lot easier than doing so in an unstable country. War, famine and corruption make dealing with malaria less of a priority to a country’s leader, and therefore malaria becomes more of a threat towards civilian populations. Unfortunately the more time that passes, the more likely the easier methods towards removing malaria are likely to become less effective. The more a parasite is exposed to the chemicals and drugs the more likely it is to become resistant to them, meaning a new way will be needed to control the parasite. This suggests that malaria should be made a higher priority sooner rather than later, yet there is not enough funding for the removal of malaria at the current time. The WHO estimated that between 2010 and 2015, 5 Billion USD a year should be spent on malaria prevention. The costs are shown in Appendix A.
Currently around $1.8 billion a year is being spent on malaria prevention, only a 1/3 of the estimated cost needed. This can be seen in Appendix B. The lack of funding backs up the lack of results. Between 2000 and 2009 only 11 countries in the African Region had a decrease of over 50% in number of cases of malaria. This can be seen in Appendix C. This shows that although funding has improved over the past decade it hasn’t improved enough and s the results are less than would be desired. The lack of results also could be due to lack of education about malaria. In which case, when nets are distributed, the population should be educated about their use, and any environmental changes that they can carry out. If people are educated about the infection then it would become easier to prevent.
Outside the African region however and prospects for the reduction of malaria look a lot more developed, as a decrease of more than 50% was found in 32 out of the 56 malaria endemic countries outside of Africa, as can be seen in Appendix D. This suggests that the efforts are successful when targeted correctly, and therefore a more wide scale operation needs to occur in a similar fashion within Africa. The difference between the results in Africa and the results in the other malaria endemic countries is substantial. This could suggest that not enough is being done to prevent malaria in the sub-Saharan African countries.
Another problem within Africa could be the distribution of nets, and getting the supplies to where they are needed. Logistical problems such as in the DRC can stop nets and insecticides getting to where they are needed most. In addition to this, corruption is rife, not only in the African dictatorships but also within the aid agencies who have the responsibility for getting nets and insecticides to that populations. Also, aid money (such as given to charities) can often be spent on things that do not benefit the people who require the aid; money is spent on expenses, accommodation for visiting officials, cars and international travel.
Also, it has been said that aid can’t keep coming from donations, as outsiders taking over responsibility in towns and villages means that they removed the responsibility from the leaders of the villages, which can lead to loss of skills and a dependency on outside help. There is work being done trying to counter this, in 2010 the African Leaders Malaria Alliance (ALMA) was set up, with the intention of trying to help sort out the malaria problem within African from within Africa.
Another issue with trying to eradicate malaria is that eradication programs would first have to be focused on areas in which malaria could be eradicated, and these would be the less malaria-prone areas, meaning that funding and resources would be going to lower priority areas that don’t need as much as some others. Also, is has been said that
‘Killing mosquitoes outright pits us against evolution. We need to keep evolution on our side’ (Andrew Read, New Scientist, 27 Aug 2011)
which backs an idea that the mosquito’s diet could be changed by the use of parasitic fungi that would affect the mosquitoes ability to smell us but not other animals, rather than trying to eradicate the mosquito completely.
In conclusion, the number of deaths due to malaria was estimated to have decreased from 985,000 in 2000 to 781,000 in 2009 (WHO Malaria Report 2010). This indicates that progress is in the right direction, however due to the fact that malaria is preventable and curable there should be no deaths from malaria, no matter where in the world you live. If one country can become malaria-free it then so should the others. Unfortunately it may seem that sub Saharan Africa needs to become more stable before the WHO’s plans for the control of malaria there can work. Also more money is needed before all the initiatives that have been put forward by the WHO and other organisations, can be implemented to make the WHO’s goal of a malaria free world by 2015. The WHO initiative is shown to work, as Morocco and Turkmenistan were certified of free from malaria in 2010. This highlights the progress that can be made if funding and support is present.
Overall it would seem that not enough is being done about malaria. More money needs to be funded from the Global Fund and the PMI to pay for enough nets so that everyone can be covered by one while sleeping, enough malaria treatments so that 35% of the population don’t have to go without, enough IRS so that each household can spray their walls to reduce the mosquitoes life cycle, and money should be given to educate people living in malaria prone areas about how they can improve their environment so that the number of mosquitoes is reduced.
Appendix A. This table shows the global resource requirements in millions of US dollars, that were estimated to be needed in the Global Malaria Action Plan, with the idea of removing malaria as a problem in the world. (WHO Malaria Report 2010, page 11)
Appendix B. This shows the funding for malaria-related initiatives for the past 7 years, including where the funding comes from. (WHO Malaria Report 2010, page 12)
Appendix C. This table shows the countries within African that have a decrease in cases of malaria between 2000 and 2009. Countries in bold have tried malaria-prevention initiatives. Countries with a cross by their names have had low levels of malaria for the time period. Countries with a star by their names have substantial improvements in several areas of their country but not wide-scale improvement. (WHO Malaria Report 2010, page 41)
Appendix D. This table shows the countries outside of Africa that have a decrease in cases of malaria between 2000 and 2009. Countries in bold have tried malaria-prevention initiatives. Countries with a cross by their names have had low levels of malaria for the time period. Countries with a star by their names have substantial improvements in several areas of their country but not wide-scale improvement. (WHO Malaria Report 2010, page 41)
Alberts et al. (2008) ‘Molecular Biology of the Cell’. New York: Garland Science.
Madigan M et al. (2009) ‘Brock Biology of Microorganisms’. San Francisco: Pearson Education Ltd.
Perry. A. (2011) ‘Lifeblood: How to Change the World, One Dead Mosquito at a Time.’ London: Hurst & Co.
Prüss-Ustün, A. Corvalán, C (2006) ‘Preventing Disease Through Healthy Environments : Towards an Estimate of the Environmental Burden of Disease’ Geneva: WHO Press.
‘Drugs don’t work on mosquitoes’. DNA [Daily News ; Analysis] 22 Oct. 2011. General OneFile. (accessed 27 Oct. 2011)
Fox, Maggie. ‘New Malaria Vaccine Protects Half of Babies For a Year, Researchers Say.’ Nationaljournal.com 18 Oct. 2011. General OneFile. (accessed 27 Oct. 2011)
‘Malaria, Causes and Symptoms’ Global Malaria Foundation. Available at: www.globalmalariafoundation.com (accessed 28 October 2011)
Massachusetts Institute of Technology. “Fighting Malaria By Changing The Environment.” ScienceDaily, 28 Jan. 2009. (accessed 2 Nov. 2011)
‘Not swatted yet; Malaria.’ The Economist [US] 22 Oct. 2011: 102(US). General OneFile. (accessed 27 Oct. 2011)
‘Befriending the Body Snatchers’ New Scientist. 27 August 2011. Vol 211.Reed Business.
World Health Organisation. (2010) World Malaria Report (2010) Switzerland: WHO Press.