It is not very often that we see a talk exclusively on malaria at a global TED event. And now there is a new one. Anyone that has an interest in malaria by now should have heard about Sonia Shah. She wrote the excellent book 'The Fever' in 2010, a book that received praise around the world. Shah has now condensed the book in a 15 minute talk. She does so in a simple yet authorative manner that is clear even to someone that has never heard about malaria.
Basically she describes three reasons why it is so hard to tackle malaria in its heartland: Africa. First, the complexity of the disease and the challenges we continue to face to either combat the parasite or its vector make it a tough disease to conquer. True. Parasite resistance to drugs, vector resistance to insecticides, the difficulty of making a potent vaccine, it all adds up to what may seem an impossible task. Second, she talks about economics, the costs involved and the lack of the myriad of resources needed (health facilities, trained staff, control personnel and so on) to do a thorough job. Again true. And third she talks about indifference and the fact that malaria is as engrained in developing country nations as a simple cold or flu in the North. Hmmm, food for thought.
There is little to say about the facts and figures that Shah mentions. These are all correct. Where we differ in opinion is her statement that the first global eradication campaign that ran from 1955-1969 was a big mistake. It wasn't. After all, that effort resulted in malaria elimination in many places around the world and resulted in more than 800 million people being freed from the malaria scourge for good. Hard to argue that that was a mistake I would say.
Where we have failed though is in sustaining the global efforts to free more countries of malaria. And there are good reasons why the campaign stopped. There were financial constraints and there were problems with drug resistance (chloroquine) and vector resistance (against DDT) with a lack of alternatives at that time.
Ever since, the world is mounting massive efforts to come with alternatives. And they were found. We have ACTs, rapid diagnostics, a massive amount of knowledge on vectors we did not have back then, and a suite of novel insecticides (the pyrethroids came in the 1980s). Where we have not gone in the right direction, I believe, is applying those new tools in such a way that we free more land of malaria. We've merely been 'controlling' malaria. And that's been the recipe for disaster - evolution has always won (and gave us resistance). So, we need to change...
Have a look at Sonia's talk. What do you think?