History of Malaria Control

   

[http://profiles.nlm.nih.gov/VC/B/B/C/S/_/vcbbcs.jpg]

In 1929, an effective two decade long malaria program was established at the Roan Antelope copper mine in Zambia with the intention of eradicating the disease to attract labour to the region. The program consisted of a combination of control efforts: “environmental management” as well as administering chloroquine to the local population and providing insecticide treated bed nets (ITNs). “Environmental management” consisted of vegetation clearance, draining of swamps, modification of river boundaries and oil application to open water bodies. This combination control effort sustained over two decades proved to be very effective. [1]

Malaria research was initiated during World War II through the efforts of the U.S. Army to fight malaria endemic in combat zones. DDT and dieldrin were developed during this period and widely used after the war in the Global Malaria Eradication Campaign (1955-1969). Malaria was eradicated in the U.S., Europe, Chile, and significantly reduced in South Asia. [2] However, because of the reasons mentioned above, sub-Saharan Africa was largely ignored in insecticide driven anti-malaria campaigns.

Drug Resistance

According to the World Health Organization, areas in western Asia where malaria was thought to be eradicated in the 1960s reported a re-emergence of the disease in the 1990s. [3] One factor that explains the prevalence of malaria today is the emergence of drug resistance to standard treatments.  This is also a growing problem in sub-Saharan Africa where the chloroquine was eventually introduced and greatly popularized. Many strains of P. falciparum and some forms of P. vivax have shown resistance to chloroquine, the major drug prescribed throughout the last century.  One estimate predicts that in parts of Asia, Africa, and South America, over half of patients are resistant to chloroquine as a malaria treatment. [4]  It was found that the emergence of chloroquine-resistant P. falciparum was followed instantly by a great increase in malaria mortality; children who received chloroquine were at greater risk of dying than those who received other antimalarial drugs; “the overall proportion of deaths attributable to the ineffectiveness of chloroquine treatment was 60%. [5] One issue surrounding the development of resistance is the current criteria for prescribing antimalarial drugs.  The WHO recommends that any instance of high fever in an endemic area should receive a prescription for antimalarial treatment.  Although the motivation of this policy is to protect and care for individuals with a potential malaria infection, this relaxed use of treatment accelerates the development of resistance.  Even when drugs are correctly prescribed, there is still a widespread problem of patient adherence to their treatment regimen.  The prolonged or incorrect use of antimalarials encourages parasites in the body that are not affected by treatment to build resistance to the antimalarial substance.  Currently, the best treatment for malaria is a combination therapy regime that uses a mix of drugs such as Artemisin, each in a lower dose. [6] The most recent efforts to combat malaria have been through the “Roll Back Malaria” initiative started by the World Health Organization in 1998 and the Global Fund to fight AIDS, Tuberculosis and Malaria founded in January, 2002.

[http://www.pasteur.mg/Atelier-Palu/index.html]

Roll Back Malaria Campaign

Started by the World Health Organization in 1998 with a budget of $35 million [7] with the professed goal of halving the world’s malaria burden by 2010, the central features of this public health effort include: [8]

The Global Malaria Eradication Campaign was based on the principle that complete eradication was a ‘magic bullet’ solution that worked in the context of all malaria endemic countries. It employed the same method of spraying DDT, dieldrin, or other insecticides for vector control in these countries. In contrast, the Roll Back Malaria Campaign designs control programs in accordance with the local and regional needs of the country and its malaria endemic zones. For instance, the RBM campaign in India started a national committee for malaria research and strategic support whereas in Bangladesh a different approach was taken: RBM formed community partnerships in resource-poor regions to increase access to healthcare on the grassroots level. [9]

[http://www.ida.nl/documents/gf_logo.gif]

The Global Fund to Fight AIDS, Tuberculosis and Malaria

Founded in January 2002 with a budget of $1.2 billion [10], The Global Fund is the world’s latest effort towards control of three killer diseases. It acts as a financial instrument to increase resources to fight these diseases; it is a funding source which is a useful because funding is hard to come by in the field of public health. It funds initiatives that seek out and solidify partnerships between governments, the private sector and the community. 61% of its funds are directed towards efforts to control all three diseases in sub-Saharan Africa, which is encouraging because this region was ignored in earlier campaigns. Examples of its recent contributions include financing the construction and delivery of 108 million bed nets to protect families from mosquitoes that transmit malaria and delivery and administering of 145 million ACT (artemisinin-based combination) drug treatments to combat malaria. [11] In April 2002, it approved $72 million in multiyear grants for malaria control. [12]

Major malaria initiatives of the 1990s and 2000s*

Name

Year began

Mission, objective, budget, and website

Location of secretariat

Coverage

Malaria Medicines for Venture (MMV)

1999

Facilitates discovery, development, and commercialization of anti-malarial drugs at affordable prices for areas most affected by malaria; public-private partnership fosters collaborations between scientists and pharmaceutical companies to yield one new product every five years.

Geneva, Switzerland

Global

Total budget US$40 million http://www.malariamedicines.org/

Malaria Vaccine Initiative (MVI)

1998

Accelerates clinical development of promising malaria vaccine candidates and field trials of vaccine candidates; co-ordinates efforts with various malaria vaccine programs; identifies gaps in current research and applies resources to advance promising malaria candidates.

Rockville, Maryland

Global

Annual budget US$ 15 million http://www.malariavaccines.org

Multilateral Initiative on Malaria (MIM)

1997

Global research and control alliance of organisations and individuals concerned with malaria research and control in Africa, maximises the impact of scientific research on malaria in Africa through promotion of capacity building and facilitation of global collaboration and co-ordination.

Stockholm, Sweden

Strengthening research capacity in Africa

Annual budget US $2 Million http://mim.Su.se

African Malaria Network74 (AMANET)

1996

Regional training and organisation of clinical trials and regional co-operation; improves capacity of African institutions and scientists in conducting malaria research including vaccine trials

Dar es Salaam, Tanzania

Africa

Annual budget: Estimated US$ 500,000 http://www.amvtn.org/

MFI Malaria Foundation International (MFI)

1992

Advocacy and enhance communication and maximize exchange of views and expertise among malaria scientists and health workers, and encourage cost-effective use of available resources. http://www.malaria.org

New York, NY

Global

* HIV/AIDS = human immunodeficiency virus/acquired immunodeficiency syndrome.

[Table Adapted from: Alilio et al., 2004.]

Other Global Efforts

Although we are far from the eradication of malaria, there have been significant strides in the past few years in coordinating research, developing training programs for public health professionals, and broadening access to treatment and preventative tools such as ITNs (Insecticide Treated Bednets).  In 1995 the SWAp (Sector Wide Approach) program proposed for Africa and South Asia embodied a new attitude towards development.   It emphasizes both poverty reduction and the adoption of a coherent, holistic policy framework that avoids the redundancy of individual projects. [13] In addition to major global efforts such as the WHO Roll Back Malaria Campaign and The Global Fund, smaller multilateral initiatives are focusing on specific ways to target the spread of the parasite.  An overview of such efforts is shown in the table above. 

References

[1], [8] Utzinger et al., 2001

[2] Hays, 2000

[3] Schiff, 2002

[4] WHO (2005) Malaria Control Today

[5] Trape, 2001

[6] Guerin et al., 2002

[7], [10], [12] Alilio et al., 2004

[9] "Roll Back Malaria update," 1999

[11] http://www.globalfundatm.org

[13] Darrell et al., 2003

Home