Control versus elimination of malaria
Unless malaria is eliminated globally, it will continue to afflict poor and marginalised populations.
The writer is a post-doctoral fellow at McGill University
Malaria remains a public health problem in developing countries. According to the World Malaria Report 2013, published by the World Health Organisation, there were about 207 million cases of the disease in 2012, which caused an estimated 627,000 deaths. Global efforts to control malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 45 per cent. However, based on data gathered a couple of years ago, Pakistan is still considered a major hotspot for malaria.
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.
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.