Experts say efforts to beat malaria may backfire

By Neil Bowdler Science reporter, BBC News

October 29th, 2010

Efforts to eradicate malaria in some countries may be counter-productive, an international team

of researchers suggest.
In the Lancet, they suggest some countries, particularly in sub-Saharan Africa, may be better
pursing a policy of controlling the disease.
They also criticize the World Health Organization (WHO) for not providing adequate direction.
But a WHO spokesman said beating malaria must remain the ultimate goal.
'Noble' goal
The Lancet looks at the feasibility of eradicating malaria from the map, in the same way smallpox
was conquered.
As the report points out, the Bill and Melinda Gates Foundation set the world such a target in
2007, an aim which was then endorsed by the WHO's Director-General Margaret Chan.
The Lancet concludes such a goal, while noble, "could lead to dangerous swings in funding and
political commitment, in malaria and elsewhere".
And the WHO is accused of failing "to rise to their responsibilities to give the malaria community
essential direction".
The series of articles instead urges a pragmatic approach in which efforts and resources are
concentrated on shrinking the global area where malaria still prevails.
It suggests some countries, particularly in sub-Saharan Africa, may be better pursuing a policy of
controlling the disease rather than one of eradication.
The report's authors include Professor Richard Feacham of University of California's Global
Health Group and researchers from the Clinton Health Access Initiative.
Saving lives
In an editorial accompanying the series, the Lancet's editor-in-chief Dr Richard Horton and
executive editor Dr Pamela Das, argue control may save more lives.
"If existing control efforts were indeed scaled up, by 2015, 1.14 million children's lives could be
saved in sub-Saharan Africa alone. This finding is important. The quest for elimination must not
distract existing good malaria control work," they write.
They also conclude that "malaria will only be truly eradicable when an effective vaccine is fully
available".
Responding to the report in a statement, Robert Newman, director of the WHO's Global Malaria
Programme, said the ultimate goal had to be eradication
"WHO has always supported - and will always continue to support - endemic countries in their
efforts to control and eliminate malaria," he writes.
"It is entirely feasible to eliminate malaria from countries and regions where the intensity of
transmission is low to moderate, and where health systems are strong.
"Eliminating malaria from countries where the intensity of transmission is high and stable, such
as in tropical Africa, will require more potent tools and stronger health systems than are available
today."
Shrinking map
Malaria is caused by five species of a parasite that can be carried from human to human by
mosquitoes.
Over the last 150 years, the portion of the world where malaria is still endemic has shrunk, but
the disease is still endemic in 99 countries.
However 32 of these countries, most of them on the edges of the endemic zone, are attempting to
eradicate the disease, while the rest are trying to reduce infections and deaths though control
measures.

But switching from a

policy of controlling the
disease to one of
eradication brings with it
problems and risks,
according to the report.
The authors point out that
malaria and mosquitoes
do not respect national
borders and that both
parasite and insect may
develop resistance to
existing drugs.
They also warn switching funds from control to eradication may negatively impact upon
measures which have been shown to reduce infection and mortality.
The picture is further complicated by the fact that countries are dealing with two main malaria
parasite species - Plasmodium falciparum and Plasmodium vivax.
While there is more research available on the former and more drugs available to combat it, most
of the countries trying to eliminate malaria currently are largely threatened by the latter species P
vivax.
A combination of drugs from the artemisinin family are generally used to tackle P falciparum
while primaquine is the only registered drug available to combat P vivax.
The UK's International Development Secretary Andrew Mitchell, said: "Elimination is the
ultimate goal. One of this government's top priorities in international development is fighting
malaria and we have committed to help halve the number of malaria deaths in some of the worst
affected countries."
The Gates Foundation was unavailable for comment.
JLB Notes:
I often wondered about the use of “DDT”, in the ongoing battle against malaria and if for
example it has been used anywhere on the globe today – proof of it abilities are not denied, but it
side effects over the years have been proven, albeit in humans it is still only suspected in causing
cancer. One glaring example of its effectiveness is in Sri Lanka where before it use the normal
count for its citizens having malaria was approximately 3,000,000 per year, whereas after the use
of DDT this number dropped to 29 per year in 1964. Soon after because of its expense its use
was dropped, the malaria came back with a storm in 1968-1969 to 600,000 cases. They resumed
use but over time the “Mosquitoes” acquired a resistance to DDT – where Sri Lanka switched to
“Malathion” which albeit more expensive proved to work as well or better.
Today, DDT is still on WHO’s list of insecticides recommended for indoor residual spraying
(“IRS”) – it has become the policy of WHO that IRS is only used in regions of high seasonal
transmission of malaria, and in some areas a continuous intense transmission – WHO has a
commitment of a reduction of 30% worldwide of DDT by 2014, with a complete phase-out by the
early 2020s – if not sooner, testing and finding alternatives for the complete eradication
eventually of malaria.
South Africa continues to use DDT under WHO guidelines where in 1996 it switched to
alternative insecticides and watched as the incidence of malaria increased – whereas with the
reintroduction of DDT and new drugs once again reined malaria back into a manageable
existence. Research during the preceding years such as in Ecuador where they increased the use
of DDT resulted in a 61% reduction in malaria rates, where countries that have slowed their usage
of DDT their malaria rates increased.
DDT magnify through the food chain, with apex predators such as raptor birds where as the
concentration is heavy in them, the chemicals are very lipophilic and are stored mainly in body
fat. DTT and DDE are very resistant to “metabolism, where in humans their half-lives are six up
to ten years. In 2005 blood samples taken across the United States found samples of the two
chemical in almost all of the samples – this still true since “most” uses were banned in the USA
in 1972. Some foods tested today by the FDA still detect the chemicals.
Interesting covering the soil with seaweed (Marine Macrolage) helps reduce the DDT soil toxicity
by up to 80% in less than six-weeks.