Every day is Malaria Day

27 Apr 2009

Paul Chinnock

Source: TropIKA.net

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(Picture:William Daniels)
In a clinic in Sierra Leone's Pujehun district, a three-year-old boy with malaria is examined by a doctor. Fortunately he has been diagnosed early and will receive appropriate treatment with artemisinin combination therapy (ACT). William Daniels.

It is now standard practice to observe annual ‘Days’ to promote both awareness of and action against named diseases. The accepted procedure is to maintain a highly positive stance as regards to the chances of making progress against the disease in question. Achievements, rather than failures, are highlighted and every effort is made to create an impression of unity as regards the way forward. Negative thinking is not allowed.

World Malaria Day 2009 (25th April) followed this pattern and it is right that it should have done so, in order to maintain and expand support for efforts to eliminate a disease that claims around 800,000 lives every year. The Roll Back Malariapartnership (RBM), which takes the lead in organizing the event, has often faced criticism but in a spirit of unity its critics remained silent on World Malaria Day and the 2009 event was highly successful, attracting considerable and overwhelmingly positive attention from the media in the build up to the Day. The breaking news of the swine fever outbreak in Mexico and the USA did severely limit media attention on the Day itself, as it seems that the world’s press can only think about one infectious condition at a time, but this scarcely detracted from the impact of World Malaria Day overall – see TropIKA.net news story and blog.

For some, World Malaria Day is over for another year but a UNICEF photo essay from Nigeria reminds us there are many places where ‘Every day is Malaria Day’. Away from the high-profile statements from politicians, agency chiefs and celebrities, the everyday, frontline tasks of dealing with malaria continue relentlessly. This is the real world of malaria and it is realism that will be needed if the impetus generated by World Malaria Day is to be maintained.

Dangers

We must acknowledge concerns that, while the tools for malaria control set out in the Global Malaria Action Plan (GMAP) do most likely offer the best way forward, there could be dangers ahead that prevent them from delivering the goods. Treatment of malaria now focuses on the use of artemisinin combination therapies (ACTs) but artemisinin resistance has now been recorded and, based on previous experience of resistance to antimalarials, the resistant strains could rapidly spread. Mosquito control is another pillar of malaria programmes but resistance to insecticides has also been noted. And there have been theoretical concerns that if young children are shielded from exposure to malaria by insecticide treated bednets (ITNs) it may reduce their development of immunity, leading to more malaria in later life.

The GMAP strategy does not rely on a single ‘magic bullet’. There are several bullets in this gun. Nevertheless, bullets often fail to reach their target. Scaling up the delivery of ACT drugs may prove harder than anticipated. ITNs can be distributed but will they be used, and used correctly? Rapid diagnostic tests would seem to offer great potential but some question whether health systems yet have the capability to use them effectively.

All too often, false hopes have been raised when interventions are shown to be efficacious but prove to be disappointing when used in a real-world setting. We must not raise false hopes for the elimination of malaria.

Perhaps the biggest worry, however, relates to the continuing global economic decline. Will richer nations cut their support for malarial programmes? Will there be increased civil conflict in disease-endemic countries and a collapse of their health systems?

Consequences of failure

We must be wary of all these dangers if efforts to meet the goals set out in the Global Malaria Action Plan are to succeed. Failure would be not just disappointing but catastrophic ...and not just for malaria. The global plan represents a decision by the international community to focus on a specific cause of sickness and death and to mobilise resources at all levels to attack that disease. If it all turns out not to work, then it will be harder to establish similar programmes seeking to address other global health issues.

Failure would also mean that scarce resources which could have been devoted to other disease priorities had been wasted. The disease burden caused by the neglected tropical diseases is greater than that of TB or malaria and approaches that of HIV/AIDS. The increased funding provided to malaria in recent years may have been at the expense of support for conditions such as leishmaniasis, filariasis and schistosomiasis. Every day is Malaria Day but it also Sleeping Sickness Day and Trachoma Day. Many critics have always argued that the way forward is not through vertical programmes with a single-disease focus, and that resources should be devoted to the building of effective health systems offering comprehensive care.

But encouraging progress against malaria has already been made in several countries using the tools now available. New data from Zambia published just before World Malaria Day is another example of what can be achieved. By the end of next year, RBM believes that it will be possible to achieve universal coverage these tools. There can surely be no argument; every effort must be made to reach this goal. If success is achieved then the longer-term goals set out in GMAP – near-zero deaths by 2015 and the gradual elimination of malaria globally – will then seem more realistic.

RBM has recently produced a toolbox intended to "help national program managers, their teams and their collaborating partners to improve program action and performance.