The column below was contributed by Dr. Manuel Lluberas.
Judgment day for the Millennium Development Goals is less than 500 days away. While there have been significant progress made in many areas since the goals were set, there is much more to be done and there is a lot that needs to be reviewed.
According to Ray Chambers, United Nations Special Envoy for Financing the Health MDGs and for Malaria, “The record number of bed nets delivered in the first half of 2014 are expected to save 600,000 children’s lives over the next three years and get us closer to achieving our goal of near-zero deaths by 2015.” This enthusiastic endorsement of mosquito nets comes in the wake of the World Malaria Report for 2013, which reports a fifty percent reduction in global mortality due malaria since 2000. Unfortunately, while the World Malaria Report paints an encouraging picture, it also states that “in 41 of the 103 countries reporting, which account for 80% of estimated cases, it is not possible to reliably assess malaria trends using the data submitted to WHO” as “information systems are weakest, and the challenges for strengthening systems are greatest, where the malaria burden is greatest.” Simply stated, only 20% of the figures provided by the report are reliable and acceptable. The rest is questionable.
The enthusiastic endorsement of mosquito nets reflects the current position with regards to malaria vector control operations around the globe. There was sufficient time, funding and energy to implement mosquito population suppression tools beyond indoor residual spraying and mosquito nets distribution when the MDGs were developed and published, but the general misunderstanding and misconceptions regarding mosquito control placed malaria vector control in the hands of people with little to no expertise or experience in mosquito control. This position prevented the implementation of integrated mosquito control programs that would evaluate previous interventions that eradicated the disease from a large number of countries and adapt and/or adjust them with today’s technology and materials. As time flew by, this wholehearted endorsement of mosquito nets as “the key” tool against malaria at the expense of any of the other mosquito population suppression methods beyond indoor residual spraying failed to produce the desired results. Moreover, this position has not been is dampened by several press releases during the course of this year that point a diametrically opposed picture and warned about the impending failure.
All Africa News, for instance, published a statement on July 17 of 2014 stating that “African leaders admit they cannot meet the 2015 Millennium Development Goals (MDGs) targets against HIV/AIDS, Tuberculosis and Malaria.” On the 28th of the same month, Click Liverpool, an online news service, published an interview with “A British leading expert on malaria” under the headline “Malaria nets are failing in Africa.” During the interview, this expert “revealed that insecticides used on nets in Africa are failing.” At about the same timeframe, Dr. Robert Newman, former director of the WHO’s Global Malaria Program mentioned in an RBM leadership interview that “Zero malaria deaths by 2015 is wildly ambitious.”
Fearing sounding repetitious, we’ll fail to achieve the malaria MDGs because we have failed to follow the lead of those who eliminated or eradicated malaria from a large number of countries almost a century ago. Today’s approach falls way short of what needs to be done. We need to take action against the mosquito and place these programs in the hands of trained and experienced public health entomologists. Unfortunately, the expertise related to designing and managing vector control operations is not widely available in many of the affected countries. To reach the 2015 MDG goals or subsequent others, we need to generate interest and expertise in mosquito control in the countries affected and establish a career track for these professionals. Not only is there a lack of field entomologists in the countries most affected by vector-borne diseases like malaria, dengue and Chikungunya fevers (and let us not forget Chagas disease), there is no career path for the few who are there. Moreover, the opinions and actions of the few that are working on designing and/or implementing vector control programs against these diseases are often not considered as valid or appropriate under the argument that they are not public health professionals. Furthermore, many materials used for the control of adult and larval stages of these vectors are frequently viewed as contaminants that should be eliminated or banned. It is most unfortunate that many public health workers fail to understand that insecticides are drugs for the environment and have not made the connection between the limitations and counter-indications of anti-malarial drugs and antibiotics in man and those meant for the environment.
Malaria is a mosquito-borne disease. The next MDGs must address mosquito control in a comprehensive and systematic fashion. Not doing so will repeat what has been done so far and prolong the physical and emotional suffering of the populations affected and the financial burden on their countries, not mention continue to waste billions of US dollars in the process.