02 August 2013

Malaria Eradication: Is it Possible?

Boe's Bits (Health Topics by Dr. Roger Boe)

The United Methodist Church has recently launched a serious, highly publicized campaign, Imagine No Malaria, which has greatly expanded its previous antimalarial effort, Nothing But Nets.
Nothing But Nets focused on providing and distributing insecticide-treated bed nets to families in malaria prone areas, particularly in Sub Saharan Africa.  Imagine No Malaria, takes a much more comprehensive approach with the addition of programs for draining potential mosquito breeding sites, providing better access to medicines and insecticides, training community educators about malaria, and developing communication networks to provide life-saving information about malaria. 
Two recent articles in Lancet are critically important to the Imagine No Malaria campaign.  The first is an excellent review of malaria (1), which gives a well written, succinct but amazingly comprehensive overview of all aspects of the disease, and provides important background information for all of us involved in the effort to eliminate malaria or treat it in the field.  The extensive references are invaluable. 
The second article is a commentary entitled Malaria Eradication:  Is it Possible? Is it worth it?  Should we do it? (2)  The authors cite the complexity of the disease, the barriers encountered by previous efforts at elimination, and the challenges facing eradication efforts.  In their view, eradication IS POSSIBLE.  However, they list many potential challenges.
1.     Despite progress the malaria burden is great.  In 2010, 219 million cases of malaria were reported and 660,000 people, mainly children under 5, died.
2.    Drug and insecticide resistance is on the rise.
3.    An increasingly mobile, expanding population makes containment more difficult, and development of resistance more likely.
4.    Extreme events such as war and natural disaster threaten disruption of malaria control efforts.
5.    Decrease in rates of malaria may result in loss of interest in funding and the scaling back of antimalarial programs, making complete eradication more difficult, if not impossible.
The authors point out that the initial costs of malaria containment or elimination only in selected areas would initially be easier and less costly.  However, allowing pockets of malaria to exist would pose a continuing risk of resurgence and spread to malaria-free areas, require long-term surveillance, and be more costly in the long run.  They recommend nothing less than an all-out global effort that is directed at every malaria affected region.
Malaria is a formidable adversary which will require our best effort over many years, including continued research and funding, if we are to succeed in this battle for eradication.  We can be proud of the United Methodist Church’s involvement in this most important work.
References:
  1.   White, N.J. et al, Malaria.  Lancet on-line:  15 August, 2013.
  2.  Liu, J. et al.  Malaria Eradication.   Is it possible?  Is it worth it?  Should we do it?  Lancet Global Health 1:1 p. 3, July 2013
Submitted by Roger Boe MD

No comments:

Post a Comment