Recently the Gates Foundation and the United Nations released a report, "Aspiration to Action" suggesting that with the appropriate investments of time, effort and money, we could eradicate malaria by 2040. Earlier predictions regarding eradication were considered by some to be hopelessly optimistic, but the recent gains have been impressive: If this is a boxing match, we're in the fifth round with a wobbly opponent.
The wobbles are the results of direct hits from concerted, coordinated efforts by national governments, foundations and multinational organizations. Earlier this month the World Health Organization and UNICEF released a report showing death rates from malaria have fallen by 60 percent over the past 15 years. While this is tremendous news, we must to continue our efforts to knock out our adversary.
The Gates report is correctly imploring us all—researchers, funders, policy makers—to keep up the fight. Headlines such as "Malaria Death Rates Plunge by 60 percent" or "700 Million Cases of Malaria Averted in Africa," can create a false sense of security and engender complacency. We turn our attention to other causes and society moves on. Our mission against malaria, though, is far from accomplished.
Malaria remains continues one of the most deadly diseases in the world. In 2015 alone, even with our recent advances, there were still an estimated 214 million new cases of malaria, and approximately 438,000 deaths, according to the WHO/UNICEF report. This is a preventable and treatable disease—and yet about 3.2 billion people—almost half of the world's population – remain at risk of malaria.
Our recent progress is heartening, but it's critical to remember that the malaria parasite is a formidable and wily foe. It has become deeply entrenched, and bobs and weaves through both its hosts—man and mosquito—with impunity. Within minutes of its injection into the skin by the bite of a female mosquito, Plasmodium falciparum, the species responsible for the vast majority of malaria morbidity and mortality, vanishes into the liver—and then, after 10 to 14 days, having multiplied thousands-fold, it emerges into the circulatory system where it lives and reproduces within red blood cells. Among the vulnerable, largely young African children, a life threatening illness can develop within days.
Because the parasite and the mosquito can adapt quickly to the introduction of new control methods, eradication of malaria will not be easy or quick. And while we're winning now, we cannot let up on the fight to eliminate malaria deaths. I write this from Malawi, where children every day are diagnosed with new cases of malaria. This very minute the parasite is killing an African child, and beginning to develop resistance to some of the best drugs we have—the artemisinins. The mosquitos are morphing to elude insecticides and bed nets.
Complacency now, after we have seen so much progress, will counteract many of the gains we have made against malaria. Eliminating malaria deaths, while we are working to eliminate the parasite, could be pursued by combining two strategies: prompt diagnosis followed by effective treatment.
Rapid diagnostics continue to help save lives. Malaria parasite antigens can now be detected by health care workers using a finger-prick sample of blood in settings without electricity. No microscopes are needed. In 2013, however, in sub-Saharan Africa, only 61 percent of suspected malaria cases were tested to confirm or exclude the diagnosis, and only about 70 percent of patients with confirmed malaria were treated with the appropriate anti-malaria medications.
We also must continue to develop new approaches to treat children with life-threatening malaria. Until recently, we didn't understand how children with the deadliest form of malaria, cerebral malaria, die. By using MRI scans, we found that their brains become hugely swollen – so much so that the brain can be forced through the bottom of the skull, compressing the brain stem and causing the patient to stop breathing. With this new knowledge, we should be able to develop effective interventions to save these lives.
The report from WHO/UNICEF is good news—we're keeping people alive and we're putting practices in place to help one day eradicate the malaria parasite from the planet. But malaria is fighting back: already, in southeast Asia, parasites are reacting more slowly to the artemisin drugs. The Gates Foundation and UN believe that with a strong coordinated effort we can, once and for all, eliminate malaria. But we also must maintain the pressure and programs we've developed to get to this point. We've got to stay several steps ahead of the foe by continuing to invest in research, designing new drugs, developing anti-mosquito strategies, improving surveillance and expanding efforts to diagnose and treat patients. This will take a long time – but we are making progress and the foe is definitely starting to stagger!
Terrie E. Taylor, D.O., is a professor and malaria researcher at Michigan State University's College of Osteopathic Medicine.
Uncommon Knowledge
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