By Johanna Daily
The WHO’s Sixtieth World Health Assembly proclaimed the 25th of April as World Malaria Day in recognition of the continued high mortality caused by this parasitic infection, particularly in young children. The goal of World Malaria Day is “to provide education and understanding of malaria as a global scourge that is preventable and a disease that is curable.”
Over the past few decades, increasing understanding of parasite and vector biology, as well as advancement in diagnostics and therapeutics, are providing inroads into controlling malaria infection and improving clinical outcomes. The development and implementation of diagnostic tests, for example, has been critical for providing reliable data to the treating clinician and for the evaluation of malaria control programs’ effectiveness.
An obstacle to the fight against malaria is the parasite’s capacity to develop drug resistance. Drug combinations are now used routinely, and efficacy studies around the world demonstrate excellent drug treatment outcomes with artemisinin combination therapies (ACT). Future generation antimalarials are being developed to provide additional treatment options in case artemisinin resistance emerges despite ACT.
In October 2007 a goal set by the Bill and Melinda Gates Foundation during the Malaria Gates Forum reignited the pursuit of malaria eradication. Efforts in the 1940 and 1950s resulted in eradication from Europe, North America, and other regions; however, minimal impact in Africa was achieved. It is for this reason that the proposal for malaria eradication was initially met with skepticism. Nevertheless, this agenda has now been embraced by public health organizations and the scientific community. Countries that have eradicated malaria or are in pre-eradication status are increasing, and there is renewed commitment to reduce the number of malaria cases globally by 75% from 2000 levels by the end of 2015.
An effective vaccine has been a long sought goal in preventing malaria. However, recent studies have shown only modest protection against infection in African children. The development of a malaria vaccine has posed a daunting challenge and may be related to the long evolutionary relationship between humans and malaria. The parasite has developed strategies to prevent the development of sterilizing immunity, as persistence in a human blood stream is crucial for continued transmission. Residents of endemic areas typically do not develop complete sterilizing immunity and thus vaccine developers need to devise ways to provide the human host with a more effective response to prevent or limit infection. Currently, there are a number of vaccines in development and the effectiveness of these additional vaccination strategies will be closely watched.
What is striking about malaria is that, while it is a “preventable and curable” infection, it continues to cause devastating global statistics and individual suffering. Targeting the vector was central for many successful eradication programs. Eliminating or limiting contact with the anopheles mosquito, the disease vector, prevents infection. Efforts to impact vector biology have been primarily through distribution of bed nets and pesticide spraying. Educating local communities to apply sustainable interventions such as habitat modifications to limit vectors (housing modifications with screens, for example) could be important adjunctive approaches and have the benefit of long term sustainability, not requiring long-term donor dependence.
Malaria is curable. Unlike HIV, which requires chronic therapy, and tuberculosis, which requires months of therapy, malaria treatment requires only a short course of medications. How can we assist malaria endemic regions to build an effective health care system to provide rapid diagnosis and timely therapy? Leaders in business such as Michael Porter and his colleagues in the Global Health Delivery Project have advocated for the rapid dissemination of management strategies for the design and management of health care delivery systems in resource poor settings. Funding both practical and known interventions along with funding of discovery of new treatments/vaccines may further improve malaria related outcomes.
World Malaria Day provides an opportunity to critically assess the state of the battle against malaria. Today should be a day to reflect on the approaches that are having a measurable impact, and those that are not. It is a day to reinforce the global and local commitments to control this preventable and curable infection.
Johanna Daily, MD is an Associate Professor of Microbiology & Immunology and of Medicine (Infectious Diseases) at Albert Einstein College of Medicine.
To raise awareness of World Malaria Day, the Editors of Clinical Infectious Diseases and The Journal of Infectious Diseases have selected recent, topical articles, which have been made freely available through the end of May. Both journals are publications of the Infectious Diseases Society of America.
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Image credit: An African girl holding a sign with “Malaria Kills” written on it. Photo by MShep2, iStockphoto.