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Eliminating malaria in a world in turmoil

May 23, 2013 - 20:52 -- Bart G.J. Knols

Many of us work in laboratories where we study the intricacies of malaria. Where we study parasites and mosquitoes and where we develop new approaches that hopefully one day will help to reduce the malaria burden. Few of us, however, have worked in the trenches to combat malaria in the real world out there. Even fewer of us have dared to venture into places that are torn apart by civil unrest or war and do something about malaria there. We know of organisations like Doctors without Borders (MSF) but there are also people out there that risk their lives to accomplish nothing more exciting than to distribute bednets and anti-malarial drugs in remote parts of Africa that are at best unsafe.

Just recently, former TV icon Julia Samuel (Netherlands) and David Robertson (UK), who have been working for the Drive Against Malaria Foundation for years, were taken hostage in the Central African Republic by Seleka rebels. For days they were threatened at gunpoint and told that they would be killed. Miraculously, they managed to escape and make it back safely to Cameroon. Julia's story is remarkable. Whilst having a great career with Dutch TV she developed breast cancer, survived it, and then decided to devote her life to doing good. She chose malaria as her target. What does the above tell us and what are the lessons to be learned from this recent kidnapping?

First, this shows us how difficult it is to tackle malaria in settings that lack good governance. That in places that lack the basics of even the simplest infrastructure and law enforcement it is next to impossible to prioritise malaria control (forget elimination). In such places the need for shelter, safety and food aren't met and disease control can simply not be initiated.

The recent wars in Ivory Coast and Mali, the prevailing unsafety in Somalia, Southern Sudan and Tchad, and the seemingly endless conflict in DR Congo indicate nothing more than it being completely unrealistic that those countries will succeed in ending malaria deaths by the end of 2015 (the MDG target). If the political situation in these regions will not improve there won't even be a chance for this in the next decade (or two).

Secondly, this harsh reality shows us that even in the unlikely event that we would have a miracle tool to combat malaria tomorrow (think of a vaccine giving life-long protection) that we would still be very far from implementing that tool across malaria-endemic regions. Think of the killings in Pakistan last year of those that were out in remote mountainous areas vaccinating against polio. Look at the remaining three foci of polio transmission: northern Nigeria, Pakistan and Afghanistan. In northern Nigeria polio vaccination is hampered by conspiracy theories that the vaccine would sterilise girls and that this would be some secret action of the USA. In the other two foci vaccination simply means risking your life.

These difficulties present a remarkable difference with the 'early' days of disease control (take smallpox as an example). When UN-backed initiatives could reach across countries without much difficulty and were indeed remarkably successful. That world no longer exists. If anything, it will only become more difficult to reach all and roll out interventions that succeed in eliminating infectious disease.

As we work out our next experiment in the lab in search of great solutions, perhaps it is not too much to ask to consider the realities out there in the bush. And pay tribute to people like Julia and David that fight 'our' war in the trenches out there. Just like all these other people working for NGOs and National Malaria Control Programmes across Africa that work constantly in difficult and challenging environments to roll out the tools we hope will continue to save lives. These are our true heroes...

Comments

Submitted by marit de wit on

Medecins sans Frontieres is committed to saving and protecting lives, alleviate suffering and promote human dignity. As an organisation that specifically chooses to addres medical needs of people affected by conflict and deliberate neglect, we have been able over the years to deliver aid in places mentioned in your article like DRC, South Sudan and CAR. In the north of Nigeria, MSF treated 29.000 children under five for malaria in 2012 alone. But,even for an organisation like us, it is becoming impossible to keep working in this environment due to the increases kidnap-risks. Security threads has forced us to close a project in Northern Nigeria, and will deprive 29.000 kids or more this year to get the treatment they need, unless the government can provide adequate service. Worldwide, malaria incidence is decreasing, but in DRC, CAR, Nigeria, Niger and Sudan, we only see the incidence increase. As a malaria community we should see how we can take our lab-results to the people most affected by malaria. Not only the usuall <5's in general, but the <5's living in the most instable places on earth.
Marit de Wit, malaria advisor MSF-OCA

Marit de Wit MSF-OCA