Would you like to hear some Good News? Here are some nuggets, stimulated partly by recent comments from my colleagues Robert Bos, Tony Kiszewski and Pierre Bush.
Classic Problems we used to face
Ever since the collapse of the Global Malaria Initiative in the 1960’s, we had been facing some dismal problems in the fight against malaria. One was the Resistance Treadmill. Every time a new insecticide or new drug was found, the mosquitoes and parasites started on their inevitable journey toward resistance. The Second problem was the Immunity Trap. If you successfully suppressed malaria for a decade or so with the ephemeral methods of drugs, biocides and bednets, you were in danger of falling into the Immunity Trap as soon as your program faltered. The people you had been protecting during that successful decade would have lost all their immunity, and would thus be very susceptible to recurrence of malaria with a vengeance.
A New Day is Dawning
Fortunately however, it appears that the picture has changed recently. In countries where robust programs of the US Presidential Malaria Initiative are operating against malaria, not only is the disease receding, but per capita agricultural productivity is increasing. Fewer children are dying, and their healthier parents are able to raise more rice and maize to feed them. And in other African countries where only the weak and limited efforts of WHO are being made to suppress malaria, transmission and deaths are also dropping. Do we have some hidden allies in this fight?
What could these allies be? I have some potential candidates, but would appreciate your ideas too:
1. cell phones
2. better roads
4. increased literacy
5. small electric fans
6. improved income and housing* see Robert's comments below
The impact of these social improvements reflect the experience in Italy described by Snowden, when malaria began its gradual decline toward elimination, in the face of the general environmental and social improvements due to governmental stability and strengthening.
COMMENTS FROM ROBERT: Thanks Bill for these thoughts - I am inclined to say: all of the above, but each bullet point needs some annotation. For example, ongoing, rapid urbanization is accompanied by increased pollution levels, and it was shown, for example in Kumasi, that this pollution, which increases as one moves towards the core of urban centres, creates a malaria incidence gradient. Basically, anophelines don't breed in heavily polluted water. The one point you don't raise, however, is improved livelihoods and income. People have more money in many parts of Africa, and can therefore afford direct health interventions (they can buy drugs and buy insecticide impregnated mosquito nets), as well as other improvements in their environments that help reduce or protect from mosquito vectors. Housing improvement is one of these*. And perhaps also the delivery of health services has made important strides forward.
The fight against malaria is not over however. There are other negative factors outside of public health that afflict countries like Somalia, Southern Sudan, the CAR and the Congo. Notice these countries all lie on the Equator, so Global Warming might be a problem too.
But the success in all the other African countries gives us reason to hope for a brighter future, with much less malaria. That’s Good News, isn’t it?
And then there is the new kid on the block - genetically modified mosquitoes, which could lead to elimination of some of the most dangerous vector species. Let's hope ! GM certainly sounds more promising than the Mythical Vaccine.
Bill, the Optimist