This year, for the first time, the United States officially commemorated Malaria Awareness Day. Last year, the White House hosted its first-ever summit on malaria.
This is a disease that kills between 1 million and 3 million people around the world every year, and infects about 500 million—mostly children and pregnant women. So what took us so long?
A 2006 Gallup poll may offer a clue as to why: Americans identified malaria as the least serious disease in the world. If your travels are limited to places within the United States or countries such as Canada, Great Britain, Germany and Australia, you probably don’t think much about the disease. Although there were 600,000 cases of malaria in the United States in 1914, malaria was eliminated from the country by the middle of the 20th century, and from Europe by 1975.
So unless you’re planning an African safari, most Americans just don’t think about malaria—although it has killed more people throughout history than any other single illness. (Ernest Hemingway and John F. Kennedy both contracted it and survived; Oliver Cromwell and Dante weren’t so lucky.)
For about half of the world’s population, this mosquito-borne disease still represents one of the greatest threats to public health, on par with AIDS—in fact, it was only in 2007 that AIDS surpassed malaria in death rates.
Between 2000 and 2003, malaria was the fourth leading cause of death for children under 5 years old worldwide. It’s particularly deadly in Africa, where one child dies from malaria every 30 seconds. For example, in Nigeria alone, malaria accounts for 60 percent of health facility visits, 30 percent of childhood deaths, 25 percent of infant mortality, and 11 percent of maternal deaths.
Or think of it this way: According to professor Wen Kilama of the African Malaria Vaccine Testing Network in Tanzania, malaria’s death toll is “equivalent to crashing seven jumbo jets filled with children every day.”
And the danger is getting worse. In the early 1960s, only about 10 percent of the world’s population was considered at risk of contracting malaria; today, about 40 percent are at risk. That’s in part because both the mosquitoes that carry the disease and the malaria parasites themselves have proven to be dangerously adaptable, developing resistance to pesticides and mutating in response to drugs such as chloroquine that were once very effective against malaria.
But it doesn’t have to be this way. Unlike many other diseases, malaria is both preventable and treatable. Because the mosquitoes that carry the disease are active mostly at night, that’s the most important time to protect against their bites. A simple bed net, treated with long-lasting insecticide, can cover a mother and child, or several siblings, for as long as three years to five years—and it costs just . Of course, for many families at risk, might as well be ,000.
There are also new drug therapies available. The most effective drugs for treating malaria today are known as artemisinin-based combination therapies (ACTs). But until recently, these drugs were prohibitively expensive, costing as much as for a single adult dose of Coartem, the recommended first-line treatment for malaria in East Africa.
That may be changing with the introduction of Asaq, a new ACT combination drug developed by Sanofi-Aventis and the nonprofit Drugs for Neglected Diseases Initiative. Asaq—the first drug developed under the initiative—will cost less than 50 cents for children under 5 and less than a dollar for older children and adults.
The coordinator of President Bush’s five-year class=”import-text”>2007June. Malaria Crisis.txt.2 billion Malaria Initiative, Adm. R. Timothy Ziemer, has said that the government program will buy the new pill if it meets international safety standards and is requested by the countries involved, while Sanofi has pledged to sell the pill at cost to health agencies such as the World Health Organization and UNICEF. It will also not seek a patent on the new one-pill formulation to allow generic copying at will.
Ultimately, however, both nets and treatments are stopgap solutions, say many experts. They will doubtless save millions of lives, but millions of people will remain at risk, and there is always the possibility—indeed, the likelihood—that the rapidly changing malaria parasite will develop resistance to the new drugs as it did with chloroquine and other treatments.
The real goal: a malaria vaccine. Unfortunately, vaccine development is not a particularly financially rewarding area for pharmaceutical companies to pursue, particularly for a disease such as malaria that does not have much impact on developed countries. That’s where the Malaria Vaccine Initiative (MVI), founded in 1999 by the Bill and Melinda Gates Foundation, comes in. Today, MVI has 10 vaccine development projects worldwide, including two with clinical trials under way.
In 2004, one of these projects reported the results of a trial involving 2,000 children in Mozambique, demonstrating that the most advanced vaccine to date—RTS,S—could reduce severe malaria by 49 percent. According to Christian Loucq, interim director of MVI, the group expects to bring one of the vaccines in development to 16,000 children in Africa for further trials. By 2015, they hope to have a vaccine available that prevents malaria in 50 percent of people for at least one year.
But with vaccines still a goal rather than a reality, the global health crisis of malaria remains urgent—for all of us.
About the Author
Gina Shaw is the medical writer for The Washington Diplomat.
