PUBLIC HEALTH BACKGROUND

 

HISTORY:

 

In the 1950ís and 1960ís there were major eradication efforts undertaken worldwide to help stop the spread of malaria.  Funding came mainly from the developed countries, so as malaria was eradicated throughout North America and Europe, much of the involvement and funding stopped.  There was also the added difficulty that the majority of the problem with malaria was in undeveloped countries whose problems went far beyond treatment and environmental regulation adjustment to more structural geopolitical and public health problems.  With eradication as the world programsí unrealistic goal, interest and money soon dwindled and there was a serious decline in public health output after 1969, paralleled by a huge increase in the burden of malaria.  Today focus has shifted to a different approach: one of control and treatment rather than eradication.  But the need for a worldwide push like that of a few decades ago is still prevalent and is becoming more and more urgent.

 

Malaria Distribution

 

A NEW CAMPAIGN?

 

Why should the world rally to prevent this disease in a time of much more seemingly imminent problems?  While itís true that malaria has been a major problem for an exceedingly long time, the death rates from malaria in Africa and Asia are astronomical and only getting higher as time goes on.  Complications from fairly recent developments such as first line drug resistance, insecticide resistance and public health infrastructure flaws are merely complicating the already failing public health efforts.  Our expanding knowledge on the situation is also make efforts much clearer.  Breakthroughs with the genome of A. gambiae and P. falciparum promise progress in the areas of research and development, but also heightened awareness of the spread of this disease has altered the suggested approach.  With the possibility of expansion to the undeveloped areas that lack a public health system, the control of malaria could rapidly improve.  The push by the world community has also already begun, making the process that much easier and that much more likely, though funding continues to be a major challenge.

            With all these new developments, the fight against malaria has a promising beginning.  This new approach needs to take these into account, and develop a system including 5 major components.  1) a focus on the most afflicted regions as this is where we failed last time.  2) A recognition of the specificity of site, vector, and population activity as affecting the approach taken, especially those variants that occur within political boundaries.  3) the pursuit of 2 tracks: both prevention and treatment through current technology and an increase in research and development.  4) Constant and reliable funding for at least 2-3 decades as without this duration progress will be limited and short-lived.  And finally 5)a blend of disease-specific controls (drug treatments etc.) with more wide spread approaches, such as the development of a more stable public health infrastructure in undeveloped regions.

 

Sources:

Morel, Toure, Dobrokjotov, Oduola, The Mosquito GenomeóA Breakthrough for Public Health.  Science.  2002 Oct 4; 298 (5591): 122-4

Sachs, Jeffrey D. A New Global Effort to Control Malaria.  Science. 2002 Oct 4; 298 (5591):122.

Tan DH, Upshur RE, Ford N., Global Plagues and the Global Fund: Challenges in the Fight Against HIV, TB and Malaria.  BMC Int. Health and Human Rights.  2003 Apr ; 3: 2.

For more information contact lvogel@stanford.edu

 

 

PUBLIC HEALTH EFFORTS

 

THE FUTURE OF MALARIA

 

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