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Yale Declaration on Malaria of November 2008

July 29, 2014 - 16:36 -- William Jobin

We are all pleased with development and posting of the Jerusalem Declaration on Malaria of December 2013. It follows in the footsteps of a previous Declaration on Malaria issued at Yale University in November of 2008. Please compare the two, they show remarkable similarities.

Both Declarations came after several days of discussions by people with a passionate interest in suppressing malaria in Africa, motivated by the reminder that a million people die of malaria in Africa every year, and most of them are children.

The recommendations to WHO and the US PMI are especially important because of the danger of collapse of these narrowly based efforts, following a Specialist Approach using only drugs, biocides and treated bednets, but neglecting a host of classical methods.

The only countries which have ever eliminated malaria have used the broad Generalist Approach; the USA, Italy and Israel being good examples.

I hope, given that two conferences have come out in favor of a broad, Generalist Approach to suppressing malaria, that WHO will consider this in revising their global malaria strategy.

Bill Jobin

Here is the Yale Declaration.

SUMMARY FROM FIRST YALE CONFERENCE ON MALARIA - NOVEMBER 2008

The First Yale International Symposium on the Global Crisis of Malaria met on November 7 – 9, 2008, bringing together experts on the disease from a variety of disciplines and experiences – physicians, research scientists, historians of medicine, public health officials, and representatives of several NGOs. Their names can be obtained from Frank Snowden at Yale in the History Department.

The unique nature of this Symposium was its intense scrutiny of historical successes and failures in malaria control. The conference assessed the strengths and weaknesses of previous attempts and then drafted the practical recommendations specified below for future control programs, especially for Africa. These recommendations grew directly out of presentations and discussions during the three days and are offered with the hope of assisting those agencies and donors involved in the process of ameliorating this scourge of humanity. The meeting convened as the world continues to experience a major ongoing emergency in which 40% of humanity is at risk of infection in over 100 countries. 500 million people a year become seriously ill with malaria, and over a million die, primarily children under five and pregnant women in sub-Saharan Africa.

Fortunately, awareness is growing of the appalling magnitude of the burden of physical and emotional suffering, economic hardship, neurological deficit, and death caused by malaria. There is a recent wave of support for control measures and for research to develop new tools to combat the disease. Existing approaches are being applied on an unprecedented scale, and research to devise new tools continues. In this context, there is urgent need to use all available resources in a rational and integrated strategy to reduce the unacceptably high mortality, particularly in Africa, where a child dies every thirty seconds from a disease that is both preventable and treatable. As these efforts are made, it is important to remember that significant efforts at malaria eradication were attempted previously under the auspices of the World Health Organization, and that unrealistic goals led to a severe backlash of despair and disillusionment.

As a result of our deliberations at the Symposium, we recommend measures to ensure that resources are deployed effectively and that vital lessons of earlier eradication and control efforts are integrated into the antimalarial campaign of the international community. These recommendations are:

1) The President’s Malaria Initiative (PMI) should appoint a board of experienced advisers, including experts with historical knowledge and experts on malaria in Africa. As an internationally recognized organization of specialists, the American Society of Tropical Medicine and Hygiene should also appoint an advisory panel of persons with relevant experience of malaria control. The advice of this panel should be offered to the PMI and the NGOs in the field. We further suggest that NGOs involved in the antimalarial campaign appoint boards of experienced and historically informed advisers to oversee their programs and make recommendations. An understanding of past malaria control efforts is important if earlier mistakes are to be avoided.

2) All antimalarial efforts should be tailored to the specific needs of individual countries, taking due account of their health infrastructure, epidemiology, ecology, and political realities. Inevitably success will depend strongly on national stability and economic health. The long-term goal of PMI and other outside institutions should be to shift implementation to indigenous institutions such as National Malaria Control Programs, which will require support and augmentation by PMI and other funding agencies.

3) Research aimed at the development of new tools in the struggle such as vaccines, vector control technologies, and medications should be adequately funded in an ongoing manner, but without delaying the rational use of already available methodologies.

4) Planning should empower individuals, local authorities, and national health ministers by educating them about malaria. Top-down and one-size-fits-all approaches must be carefully avoided.

5) A vital function of the health infrastructure must be the rigorous monitoring of mosquitoes, parasite prevalence, and other malariometric indices. These locally collected data should be the basis for planning and for evaluating results. The PMI and other agencies involved in malaria control should establish and strengthen national laboratories with trained and qualified local staff to generate this information for local use.

6) There should be no illusion of rapid success against malaria, perhaps the oldest of human diseases, because unrealistic targets and unsustainable goals carry the dangers of fatalism and the abandonment of the effort. Once begun, the campaign must be sustained. Otherwise there is the risk that temporary but unsustainable advances could have unanticipated, negative consequences. These could include promoting mosquito and parasite resistance and compromising acquired immunity. Devastating epidemics could then ensue as has happened in the past. Strategies setting priorities should be gradually developed into long-term public health efforts that can be maintained at regional level rather than dramatic but temporary interventions.

7) The capacity of the World Health Organization to coordinate multilateral efforts and to support national control programs should be strengthened and made effective.

Past efforts at controlling and eliminating malaria have been undermined by poorly designed development projects, armed conflicts, population dislocations, the inability of resource-poor nations to sustain control programs, and levels of poverty that prevent populations from having access to preventive or curative measures. Successful malaria control and elimination demand tremendous patience, vision, and long-term commitment.