Controlling malaria

A significant reduction in malaria deaths through targeted intervention measures, particularly in Africa, and a substantial rise in funding to fight the scourge have brought the goal of elimination of the disease nearer. The search for a malaria vaccine may eventually present a winning candidate, but the focus for the immediate future must be on controlling the deadly falciparum form of the disease. The global health community, which has been enthused by the outcome of intensified malaria control efforts, is now talking of elimination. A dramatic reduction in mortality has been demonstrated with the use of long-lasting insecticide-treated bed nets and access to Artemisinin-based Combination Therapy (ACT). The World Health Organisation's Roll Back Malaria initiative is working to bring down deaths from close to a million a year today to near zero by 2015. Much of the optimism stems from good results reported by countries such as Zambia, where malaria deaths have declined by two-thirds. This breakthrough was achieved by distributing millions of insecticide-treated bed nets and making available ACTs widely over a two-year period. If the 60 other 'malaria heartland' countries can replicate these results, the disease can certainly be rolled back within a few years. On World Malaria Day (April 25) this year, an ambitious Affordable Medicines Facility under the Roll Back Malaria framework was unveiled. This will bring ACTs within reach of everyone in a selected group of countries. It has been made possible by fixing low, subsidised drug prices through negotiations with manufacturers. If the experiment succeeds, it can become a global programme. Expanded funding running into billions of dollars has been pledged by various sources, starting with $4.6 billion from the Global Fund, to scale up malaria control and offer combination therapy where appropriate. The talk about rising India must not be allowed to obscure the harsh reality that remote areas in India, especially in the Northeast, continue to witness significant levels of death and morbidity due to falciparum malaria. Studies show that the affected regions are backward and extremely poor. It is crucial, therefore, that national malaria control efforts carefully weigh the evidence on the efficacy of fixed-dose combination therapy in comparison with conventional medicines and monotherapy. It will then be possible to make the best therapies available through the public health system to those who need them. The war against malaria has been long and costly but there is excellent evidence in hand to suggest that it can be won if the right public health choices are made.

The Hindu, 30th April 2009