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Column: A vaccine could soon be here for one of the most devastating diseases on the planet

With malaria causing 627,000 deaths last year, there are high hopes for the first vaccine. But old-fashioned people power can also make a difference.

Hans Zomer

WORLDWIDE, MORE THAN 200 million people are infected with malaria every year, according to the World Health Organisation (WHO). Last year, malaria caused an estimated 627,000 deaths globally – mostly babies and young children in the poorest countries in Africa.

Malaria is truly a disease of poverty. It affects poor people disproportionately, as they tend to live in malaria-prone rural areas and in houses that offer little protection against mosquitoes. And malaria also fuels poverty, as it slows economic growth and worsens other disease burdens, particular HIV and Aids.

But there is good news on the malaria front. The number of malaria deaths has almost halved since 2002, according to the latest edition of the World Malaria Report. From 2000 to 2012, the number of reported malaria cases fell by 29 per cent, thanks to the mass distribution of mosquito nets, public awareness campaigns and quicker diagnosis methods, allowing for faster treatment.

In Zanzibar, for instance, the number of malaria cases has dropped dramatically in just eight years. In 2005, infection rates on the island stood at 40 per cent, but last year, it had managed to bring that number down to below 1 per cent. The Zanzibar government now aims to completely eradicate the disease by 2017. Whether it will achieve that will depend not just on political will or funding; it also depends on the parasite responsible for the disease.

Research into the disease is not keeping up with demand

Scientists point out that the current strategy is threatened by “the lack of insecticide classes available for public health and the emergence of resistance to the majority of existing insecticides.”

The market for public health pesticide products is seen as risky and too small to warrant commercial investment, compared to the market for agricultural insecticides. As a result, there have been no new active ingredients in malaria treatment available to the general public in over 30 years.

This is now set to change. Researchers in seven African countries are involved in testing the world’s first malaria vaccine, developed by British pharmaceutical company GlaxoSmithKline, with funding from the Bill and Melinda Gates Foundation. The company is seeking permission to sell the vaccine, provisionally known as RTS,S, after the largest ever drug test in Africa showed it reduced infection rates among children by half.

The company has promised that the vaccine will be sold at a price only marginally above production cost, and that the surplus will be reinvested in further research on malaria. And such research is needed, as GlaxoSmithKline itself has indicated that the vaccine does not have the hoped-for universal applicability and impact. (Bill & Melinda Gates)
Focusing on people, not just technology

But the solution need not come from technology alone. One of the key findings of decades of work by governments and development organisations is that simple measures work. Sleeping under insecticide treated nets, for instance, can reduce overall child mortality by 20 per cent. UNICEF estimates that bed nets can save approximately six children’s lives per year for every one thousand children sleeping under them.

There isn’t a ‘one size fits all’ method

Not getting bitten is obviously the best protection. Malaria is transmitted exclusively through the bites of Anopheles mosquitoes, which only bite at night or in the early morning. Transmission is more intense in Africa, where the mosquitoes’ lifespan is longer, and where they prefer to bite humans rather than animals.

Anopheles mosquitoes breed in water. Countries that have improved sanitation and reduced the occurrence of stagnant pools of water have managed to bring down infection rates, but Anopheles mosquitoes breed in such a variety of situations that it is practically impossible to remove suitable habitat for the mosquito. A better strategy, therefore, is to combine approaches based on our knowledge of the biology of the mosquito, the epidemiology of the parasite, and focused on changes in human behaviour.

Aid agencies have learned that there is not a “one size fits all” method for the fight against malaria. Unless local people, local authorities and local health care practitioners are involved in a coordinated way, and unless communities have access to trained, properly remunerated technical experts, the fight against malaria will not be won.

Bringing health systems to marginalised communities

In many developing countries, there simply are not enough health workers to respond to the needs of all rural communities. Programmes funded through overseas aid can make an enormous difference in such contexts, by bringing high-quality rapid diagnostic tests (RDTs) for malaria to marginalised people and by training frontline health workers to diagnose and treat patients for common diseases such as malaria, pneumonia and diarrhoea.

Aid agencies also help train people to diagnose and treat of malaria at home. Early diagnosis prevents deaths and should be a core part of any strategy to fight malaria. NGOs, therefore, typically bring together community volunteers, mothers, village leaders, traditional healers, and health workers to help them learn about, and take action against, malaria.

But knowledge is not the only major barrier to an effective anti-malaria strategy. For many poor communities, the medicines are simply too expensive, and the local health centres simply too far away, to be a real option. In many communities, aid agencies have helped set up village solidarity funds, funded by contributions from villagers and used to subsidise the transportation of young children with serious malaria or other health concerns.

A grass-roots approach to malaria control

What NGO work in countries like Zambia, Benin and Senegal is showing is that this approach is working. While many aid donors emphasise the importance of new drugs, the grass-roots approach to malaria control works with communities and families to help them recognise the symptoms of malaria and to ensure that even the poorest and most vulnerable members of society have access to medicines and bed nets.

Both approaches meet in the middle, through the coordination by national governments. And if anything, that is the vital ingredient for the international fight against malaria: the realisation that local governments and local solutions must always be at the heart of any programme aimed at ending disease, hunger and poverty.

Hans Zomer is the Director of Dóchas, the network of Ireland’s Development NGOs. Dóchas publishes the World’s Best News, a news service initiative from Irish NGOs which aims to highlight positive news stories from around the globe. Visit the World’s Best News on Facebook or worldsbestnews.tumblr.com for more information.

Read: Cases of malaria in Ireland rise for the third year in a row

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Hans Zomer

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