Malaria's stubborn persistence: will efforts to eradicate the killer disease overcome technical, finanicial and political obstacles?

Author:Cayo, Don

The global death toll from malaria has dropped dramatically in just over a decade--more than 25 per cent overall and 33 per cent in hard-hit sub-Saharan Africa, according to the World Health Organization. Yet the WHO reckons that malaria still kills more than 625,000 people a year --roughly equal to the population of Vancouver--and some estimates, including one published two years ago by The Lancet, suggests that the WHO's figures reflect only about half the actual total. As well, country-by-country statistics make clear that progress in combating this killer disease is both fragile and spotty. For example, while the number of deaths reported in Tanzania plummeted from more than 20,000 in 2005 to just 840 in 2009, next door in the Democratic Republic of Congo the toll soared from fewer than 15,000 to well over 20,000 in the same period.

Today malaria is almost exclusively a tropical disease, but until a century ago or even less, it was also found in much of Europe and North America. Variants of the anopheles mosquito, which carries the parasite that causes malaria, are still common across Canada and in most temperate countries, but good public health measures have extirpated the parasite. Thus the disease is no longer endemic in any developed country, though imported cases crop up from time to time.

But while the rich places--southern Europe, Washington, D.C., the U.S. South, Ottawa--eliminated it years ago, malaria doesn't strike only the poor. In the fall of 2013 I set out on a round-the-world trip (supported by my employer, the Vancouver Sun, and funded by a grant from the Canadian Institutes of Health Research) to investigate all aspects of malaria. Most malaria workers I interviewed, even professionals in malaria-endemic parts of the world who are well paid by their countries' standards, had had bouts of it themselves and had seen it in their families.

In addition to the death toll, the economic cost of malaria is huge. Hundreds of millions of working days are lost in scores of countries when workers fall ill or stay away from their fields or off the job to care for sick children. And health is inextricably connected to education and economic progress. "In a village where malaria is endemic, life expectancy goes down," says Sir Fazle Abed, the founder and head of BRAC, a multifaceted Bangladesh-based NGO that has grown into one of the largest development agencies on earth. "If half the time I'm sick, my productivity will go down, and I'll always be a poor person. All kinds of other deprivations will happen because of my poverty, and each deprivation will mean I can never get out."

Rosemin Kassam, an associate professor in the University of British Columbia's School of Population and Public Health who has worked on malaria-related issues in Uganda and elsewhere, says the early impact of malaria on children can drag them down for life: "Even if they don't die, they're likely to be left with some kind of morbidity. It can be significant--paralysis, brain damage and retardation, a lot of negative consequences. Even just carrying the parasite can create anemia, which can make it difficult to sit in school and concentrate."

The international effort

Successes to date in controlling malaria are due to many factors--billions of dollars from governments and private donors, better and better-targeted insecticides, effective environmental management, easy and cheap diagnosis, new medicines, education on preventing malaria and seeking appropriate treatment, community organization to ensure that people get the prophylactics and the care they need. But it will take at least as large an arsenal--accompanied by luck and bolstered by a promising new vaccine--if the fight is to be finished.

The catalyst and guiding hand for much of the progress--and no doubt a vital player going forward--is the Global Fund to Fight AIDS, Tuberculosis and Malaria. It has not only funded billions of dollars worth of work on several fronts around the world since it made its first grants in April 2002, but has also marshalled political will in both rich countries and poor, focused prevention and treatment initiatives, and broken down silos and coordinated research to a degree not seen before in the annals of medical history.

The Global Fund's role was one of my interests in my global investigation. At every major stop--the funding and research hubs of Washington and Geneva and the fieldwork centres in northern Liberia, northern Namibia, western Kenya, the Indian border region of Bangladesh and the remote hills of the off-the-beaten-path Philippine island of Palawan--the depth and breadth of its influence became ever more apparent.

The impact of the Global Fund's involvement goes well beyond paying for prevention, diagnosis and treatment in countries too poor to cover the costs themselves, says Kishor Wasan, who until his recent move to the University of Saskatchewan was dean of pharmacy research at UBC, where he founded the university's Neglected Global Diseases Institute. It has also enticed researchers out of their ivory towers by funding only multidisciplinary research.

"The range of work on our campus [UBC] alone is exciting," Wasan said in an interview in late 2013. "It's all the way from drug discovery and development to implementation and understanding the barriers to getting a product from a bench in the lab to the patient on the ground. We're touching business, chemistry, community geography. Fifteen years ago these researchers would never even have talked to each other. "

The Global Fund's financial support for research is...

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