News About Malaria Continues to Improve

Stephen DeAngelis

February 13, 2008

I have written before about efforts to rid the developing world of malaria, including efforts by the Bill and Melissa Gates Foundation. Articles in the New York Times and Washington Post report that significant improvements are being seen as a result of these efforts [“Nets and New Drug Make Inroads Against Malaria,” by Donald G. McNeil, Jr., New York Times, 1 February 2008 and “Anti-Malaria Efforts Yield New Success,” by David Brown, Washington Post, 1 February 2008]. Both articles reflect on the findings of a just released World Health Organization report. McNeil writes:

“Widespread distribution of mosquito nets and a new medicine sharply reduced malaria deaths in several African countries, World Health Organization researchers reported. … The report was one of the most hopeful signs in the long battle against a disease that is estimated to kill a million children a year in poor tropical countries. ‘We saw a very drastic impact,’ said Dr. Arata Kochi, chief of malaria for the W.H.O. ‘If this is done everywhere, we can reduce the disease burden 80 to 85 percent in most African countries within five years.’ There have been earlier reports of success with nets and the new medicine, artemisinin, a Chinese drug made from wormwood. But most have been based on relatively small samples; this is the first study to compare national programs.”

Brown writes:

“The findings from Rwanda and Ethiopia are the first to show a greater than 50 percent reduction in malaria mortality nationwide in ‘high burden’ countries. Such dramatic reductions had been achieved previously only in smaller regions or in countries where the disease is less pervasive. The results suggest what may be possible in dozens of other countries, and they are likely to spur efforts already underway to roll out the relatively low-cost measures.”

This is good news. Malaria not only kills children, it saps both emotional and physical strength from those who contract the disease as well as those who must watch loved ones suffer from it. Development has no hope of gaining purchase in areas with sick populations. Brown continues:

“Malaria is responsible for 2 percent of all deaths worldwide and 9 percent of deaths in Africa. Each year, about 1.1 million deaths — almost all in children — are directly attributable to the disease, and at least a million more occur from complications such as severe anemia. In Africa, where most cases occur, malaria costs $12 billion a year in medical expenses and lost productivity.”

McNeil provides a little more detail about some of the countries examined in the report.

“In Ethiopia, deaths of children from malaria dropped more than 50 percent. In Rwanda, they dropped more than 60 percent in only two months. Zambia, Dr. Kochi said, had only about a 33 percent drop in overall deaths because nets ran short and many districts ran out of medicine. But those areas without such problems had 50 to 60 percent reductions, he said. Ghana was a bit of a mystery, according to the report. It got little money from the Global Fund, Dr. Kochi said, and so bought few nets and had to charge patients for drugs. Malaria deaths nonetheless fell 34 percent, but deaths among children for other reasons dropped 42 percent. Holding drives to distribute insecticide-impregnated nets is a growing trend, now that the Global Fund, the President’s Malaria Initiative, United Nations agencies, the World Bank and private fund-raisers like AgainstMalaria.org have offered hundreds of millions of dollars. Such drives must be continuous because ‘permanent’ nets wear out after three to five years.”

According to some of those who have spent their lives trying to deal with global health challenges, this is more than just good news. From Brown’s article:

“‘This is a genuinely historic achievement,’ said Richard G.A. Feachem, former director of the Global Fund to Fight AIDS, Tuberculosis and Malaria who is now the director of the Global Health Group at the University of California at San Francisco. ‘This is not theoretical. We do not have to wait for a vaccine or new drugs. If we implement today’s technologies aggressively on a national scale, we will have a big impact.’ … While cheap, the items in the malaria tool kit are still out of reach for many high-burden countries, which are among the world’s poorest. The insecticide-treated nets cost about $5.50 each, plus $2 to $3 for shipping and distribution. Artemisinin-containing drugs — generally taken twice a day for three days — cost about $2.50 for a course of treatment. The common alternative, chloroquine, costs about 20 cents but is less effective.”

This “historic achievement” might be short-lived if money doesn’t continue to flow to the program. The World Health Organization “estimates that about $4.5 billion a year is needed to control and treat the disease. At the moment, about $1 billion is spent yearly by donor countries and about $600 million by countries where malaria is prevalent.” Finding the additional funds won’t be easy.