At the time of writing, the World Cup is well underway and with the quarter-finals about to begin the competition is heating up. So too will any fans who’ve been unlucky enough to catch malaria! So what can the World Cup tell us about the global malaria picture?
Although the host country Brazil, has a complex malaria profile, exposure to malaria is not common for most competing nations; in fact less than half of them have any degree of malaria transmission. In this context, I’ve been interested to see how the media have covered potential risks, and the first articles I came up against were controversially debating whether the teams should take malaria prophylaxis. Fears about their side effects on fitness meant that the Italian team has decided not to take any anti-malarials, whilst the England team’s decision to use malarone had to be defended before the matches began . It is sincerely hoped that disgruntled fans will not blame the medication for their poor performance as one fan even joked that his course of tablets lasted longer than the team! Other players have not been as fortunate to avoid malaria however; Kolo Toure (Ivory Coast) recovered from a recent bout, just days before the competition started. His other team-mates have also been affected including Didier Drogba, who inspired a video to inform football fans that was recently posted on MW: World Cup and malaria.
Sadly in the league table for tackling malaria, few of the World Cup competitor nations are close to the ultimate goal of eradication:
A. All countries participating in this year’s World Cup are represented by an equal sized segment. Countries without malaria transmission are depicted in grey, those with low transmission (as defined by the WHO 0-1 cases per 1000 of the population) in pale red, and those with high transmission (>1 case per 1000 of the population) in dark red. Countries having regions of both high and low transmission are striped.
B. The number of people living within areas of malaria transmission are shown in circles of proportionate size for each country, ranked in order (closest to the goal of elimination are those with the lowest population numbers at risk). Each circle is coloured to represent the dominant Plasmodium species in each country; yellow: P. falciparum; blue: P. vivax. Where both infections occur, the dominant spp colour is depicted as the background whilst the other spp as dots.
In diagram A, the World Cup nations that experience malaria are shown, along with the generalized transmission profile (high or low). Of these countries, the population numbers remaining at risk of malaria are depicted in ranked order (B), with the lowest being closest to the ‘goal of eradication’. The population size in transmission areas is reflected by the size of the circle and the proportion of cases arising from infection with P. falciparum (yellow) or P. vivax (blue).
Assuming that this subset is representative of other countries’ profiles, what jumps out is that P. vivax dominated malaria appears to be more vulnerable to our current intervention strategies than P. falciparum. Of course this is an extremely naïve view of highly complex situations in every affected country (and fails to account for differences in socio-economics; investment, reporting, political stability, etc), but it does suggest that reduction of P. falciparum will require additional control and survey measures than are currently available, particularly in sub-Saharan Africa.
Worryingly, above the Sahara, Algeria has recorded an almost a four-fold increase in annual malaria cases between 2009 and 2012, vastly reducing their progress towards elimination (*). These dates coincide with the Arab spring; there is a sad link between conflict and risk of malaria, as Marit recently mentioned in her column 'How fragile we are'. This has also been illustrated in a comprehensive review by Cohen and colleagues (2012); identifying resource constraints, often resulting from conflict, as a major factor for malaria resurgence, alongside ecological changes and resistance . Similarly, as conflict grows in other regions including Nigeria, the potential risks of malaria may add to the woes not only of the people directly affected by the insurgency, but also their neighbours.
We must hope that the spirit of unity brought by the World Cup can help to break down some of the barriers that give rise to conflict and misunderstanding, so that future regressions in malaria control can be avoided whilst offering democracy and human rights to the communities who often suffer in both ways.
For the next few weeks and beyond, let’s hope that all fans will remain safe and avoid being bitten – either by mosquitoes or by players…
Jenni Lawton is a post-doctoral researcher at the University of Glasgow, UK. Her research interests focus on the interactions between Plasmodium infected red blood cells (iRBCs) and the host; dynamic processes which are still incompletely understood. The behaviour of iRBCs may have important implications both in generating effective immune responses and in the escalation of some malaria infections towards severe complications. This will be her first foray into communications and she hopes to provide some interesting perspectives from the lab to the Malaria World community!