The writer is a post-doctoral fellow at McGill University
Pakistan has joined several multilateral efforts to roll back malaria and made some progress in enhancing operational reach and adaptation of more holistic interventions to combat it. But a range of factors, including climate change, population displacement and inadequate access to health services have exacerbated malaria prevalence in the country. Malaria has especially re-emerged as a major cause of morbidity in districts near the Afghanistan and Iran borders, where health services remain inadequate. Transmission rates are also very high in southern and western districts of Punjab bordering K-P and Balochistan, where similar problems exist.
Pakistan typically faces an increase in the spread of malaria after the monsoons, which provide abundant stagnant water bodies for disease-carrying mosquitoes to breed. Recent major floods created even more stagnant pools of water across the rural areas, providing additional breeding grounds for such mosquitoes. Pakistan has also seen malaria strains develop resistance to the common anti-malaria drugs. Artemisinin-based combination therapies (ACTs) are now being used to provide more effective treatment solutions in malaria-affected countries. There is a significant reduction in incidence and malaria child mortality since 2000. However, ACTs have stopped working in areas around the Thailand-Cambodia border and it is vital to stamp out this resistant malaria strain before it spreads.
British drug-maker GlaxoSmithKline is now seeking marketing approval for a malaria vaccine developed with funding from the Bill & Melinda Gates Foundation. Medical trials have shown this vaccine’s efficacy was 65 per cent in babies analysed six months after vaccination, and around 50 per cent in five to 17-month-olds. If this vaccination is made widely available, it could serve as a useful additional tool, alongside other measures. Sustaining the global effort to eradicate malaria is, however, not easy. It is less of a problem in many developing countries than it was a few decades ago, compared to other emergent public health challenges. In a world where limited resources are available to address public health concerns, it remains hard to persuade donor agencies and governments to keep funding a malaria eradication programme, when there are competing public health challenges.
Yet, unless malaria is eliminated globally, it will continue to afflict poor and marginalised populations. These remaining parasite reservoirs are likely to become drug-resistant and the local disease carrying mosquitoes insecticide-resistant. These enduring pockets of malaria will continue posing the threat of reintroducing the disease in malaria-free areas elsewhere. It is thus vital that the global community strives to gradually eliminate malaria rather than becoming complacent and merely controlling the prevalence of this disease.
Published in The Express Tribune, March 7th, 2014.
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In this age and time Storm Water drains and effective sanitary waste lines seem to be a Rocket Science for South Asian countries. The amount of money in last 60 years spent in spraying insecticides on puddles of collected rain water and open sewage could have built drainage system. In early thirties Malaria was present in some southern States of the USA. They eliminated it by taking care of the root cause, accumulation of rain water and built infrastructures of storm water sewers.
Introduction of Malaria vaccine, in the lack a robust scientific evidence, is a bad idea. The current trend of the disease in Malaria endemic areas show that the adult population gradually becomes immune to clinical malaria after exposure to the infection during early childhood. The proposed vaccine, that does not provide long term immunity, would only delay infection in children less than 5 years of age. This will result in a drop in malaria specific child mortality but there will be a significant rise in Malaria related morbidity and mortality in the adult population. Imagine the impact of such a trend on health system and economics as the productive workforce gets affected by the disease. Vaccination is a powerful public health tool to prevent the transmission of many communicable infections, eradication of small pox and containment/elimination of poliomyelitis being good examples. But the increasing commercialisation of vaccines is being ignored by the scientific community across the globe. The latest examples being the hasty decision of including rota virus vaccine in routine immunisation setup in developing countries when robust evidence for the efficacy and effectiveness of this vaccine in developing countries (Africa, Asia in particular) is non-existant.
Lack of substance in the article -- not sure what the point was, but it was poor arguments that are not accurate or reflect the current status of malaria or malaria cure programs. Poor quality overall.
It is unfortunate to see that the author knows neither the history nor the biology or epidemiology of malaria. Roll back malaria programs in 50s and the 60s failed miserably and if the author had bothered to read any recent literature on the disease, he would have known that the goal now, including in programs such as PMI and Roll Back Malaria is to manage and control rather than complete elimination. Even GSK and other vaccine producers are focusing on managing it and not completely eliminating it. I would recommend the author start with a basic book, like "Fever" by Sonia Shah to understand the disease before making claims that are not only unsubstantiated, but simply misleading.