Studies examine costs, prospects of ending malaria

• Infections • Oct 30, 10

Eliminating malaria can be achieved only with repeated investment over the long term and will require a major shift in policy and funding now focused on control of the disease, experts said on Friday.

In a series of studies in the Lancet medical journal about the prospect of trying to eradicate the often deadly infectious disease, scientists said that for many countries, wiping it out would take many decades rather than be a quick victory.

Like routine immunizations against diseases such as smallpox or measles, it would require long-term investment to make sure the disease does not come back, even after the intensive elimination activity is over, they said.

“Successful elimination will need a fundamental shift in the perception of malaria investment from a so-called quick win to a routine expenditure,” said Oliver Sabot of the Clinton Health Access Initiative in the United States, who led one study.

According to the World Health Organization, about 3.3 billion people—half of the world’s population—are at risk of malaria, which is spread by mosquitoes.

There are about 250 million malaria cases and almost a million malaria deaths each year, and people living in the world’s poorest regions are most vulnerable.

British drugmaker Glaxosmithkline is carrying out late-stage testing of an experimental vaccine called Mosquirix against malaria and expects to see results by 2011. If it proves effective, the firm will seek approval for the vaccine by 2012.

SHRINKING THE MALARIA MAP

In a commentary on the findings of the papers, Lancet editors Richard Horton and Pamela Das said they showed that countries should not set their sights on malaria elimination without careful analysis of the costs and implications.

Focusing on trying to eradicate the disease when that goal is too far off could lead to dangerous swings in funding and political commitment, they said, and may jeopardize the success of efforts to control malaria.

“The quest for elimination must not distract existing good malaria control work,” they wrote. “If existing control efforts were indeed scaled up, by 2015, 1.14 million children’s lives could be saved in sub-Saharan Africa alone.”

Sabot told a London briefing that a major risk of eliminating malaria was that it might mean health authorities and international donors would shift focus to other issues.

“What we know very clearly about malaria is that the moment you take your eye off the ball, the moment you let funding slip and coverage slip, it is going to come roaring back,” he said.

In another paper, scientists said that the most practical way forward in fighting the disease was to continue shrinking the “malaria map” of countries where it is endemic.

Richard Feacham, director of the Global Health Group at the University of California, who worked on the studies, said global eradication of malaria was unlikely until around 2050 or 2060, but elimination country by country was feasible.

During the first half of the 20th century, 178 countries had endemic malaria, the scientists found. Since 1945, 79 have eliminated malaria, including Britain and the United States in 1952, Australia in 1970 and, most recently, Morocco in 2005 and Turkmenistan in 2010.

But 99 countries still have endemic malaria and of these, 32 are moving from controlled low-endemic malaria to elimination, while 67 are seeking to control the disease. The 32 eliminating countries have more than 2 billion people and include China, Argentina, Iraq, Mexico, South Africa, Turkey and North Korea.

SOURCE: The Lancet, online October 29, 2010.