Could malaria be the new smallpox?
The World Health Organization announced on Monday that nearly a third of the countries where malaria is endemic could eradicate the disease within 10 years -- a huge breakthrough against a disease that has plagued tropical regions for more than 50,000 years.
Malaria is endemic to 108 countries, mostly in sub-Saharan Africa, and the disease, which is transmitted by mosquitoes, killed more than 780,000 people in 2009. There are effective prevention and treatment methods, but the challenge is making them available on the ground.
We know that we can save lives with today's tools, Robert Newman, the director of WHO's Global Malaria Program, said at an international Malaria Forum conference in Seattle on Monday. Better diagnostic testing and surveillance has provided a clearer picture of where we are on the ground and has shown that there are countries eliminating malaria in all endemic regions of the world.
Since 2007, WHO has certified Armenia, Morocco, Turkmenistan and the United Arab Emirates as malaria-free, Director-General Margaret Chan announced at the conference.
Malaria Elimination Count
According to a report that WHO released on Monday, seven countries are believed to have recently eliminated malaria and are working to keep the disease out and get certified as malaria-free. Another 19 are actively pursuing eradication.
Many public-health experts doubt that these gains can be maintained, because WHO's only previous attempt to eradicate malaria on an international scale -- the Global Malaria Eradication Program, which lasted from 1955 to 1972 -- was a resounding failure. WHO certified 20 countries as malaria-free, but the disease has since returned to 16 of those countries after public-health officials dropped their efforts to control its spread.
The world sort of gave up on malaria, and we lost ground, Newman said at the conference.
But the difference this time, Chan said, is that we are not blindsided by illusions.
We know that, using currently available tools, malaria can be eliminated from the fringes where prevalence is already low, but we also know that these tools are insufficient to defeat malaria in its heartland and eventually interrupt transmission, she said. We know this is impossible right now, but we also know the kind of game-changing tools needed and the research agenda that will get us there.
WHO and other public-health organizations continue to pursue traditional preventative methods like distributing mosquito nets, but researchers are also working on new methods, like a malaria vaccine. One vaccine is undergoing a Stage III trial in Africa. It is the first malaria vaccine to make it that far in testing, and, if approved, it would be the first-ever vaccine against a parasitic disease.
Five species of parasite can cause malaria in humans, but the most severe cases are usually caused by Plasmodium falciparum. The classic symptom is a cyclical fever, with sudden episodes of coldness and shivering followed by fever and sweating. Untreated malaria can lead to convulsions, coma, kidney failure and death. Children who survive a malaria infection may have developmental impairments.
Making treatment widely available is already a formidable task, and scaling up prevention efforts to eventually eliminate the disease will be even harder -- but WHO officials believe it is possible. Eventually, malaria could become only the second human disease, after smallpox, to be eradicated.
Our eyes are wide open to the realities, the formidable challenges, the inevitable threats and the fragility of progress, Chan said. We know that eradication will take at least four decades. This is a long-term investment, not a quick win.