Ken Walker, author

Because the deaths came in ones and twos, the mid-summer and early fall 2019 headlines were more local than national in scope. They told of a 70-year-old man in Massachusetts—one of 10 people infected in the state—dying from Eastern equine encephalitis (EEE)s, a virus transmitted through a mosquito bite; two deaths in Connecticut, where officials identified EEE-carrying mosquitoes in a dozen municipalities; and a 68-year-old man in Ohio who died from mosquito-linked West Nile virus.

Malaria test kits.

It is critical that patients everywhere have access to the regimens needed to combat this “deadly scourge.”
Photo by Nothing but Nets

Before the year ended, more than a dozen fatalities had been recorded. As of mid-November, the Centers for Disease Control reported three dozen cases of EEE in 2019, the highest in 60 years.1 The annual average for the previous decade: just seven.

Granted, a relative handful of tragic fatalities from EEE doesn’t compare to thousands of deaths attributed each year to malaria, which still vexes health officials centuries after its discovery. Still, this five-fold increase in EEE cases may help sensitize Americans to the scourge of mosquito-borne health dangers. Such an awakening is especially timely with the observance of World Malaria Day on April 25, which draws attention to the 400,000 lives per year lost to this deadly disease.

In fact, while the total number of confirmed COVID-19 cases worldwide (on the date of this report) currently stands at 2.5 million and rising, each year there are more than 200 million reported cases of malaria, mostly in sub-Saharan Africa and South Asia.

A previous special report on this topic, entitled “Fighting Malaria – A Chilling Disease,” details how mosquito netting and malaria prevention are being used to combat this parasitic genius. This update unfolds the ongoing efforts of the global community to combat mosquito-borne scourges, including malaria, even among developing nations.

Despite advances in recent years, malaria remains a leading cause of death globally.

The latest World Malaria Report, released last December by the World Health Organization (WHO), said 405,000 people died from the disease in 2018.

While that is less than the 435,000 fatalities recorded the previous year, the number of cases rose from 220 million to 228 million, a 3.6 percent increase (since 2016, cases are up 5.6 percent). A staggering 93 percent occurred in the African region in 2018, followed by Southeast Asia (3.4 percent) and the eastern Mediterranean (2.1 percent).

There was a mixture of good and bad news in the report.

Globally, malaria’s incident rate declined from 2010 to 2018. Formerly at 71 cases per thousand in population, the rate slowed to 57 in 2014. Yet it remained at similar levels the next four years. The reductions were most encouraging in Southeast Asia, where 17 cases per thousand in 2010 declined to five cases in 2018, a 70 percent decrease. Also on the positive side, the WHO said more countries moved toward zero indigenous cases, with 49 countries reporting less than 10,000 in 2018.

However, between 2015 and 2018, only 31 countries where malaria is still endemic were on track to reduce this rate by 40 percent or more by this year.2 Without major changes, the WHO’s long-term global strategy for 2015−30 may not reach milestones for morbidity in 2025 and 2030.

Intermediate magnification micrograph of maternal malaria. Placenta. H&E stain.
Photo by Nephron, Wikimedia (CC BY-SA 3.0)

Advancements in the Fight

Thanks to a consortium of governments, foundations and non-governmental organizations, there have been advancements in treatment. In 2015 the WHO announced the global incidence of malaria had finally slowed: Between 2000 and 2015, mortality rates in Africa fell by 66 percent overall and 71 percent among children under 5, the most vulnerable victims.3

66%

fewer mortalities overall and 71% among children under five in Africa between 2000 and 2015.

“The last decade has seen a significant transition in the ways that countries are responding to malaria,” Dr. David Reddy, CEO of the partnership, Medicines for Malaria Venture, said in a 2015 interview. “Significant new international resources (including Global Fund and President’s Malaria Initiative) have been better mobilized in the last 10–15 years to support programmatic strengthening and introduce greatly improved tools to prevent and treat malaria.”4

In his foreword to the WHO’s 2019 report, Director-General Dr. Tedros Adhanom Ghebreysus noted that at least 10 countries are on track to reach the 2020 elimination milestone set in its long-term global strategy. In 2015, he said all those countries were malaria endemic, but now have either achieved zero indigenous cases or are nearing that goal.

Community health worker, tests a child for malaria

In 2018, 259 million Rapid Diagnostic Tests for malaria were distributed by National Malaria Programs across the globe. Here Souleman Balde, a 32 year-old-community health worker, tests a child for malaria in a village in the Bafata region of eastern #GuineaBissau.
Photo by @UNDP Guinea Bissau / Gwenn Dubourthoumieu

More resources are appearing too. Just before the release of the WHO report, the board of the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria approved increased funding for investments over a three-year period (starting in 2020) to fight these epidemics. The investments total more than $12.9 billion U.S. as of March 2020.

Medical advances are occurring as well. In September of 2019, a paper in Science Translation Medicine described how redesigning molecules first designed to treat a skin disease (psoriasis) could lead to an effective new drug. An international team of researchers described modifying a class of molecules called pantothenamides to increase their stability in humans. In brief, the new compounds stop the malaria parasite from replicating in infected people and are effective against parasites resistant to current drugs.5

One of the paper’s authors, Penn State University professor Manuel Llinás, said while pantothenamides are potent against parasites, they become unstable within biological fluids because an enzyme clips them apart before they can act. Changing a chemical bond prevents this from happening.

Significant new international resources ... in the last 10–15 years ... introduce greatly improved tools to prevent and treat malaria

“By also preventing the transmission of malaria parasites from infected people into mosquitoes, these pantothenamides can reduce the chances that mosquitoes will be infectious to others,” Llinás said. “It is currently widely accepted that next-generation antimalarial drugs must target the parasite at multiple stages to both cure the disease in an infected individual and prevent its spread to others.”

200

mortalities in Myanmar in 2017, dropping from 4,000 in 2010.

This news came on the heels of a story by Joshua Carroll in The Guardian newspaper about Myanmar becoming an example in the fight against malaria. It chronicled how thousands of volunteers received training and supplies from donors after political reforms opened the door for a flood of aid.

These efforts helped save thousands of lives and turned Myanmar into a leader in the battle to eliminate the disease. Nationwide in 2010 nearly 4,000 people died from malaria, but in 2017 that number dropped to 200.

“Dr. Patricia Graves, a leading specialist on the transmission and control of malaria, is confident Myanmar is on track to be malaria-free by 2030,” Carroll wrote. “The country’s success with village-based health workers ‘is a huge thing that other countries can learn from,’ she says.”6

Family sleeping inside mosquito net covered bed.

A study of Africa released in the spring of 2019 found that the single-most important factor to a 15-year decline in malaria fatalities was increased distribution of insecticide-treated bed nets. Photo by Nothing But Nets

Rising to the Challenge

Doctors developing vaccine for malaria.

Drs. Nana Minkah (back) and Deba Goswami work with Kappe Lab colleagues to develop a vaccine for malaria. Photo by Seattle Children’s Hospital

One of the ironies in the fight against malaria is that past victims are combating it, including people like Dr. Nana Minkah, a scientist at the Kappa Lab at Seattle Children’s Hospital. Growing up in the sub-Saharan nation of Ghana, he contracted the disease multiple times. Among his memories are bouts when he spent more than a week in bed with pain and chills so bad he visibly shivered.

In 2015, after earning a Ph.D. in molecular genetics and biology, Dr. Minkah joined the Kappa Lab. Even though he didn’t have experience in parasitology, he wanted to work on malaria, especially since it still plagues his homeland.

One of the ways the lab hopes to pioneer new methods of preventing malaria is with genetically engineered vaccines. In March of 2019, it successfully completed a vaccine with a first-generation strain of the most lethal parasite. Such vaccines rely on a basic principle: to give the immune system an advantage over a pathogen by teaching it to recognize the invader before the infection occurs.

“I wanted to do work that has clinical implications with the potential to save the lives of people who look like me,” Dr. Minkah said. “What we are trying to do is a tall order. We are trying to develop a product that will create unnatural immunity.”7

Despite such inspiring stories, challenges still exist. For example, while malaria was eliminated in the U.S. in 1951, the country still has Anopheles mosquitoes that can bite an infected person and transmit to others.

Health workers take blood sample from an infant, testing for malaria.

Health workers take a blood sample from an infant to test for malaria at a clinic along the border between Thailand and Myanmar. Photo by Ben De La Cruz / NPR

During last summer’s EEE outbreak, health officials in five southwest Michigan counties warned of a “critical risk” of the virus in 35 communities, with another 40 at high risk. Dr. Brian Chow, a doctor of infectious diseases at Tufts Medical Center, said 2019 seemed to be much more severe than in years past. “It is a concern,” Chow said.8

Such situations point to the vigilance needed for the fight. A 2019 article in the Scientific American pointed out how, over time, drug treatment of the disease lose their effectiveness as parasites grow resistant to it. For example, in the 1990s, chloroquine was of first-line importance in Africa. By the early 2000s, that drug was replaced by sulfadoxine/primethamine and later ACTs (for Artemisinin Combination Therapy). Each time, resistance developed.

“While mutation in this gene has occurred in Southeast Asia and is spreading around the region, there are fears it will spread to Africa, like it did for the drugs before it,” wrote Ify Aniebo, a research scientist and fellow at Harvard’s school of public health. “The more drugs we use to treat malaria parasites, the more resistant they become due to selective pressure.”9

It is widely accepted that next-generation antimalarial drugs must target the parasite at multiple stages to both cure the disease in an infected individual and prevent its spread to others.

Ironically, even as parasites adapt to resist technology, one of the most effective methods to combat malaria is rather old-fashioned: mosquito nets. A study of Africa released in the spring of 2019 found that the single-most important factor to a 15-year decline in malaria fatalities—from 840,000 deaths in 2000 to 440,000 in 2015—was increased distribution of insecticide-treated bed nets. The authors of the study estimate they were responsible for averting 451 million cases during that 15-year period.10

Zero Malaria Starts with Me

Surrounding World Malaria Day 2020, WHO joins the RBM Partnership to End Malaria, the AUC and other organizations in promoting “Zero malaria starts with me” a grassroots campaign that aims to keep malaria high on the political agenda, mobilize additional resources, and empower communities to take ownership of malaria prevention and care. Photo by World Health Organization, World Malaria Day 2020

Joining the Fight

This study highlights the importance of one group’s primary methods of fighting the disease in South Asia: distributing mosquito nets free of charge to vulnerable families. Workers supported by GFA World (GFA) distributed 360,000 nets in 2018.

Children sitting on a bed with Mosquito Net covering.

Through the gift of a simple net given by Gospel for Asia, these children are protected from the mosquitos that transmit malaria that causes death in over 400,000 victims per year.

“As GFA combats these mosquitoes and the deadly disease they carry, we’re seeking to minimize the risk of children being infected,” founder K.P. Yohannan says in a 2019 press release for World Malaria Day. “It’s part of our commitment to the remote communities and one way to express God’s love for them. Many villagers in remote areas can’t afford to buy mosquito nets or preventive medications. This is why our efforts are so critical.”

Distribution of nets is only one aspect of multi-faceted efforts by GFA in these areas. The ministry also supports workers who hold free health seminars, distribute vitamins and educate villagers about hygienic routines to reduce the potential for disease and infection.

Such efforts create heart-rending anecdotes, like that of Pastor Ronsher, who serves in an area with high transmission rates. There, impoverished farmers and daily wage laborers struggle to secure proper medical care and hygiene; among their numbers is a couple named Bahman and Salli, whose daughter had been paralyzed for three years. After Pastor Ronsher gave them a net, he visited them for several weeks to teach them how to use it and offer encouragement.

Ironically, even as parasites adapt to resist technology, one of the most effective methods to combat malaria is rather old-fashioned: mosquito nets.

“You helped us by providing a piece of mosquito net in our lives, though you never knew us before,” Bahman said. “Many knew about our problems, but except [for] you, none of them showed their kindness toward us. We are touched with your love.”

Such love may be needed for those living in the U.S. as well. In addition to the increased rate of Eastern Equine Encephalitis cases last year, one malaria researcher at the University of Maryland’s medical school recently warned of limited access to an intravenously-administered drug. The IV treatments are needed for the more serious cases of mosquito-linked diseases in America.

A mother watching her children sleep inside a mosquito net covered bed.

One simple way to make a personal impact on mosquito-borne diseases like malaria, is to consider giving an at-risk family a simple mosquito net to provide them with safety from insects during the day and at night.
Photo by Nothing but Nets

“Severe malaria is a medical emergency that requires immediate treatment with IV medication to reduce the risk of death,” says Dr. Mark Travassos, a pediatric infectious diseases specialist who cited a 2015 Centers for Disease Control and Prevention report showing 1,500 malaria cases in the U.S., of which 259 needed IV treatment.11

Dr. Travassos says while oral treatments for malaria are available, in the U.S. these are often not effective in more serious cases: “Severe malaria patients can have brain involvement or repeated vomiting and may not tolerate oral medication, placing them at high risk for complications.”

As his University of Maryland associate, Professor Kathleen Neuzil, puts it, “Malaria is a leading killer worldwide, impacting millions of people each year. While we continue to work on developing vaccines and other treatments, it is critical that patients everywhere have access to the regimens needed to combat this disease.”

That means patients in places as poor as South Asia and as affluent as the U.S.


What can we do about mosquito-driven scourges?

One simple way to fight mosquito-borne diseases like malaria, is to consider giving a needy family a simple Mosquito Net. For only $10, GFA World's field partners can distribute one of these effective nets to an at-risk family in Asia and provide them with safety from insects during the day and at night.



This ends the update to our original Special Report, which is featured in its entirety below.


Ken Walker, author

Malaria. Though eradicated in many developed nations, this disease still claims thousands of lives around the world. One victim who survived this mosquito-borne disease compared its chills to “lying down between two blocks of ice.”12 Each year, more than 400,000 people don’t survive those terrifying shudders.

As part of its long-term goal to eradicate this life-threatening disease, this year the World Health Organization (WHO) is launching the first field test of a vaccine in real-world settings. Known as RTS,S, or Mosquirix™, the United Nations agency says this is the first vaccine shown to provide partial protection against the disease in young children by acting against the deadliest parasite globally. It will be made available to select residents of three countries in Africa, the continent linked to the highest number of cases. In addition to combating it, the organization hopes to train a spotlight on the need for dramatically increased funding in the fight against malaria.

Dr. Alonso of the World Health Organization

Dr. Pedro Alonso, director of the World Health Organization's Global Malaria Program. Photo by Malaria World Congress

“Progress in the global malaria response has unquestionably stalled,” said Dr. Pedro Alonso, director of WHO’s Global Malaria Program, in a letter last December.13 “Clearly, to get the response back on track, increased funding is urgently needed from international donors and endemic countries. Critical gaps in access to tools that prevent, diagnose and treat malaria must be found and filled.”

To get an idea of the obstacles presented by malaria, consider the toll during 2016. Worldwide, there were 216 million cases, an increase of 5 million over the previous year. The death toll of 445,000 nearly matched that of 2015.

Although $2.7 billion was invested in the fight against malaria in 2016, WHO estimates a minimum of $6.5 billion will be needed annually by 2020.

Anopheles, the mosquito that transmits malaria

Malaria is transmitted by infected female mosquitoes called anopheles. (Public domain)

A life-threatening disease, malaria is caused by parasites transmitted to people through bites of infected female mosquitoes, known as anopheles. In people lacking immunity—especially pregnant mothers and young children—symptoms appear 10 to 15 days after the bite. Fever, headache, chills and vomiting are among the symptoms.

Severe cases in children can include severe anemia and respiratory distress, while in adults, the disease can affect multiple organs. Without treatment within 24 hours, certain kinds of malaria can cause death.14

The Centers for Disease Control (CDC) says malaria occurs mostly in poor tropical and subtropical areas of the world and is a leading cause of illness and death in those regions. Some 3.3 billion people live in areas at risk of transmission.

Although Africa is home to the majority of cases, the problem exists across the globe, as evidenced by its presence in 91 countries. For example, to the east of the continent, CDC maps show malaria is prevalent across South Asia. That includes all of Laos, Bangladesh and India (except at higher elevations), and much of Cambodia and Pakistan (below 2,500 feet altitude). It is also present in areas of eastern Indonesia and some areas of Thailand, Vietnam, Burma (Myanmar) and Papua New Guinea.15

CDC Malaria Map

The CDC Malaria Map shows where malaria is prevalent in the world.

Even in the United States, which largely eradicated the problem in the early 1950s, the CDC says 1,700 cases are diagnosed annually. The majority are among travelers and immigrants returning from countries where transmission occurs, many from South Asia and sub-Saharan Africa. There were also 63 outbreaks of locally transmitted, mosquito-borne malaria between 1957 and 2015.16

This fight goes on despite the awarding of five Nobel Prizes in physiology or medicine for work associated with malaria between 1902 and 2015. Small wonder that a National Institutes of Health researcher once commented, “In its ability to adapt and survive, the malaria parasite is a genius. It’s smarter than we are.”17

Spotlight on World Malaria Day

Bill and Melinda Gates talking about malaria at the Bagamoyo District Hospital in Tanzania.

Bill and Melinda Gates discuss malaria at the Bagamoyo District Hospital in Tanzania. Photo by Bill & Melinda Gates Foundation, 2018 Annual Letter

It isn’t just WHO focusing attention on malaria. In January, the Bill and Melinda Gates Foundation (long involved in anti-malaria causes), the Inter-American Development Bank and the Carlos Slim Foundation announced they would provide a collective total of $83.6 million in new funding to combat malaria in seven nations in Central America and the Dominican Republic.

The Regional Malaria Elimination Collective is also aimed at ensuring malaria treatment remains a health and development priority. The funds are to help leverage more than $100 million in domestic funding and $39 million of existing donor money by 2022. Although Central America has seen a 90 percent drop in cases since 2000, “progress against the mosquito-borne disease has stalled and several countries in the region still have significant problems with malaria,” reported Reuters News Service in late January.18

These developments occur amid the upcoming World Malaria Day (Apr. 25), which has been an annual emphasis since 2007. The international observance was established by WHO’s decision-making body to provide education and understanding of the disease and to spread awareness of strategies to curtail its spread.

President George W. Bush gestures as he addresses his remarks in honor of Malaria Awareness Day Friday, April 25, 2008

Former President George W. Bush gestures during an address in honor of Malaria Awareness Day on Friday, April 25, 2008. Photo by George Bush Archives

On its first year, former President George W. Bush designated Apr. 25 as “Malaria Awareness Day” and called on Americans to join the effort to eradicate the disease on the African continent.

Among the initiatives announced were a $3 million challenge grant from ExxonMobil, a fundraising promotion by Major League Soccer, a challenge by Pastor Rick Warren to 300,000 churches to take on malaria as a cause, and a campaign against malaria by the Boys and Girls Clubs of America.

A number of countries participate, spanning such nations as the U.S. to Germany to India, Nigeria and Uganda. In addition to governmental action, businesses, non-governmental organizations and individuals use the day as an opportunity to engage in fundraising, while many media outlets help publicize public awareness campaigns.

World Malaria Day helps shine a spotlight on prevention, a crucial strategy in reducing the incidence of the disease. WHO says that since 2000, this has played a key role in reducing cases and deaths, with the indoor spraying of insecticides and distribution of insecticide-treated nets leading the way.

What difference has this made? Across sub-Saharan Africa, just over half the population slept under nets in 2015, compared to less than a third five years earlier. During that time period, preventive treatment for pregnant women increased five-fold in 20 African nations. Globally, new malaria cases fell 21 percent between 2010–2015, while death rates declined by 29 percent. However, much remains to be done.

WHO’s global technical strategy has a goal of a 40 percent reduction in malaria cases and deaths by 2020, but less than half of the countries facing the threat are likely to meet that target.

Dr. Noor of WHO's Global Malaria Program Surveillance Unit

Dr. Abdisalan Noor of the World Health Organization’s Global Malaria Program Surveillance Unit.
Photo by Wellcome Trust Blog

Indeed, Dr. Abdisalan Noor, team leader of WHO’s Global Malaria Program Surveillance Unit, says the declining trend in malaria cases and deaths has slowed and even reversed in some regions over the past three years.

In commenting on the 2017 World Malaria Report issued last November, Dr. Noor said there are continued gaps in coverage of basic prevention, diagnostic and treatment tools.

“As noted in the report, less than half of households in countries in sub-Saharan Africa have sufficient bednets, and only about one-third of children in the African Region with a fever are taken to a medical provider in the public health sector,” he said.19

Combatting a Tough Disease

Hippocrates

Hippocrates (460–370 B.C.) described malaria in the ancient world.

Malaria has a history extending back thousands of years. The legendary Greek doctor, Hippocrates (born in 460 B.C.), described periodic fevers. It was so common in the Roman Empire that one report said it may have contributed to the empire’s decline.20 At one time, it was also common across Europe and North America.

Malaria needs a combination of high population density, high anopheles mosquito density, and high rates of transmission from humans to mosquitos and vice versa. If any of the factors is lowered sufficiently, the parasite will eventually disappear from the area. However, unless eliminated entirely, it can be re-established if conditions revert to a combination favorable to the parasite.21

The battle against the disease has raged for centuries. Scientific studies on malaria saw their first major advance in 1880, when a French army doctor working at a military hospital in Algeria observed parasites in the red blood cells of infected patients. Alphonse Lavern suggested that malaria was caused by this organism, which along with other later discoveries, earned him the Nobel Prize in 1907.22

More than a century later, the battle against malaria continues. It is expensive. According to one report on research and development challenges in the health field, one drug costs $150–200 million and seven to 10 years to develop, one vaccine costs $600–800 million and takes 10–15 years, one diagnostic costs up to $50 million and takes three to five years, and one vector control product takes $60–65 million and 10–12 years. It projects the annual research and development need for malaria over a decade ending in 2022 will range from $5.5 billion to $8.3 billion.23

Still, it is a war worth waging. Not only can severe cases cause lifelong intellectual disabilities, but its economic impact can cost billions of dollars annually in lost productivity. WHO says certain population groups are at higher risk of contracting malaria and developing serious disease: children under 5, pregnant women, patients with HIV/AIDS, non-immune immigrants, and mobile populations and travelers.

Children are one of the groups most suscepitble to malaria

Young children are often at higher risk of contracting malaria. In 2012, an estimated 207 million people suffered from malaria. About 627,000 people died, and 77 percent of those deaths were among children under the age of 5.24 Photo by Nothing But Nets

To date, vaccines have been lacking, but WHO hopes Mosquirix™ will prove to be a game changer. It will be administered to at least 360,000 children in areas of Ghana, Kenya and Malawi, with some regions selected for participation to serve as comparison groups to areas where the vaccine will not be available initially.

Developed by the PATH Malaria Vaccine Initiative and GlaxoSmithKline with support from the Gates Foundation, Mosquirix™ was engineered with genes from the outer protein of a malaria parasite, a portion of a hepatitis B virus, and a chemical component to boost immunity. The vaccine works to prevent infection by blocking the parasite from infecting the liver.

Although WHO has yet to make a policy recommendation for large-scale distribution beyond the pilot program, it saw some encouraging—though limited—results in a five-year-long trial (phase three of the program).

“In its ability to adapt and survive, the malaria parasite is a genius. It’s smarter than we are.”

The trial, which concluded in 2014, enrolled approximately 15,000 infants and children in seven sub-Saharan nations. Among participants who received four doses, the vaccine prevented approximately four in 10 cases of malaria (39 percent) over four years of follow-up and just over three in 10 cases of severe malaria (32 percent). Significant reductions were seen in overall hospital admissions and those for malaria and severe malaria.25

It will be evaluated for use as a complementary tool, along with the preventive, diagnostic and treatment measures WHO recommends, such as indoor residual spraying with insecticides and the use of anti-malarial medicines.

Challenges Ahead

Progress has been made in the past. WHO’s long-term strategy report, which outlines steps to attack the problem by 2030, says between 2001–2013 an expansion of intervention contributed to a 47 percent decline in mortality rates worldwide. That meant an estimated 4.3 million fewer deaths.

Still, malaria remains a persistent foe. The ability of parasites to evolve and develop resistance is one of the leading challenges. According to one report, a particular class of parasites has demonstrated the capability—through the development of multiple drug-resistant forms—for evolutionary change, which can affect the efficiency of vaccines and other treatments.26

Malaria Medication

As malaria mutates, it can gain resistance to common drugs like this one.
Photo by Arne Hoel / World Bank on Flickr / CC BY-NC-ND 2.0

Such possibilities surfaced recently in the United Kingdom. Like the U.S., the UK is largely malaria-free but still sees about 2,000 cases annually among travelers returning from other nations. In early 2017, researchers found a drug commonly used in the UK that had been highly effective at treating malaria, but it had failed to cure four patients who contracted the disease while visiting Africa.

Although the patients recovered after receiving alternative treatment, research by the London School of Hygiene and Tropical Medicine said the failure was due to strains of the disease showing reduced susceptibility. It was also a possible first sign of drug resistance to a drug known as AL, for artemether-lumefantrine.

Dr. Sutherland led a study on malaria's resistance to treatment

Dr. Colin Sutherland led a study on malaria’s resistance to certain treatment drugs. Photo by sverigeradio.se

Dr. Colin Sutherland, who led the study, told the London Telegraph that treating patients there with AL “might need reviewing.”

“Fortunately, there are other effective drugs available,” Dr. Sutherland said. “(But) frontline doctors should be alert to the possibility of artemisinin-based drugs failing, and assist with the collection of detailed information about specific travel destinations. A concerted effort to monitor AL outcomes in UK malaria patients needs to be made. This will determine whether our front-line malaria treatment drug is under threat.”

In addition, Sutherland told the newspaper that drug resistance is one of the “biggest threats we face” in fighting malaria, and it had already started occurring in parasite strains prevalent in parts of Southeast Asia. Mutations found in genes previously implicated in drug failure in Africa warrant further investigation, the doctor said.27

A GFA-supported pastor helps those affected by flooding in South Asia

A GFA-supported pastor helps those affected by flooding in South Asia. Standing water after a flood provides a breeding ground for mosquitoes, and the danger of malaria can increase.

In addition to the medical challenges, there are social and environmental factors. WHO’s 15-year strategy report outlines such problems as social unrest, conflict and humanitarian disasters as major obstacles to progress. So are outbreaks of other diseases, like the Ebola virus in West Africa, which affected countries endemic for malaria and diminished their ability to control malaria.

Climate change is another factor.

“Given the association between malaria transmission and climate, long-term malaria efforts will be highly sensitive to changes in the world’s climate,” the report says. “It is expected that—without mitigation—climate change will result in an increase in the malaria burden in several regions of the world that are endemic for the disease, particularly in densely-populated topical highlands.”28

Dr. Ghebreyesus is the WHO Director-General

Dr. Tedros Adhanom Ghebreyesus, the Director-General World Health Organization (2017-present).
Photo by itupictures on Flickr / CC BY 2.0

In the 2017 World Malaria Report, WHO Director-General Dr. Tedros Adhanom Ghebreyesus—former health minister for Ethiopia—termed the malaria response as “at a crossroads.” He said continuing with a “business as usual” approach with the same level of resources and interventions means a likely increase in malaria cases and deaths.

“It is our hope that countries and the global health community choose another approach,” Ghebreyesus said in his foreword, “resulting in a boost in funding for malaria programs, expanding access to effective interventions and greater investment in the research and development of new tools.”

Bringing Hope to the World

The fight against malaria has been a multi-faceted one, receiving renewed attention in the late 1990s with the 1998 formation of the Roll Back Malaria Partnership, a global network to coordinate efforts among governments, UN agencies, international organizations and affected countries. Following that, the Global Fund, which fights malaria, AIDS and tuberculosis by providing grants to countries addressing those problems, was established in 2001.

Numerous charities have formed in the wake of these actions; one of the largest is Malaria No More. Its inception came at a White House event in 2006 that launched former President Bush’s malaria initiative. Nothing But Nets is the United Nations’ campaign to end malaria and enjoys broad support. Imagine No Malaria was launched by the United Methodist Church and partners with Nothing But Nets. In addition to raising money for nets, Imagine works on prevention and education, including distributing malaria advocacy kits for churches.

Major Christian ministries are also active in anti-malaria work, such as Samaritan’s Purse, Compassion International and World Vision. The latter’s Malawi arm announced in mid-February that it would distribute 10.9 million treated mosquito nets by the end of 2018 as part of that African nation’s malaria-control program.

“As World Vision Malawi (WVM), we have never undertaken such a mass campaign, but through close collaboration with the Ministry of Health and the Global Fund Country Coordinating Mechanism, we are going to achieve this,” said Charles Chimombo, WVM’s director of programs.29

Among lesser-known, but no less effective, efforts on the ground are those by such ministries as GFA World (GFA). Based in Wills Point, Texas, for more than 30 years GFA has provided humanitarian assistance and spiritual hope to millions across Asia.

In addition to such services as feeding and educating thousands of needy children, offering free medical care and training, and drilling clean water wells, the ministry distributed 600,000 mosquito nets in 2016.

GFA-supported workers distribute mosquito nets

On World Malaria Day in 2016, GFA-supported workers distributed 2,000 mosquito nets to needy families in a community in Asia. Mosquito netting is one of the most cost-effective protections from the spread of diseases transmitted by mosquito bites.

“In many cases, simple changes can create a profound difference in everyday health,” said K.P. Yohannan, founder and director of GFA. “Christ calls upon us to care for the poor, which is why we are there to offer tools like mosquito nets, which can literally make the difference between life and death.”

One case study of a family helped by such gestures involves a couple named Jitan and Shara and their two children. Living in an area where temperatures commonly soar above 100 degrees for weeks left Jitan, a laborer in the fields, a prime target for the mosquitoes breeding in nearby stagnant ponds and water reservoirs.

In 2015, one of those mosquitoes bit Jitan and injected malaria parasites into his body.

Fortunately, medical treatment (and prayers from Shara and her father) enabled Jitan to recover after three weeks.

Shara, whose family is now protected with a mosquito net

Shara and her family are now protected from disease with a mosquito net.

Five months later, the GFA-supported pastor at Shara’s church put her name down as one of 150 recipients for an upcoming GFA-supported mosquito net distribution. Not only did the fabric mean safety at night from mosquito bites, but to Shara it also symbolized how God saw even their smallest needs.

“My husband suffered with malaria fever,” she said. “Consequently, he is physically weak. But this mosquito net will be protection for my family now.”

The gift touched Jitan’s heart as well.

“Christians not only pray for people, but they also fulfill the basic needs of people in the community,” he said.

One night, as they crawled under the safety of their net, he told Shara: “Really, the Lord Jesus is fulfilling our basic need.”

Strategic Battle

When the Gates Foundation adopted its “Accelerate to Zero” strategy in late 2013, it established a core set of foundational principles to make progress toward the goal of eradicating malaria, which it defined as removing the parasites that cause malaria, not simply interrupting transmission.30 It sees new drug regimens and strategies as key to that goal, saying clinical cures for individuals do not eliminate the parasites responsible for transmission.

The majority of infections occur in asymptomatic people, who are a source of continued transmission. A successful eradication effort will target such infection through community-based efforts.

Emerging resistance to current drugs and insecticides is a threat to progress, which must guide the use of current tools and development of new ones. And since malaria is biologically and ecologically different throughout the world, strategies must be developed and implemented on a local or regional level.

Nearly five years later, how is the fight proceeding? WHO’s latest malaria report shows some bright spots, such as 44 countries reporting less than 10,000 malaria cases in 2016, compared to 37 nations in 2010.

A malaria researcher sorts mosquitoes

A malaria researcher sorts mosquites. (Photo by Malaria Consortium on Flickr / CC BY-NC-ND 2.0

There is also better access to tools to prevent malaria, such as insecticide-treated bednets, and the testing of suspected cases in the public health sector has increased in most regions. Except for the eastern Mediterranean region, where mortality rates have remained unchanged, all regions reported declines in mortality between 2010–2016.

Yet, despite an unprecedented period of success, Dr. Noor says the corresponding slowdowns in mortality decline in some regions, coverage gaps and lack of medical care have slowed progress.

“Identifying what is behind this trend is difficult to pinpoint,” he says. “In any given country, there may be a multitude of reasons as to why the burden of malaria is increasing. Factors impacting progress could range from insufficient funding and gaps in malaria prevention intervention to climate-related variations.”

In its latest report on malaria, WHO set global targets for 2030 to achieve its vision of a world free of the disease. The three pillars of its plan: 1) Ensure universal access to prevention, diagnosis and treatment, 2) Accelerate efforts toward elimination, 3) Transform malaria surveillance into a core intervention.

Accompanying each target are preceding milestones in 2020 and 2025. The four include:

  1. Reduce malaria mortality rates globally compared with 2015 by at least 90 percent.
  2. Reduce malaria case incidence globally compared with 2015 by at least 90 percent.
  3. Eliminate malaria from countries in which malaria was transmitted in 2015—at least 35 countries.
  4. Preventing re-establishment of malaria in all countries that are malaria free.
Dr. Margaret Chan of the World Health Organization

Dr. Margaret Chan, former Director-General of the World Health Organization (2006-2017). Photo by WHO/Pierre Albouy

Director General Dr. Margaret Chan said a major “scale-up” of malaria responses would not only help countries reach 2030’s targets but would also contribute to poverty reduction and other development goals.

“Recent progress on malaria has shown us that, with adequate investments and the right mix of strategies, we can indeed make remarkable strides against this complicated enemy,” she said. “We will need strong political commitment to see this through, and expanded financing. We should act with resolve, and remain focused on our shared goal to create a world in which no one dies of malaria.”

Few would argue with those words.


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