Eradicating Malaria Within Reach, But Will Take Support

Marcia Frellick

October 14, 2015

SAN DIEGO — We have — or will within the next 25 years — the tools, the diagnostics, and the treatments to eradicate malaria, said an expert speaking here at IDWeek 2015.

"We have a quite promising pipeline of diagnostics, drugs, vaccines, and even delivery strategies," and the President's Malaria Initiative currently provides more than a billion dollars a year in total funds, said Bruno Moonen, MD, deputy director of the Malaria Global Health Program at the Bill & Melinda Gates Foundation in Seattle.

Dr Moonen spoke in place of his colleague, Alan Magill, MD, director of the malaria program at the Gates Foundation, who died suddenly on September 19 at the age of 61.

Fifteen years ago, there were half a billion cases of acute malaria and 2 million deaths, mostly in sub-Saharan Africa, Dr Moonen reported. At that time, there were no long-lasting insecticide-treated nets, no broad global investment of funds, and there was widespread resistance against chloroquine, limited diagnostic testing available, and limited access to treatment.

But with global investment, there has been a substantial decrease in malaria in most countries in Africa.

Malaria on the Decline

Since 2000, death rates have dropped by 60%, according to a joint report released on September 17 by the World Health Organization and the United Nations Children's Fund (UNICEF), as reported by Medscape Medical News.

In 2007, the Gateses announced that they wanted to fund malaria eradication, not control.

"For them, this is not some crazy dream driven by scientific advances and technology. For them, this is about equity. They feel that if you can get rid of malaria in some places, it's actually unacceptable to say that in other places, people should just live with the disease," Dr Moonen said.

The foundation released a report at the end of September — entitled From Aspiration to Action — detailing how malaria can be eradicated by 2040.

There are advantages to eradication, instead of control, because you don't necessarily have to continue with all the interventions that have been put in place to get there, Dr Moonen explained.

"If you want to control malaria, you need an estimated $5.1 billion — and that's a conservative estimate — every year between now and 2030 to achieve universal access to interventions," he said.

Ambitious Goal, Complex Challenges

It is hard to project when malaria might be eradicated because "it is one of the most complex infectious diseases," William Moss, MD, from the Malaria Research Institute at Johns Hopkins University in Baltimore, told Medscape Medical News.

Malaria is caused by five different parasites with more than 50 mosquito vectors. Each has a complex set of behaviors, and each can develop resistance to insecticides, he explained.

"I think it is biologically possible to eradicate Plasmodium falciparum, which is the parasite that causes most of the disease and deaths. But there are subtleties around some of the other species," said Dr Moss.

Skeptics would say we tried eradication in the 1950s and 1960s and we were unsuccessful in sub-Saharan Africa, he added.

Polio eradication is another challenge. But "polio is easier than malaria because we have a very effective vaccine and it's not a vector-borne disease," he pointed out.

Dr Moss said he agrees that the cost of eradicating disease increases as the disease burden diminishes because it gets harder to find and eliminate the pathogen in small geographic areas. Also, funding tends to go down when the public perceives there is less need for help.

He also said he agrees on the magnitude of the task ahead.

"It will take new tools, new strategies, and new financing mechanisms. It can't be the status quo," said Dr Moss. "It won't be done if we follow the model of the first malaria eradication efforts, which were largely based on insecticide spray with DDT."

"I think the foundation recognizes, too, that it will require the buy-in of all the affected countries. They have to want to eliminate malaria transmission within their borders," he said. The countries will also have to agree to work together, which has been a problem in the past because some place more emphasis on the effort than others.

Dr Moonen and Dr Moss have disclosed no relevant financial relationships.

IDWeek 2015: Abstract 1978. Presented October 10, 2015.

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