Malaria revisited

New tools for vector control will be essential to combat an old disease like malaria.

The United Nations has designated the 25th of April of every year as the day for the entire world to focus attention on malaria, a disease that is reputed to kill about a million people all over the world every year. The theme of this year's Malaria Day was "Malaria: a disease without borders". The day was celebrated with much fanfare, but with a feeling of guilt among global health leaders. Major health bodies like the World Health Organization (WHO) and the Global Fund to Fight AIDS, Tuberculosis and Malaria are now joined by the Roll Back Malaria (RBM), McKinsey and the Boston Consulting Group, Bill and Melinda Gates Foundation and others to lament for all the missed opportunities to tackle the disease and eradicate it. President Bush, despite his poor record in Iraq, has pledged $1.2 billion in a high-profile summit on malaria eradication attended by Exxon Mobil and other corporate people. Each year as many as 500 million people catch malaria and more than a million die. Sri Lanka, which once eradicated malaria, now has over 10,000 deaths due to malaria every year. In India there are no authentic records to show the mortality trends due to malaria.

This is one public health disease, which has simple solution but complex management problems of recurring costs and emerging contradictory research findings from time to time. Despite Bill Gates Foundation's generous monetary aid to fight malaria and other diseases to the tune of $8 billion, it has created "ego" problems to people like Dr Arata Kochi, head of malaria program in WHO, who said that "Gates Foundation has negative influence on research into killer diseases like malaria". Dr Kochi feels the Bill Gates Foundation bets too much on a particular treatment such as artemisinin derivative-based combination therapy (ACT). Although ACT does work better than older therapies, there are signs that drug-resistant strains of the disease are emerging and in the words of Dr Kochi, "what happens if under the Gates influence, malaria researchers put all the eggs in that one basket?" (The Economist, February 23, 2008).

But there are some like Dr Yamada of Gates Foundation who feel that the Gates Foundation is open to all new research ideas and although ACT therapies are supported by Gates Foundation, they also support the use of bed nets and vaccines. But the world's premier health body, the WHO, is worried about the new "power centers" in healthcare like the Bill Gates Foundation, which may reduce the relevance and authority of the WHO. This is the trouble with UN bureaucracy and they should support any intervention which is affordable and manageable. Recently the Gates Foundation has given $100 million to the University of Washington to evaluate health treatments and monitor national health systems – jobs supposed to be done by the UN agency like the WHO.

Luckily for the good of the world's malaria community, particularly in the African sub-continent, a clear consensus is emerging which supports treatment strategy involving bed nets impregnated with long lasting insecticides, indoor spraying of insecticides and pills using ACT therapies .

Half a century ago, the WHO led a campaign for the total eradication of malaria. Many countries made great progress in reducing deaths due to malaria. But the recurring costs are high in the malaria eradication program. Mckinsey has now calculated that once the five-year spending plan for malaria eradication is complete, the recurring expenditure has to be in the range of $1.8 billion a year for an indefinite period. Which African country can afford this huge budget? Hence a vaccine against malaria has to be discovered soon so that like small pox, it can be eradicated once and for all.

Dr Manu N Kulkarni
Professor Emeritus, Siddaganga Institute of Technology, Tumkur
& Member, National Population Commission
manukulkarni@yahoo.com