Haitian child Ais Cadelnaudaly, 5 year-old, is treated for malaria by a volunteer doctor at a field hospital in Port-au-Prince. AP Photo/Brennan Linsley
There has been significant progress over the past 15 years, as a result of massive mobilization to confront malaria. Around 2003, resources began flowing not only from the Global Fund to fight Aids, Tuberculosis and Malaria (GFATM), but also from the affected countries themselves, allowing for the fundamentals of success – people in place with the right tools to both treat and prevent malaria. Since 2000, the number of new malaria cases and deaths has fallen by around 40% and 60% respectively. What sounds so simple has required a fundamental shift to new tools (no long-lasting bednets, new insecticides, rapid diagnostic tests, or artemisinin-based combinations were available 15 years ago), reorganizing decaying health systems, and a focus on an “end game”.
What is an end game? In the case of malaria, the end game is at the same time obvious and enormously challenging. Obvious because the disease can be prevented (mosquito target) and treated (human target) with tools which already exist - so that it is, indeed, obvious that it can be done. Challenging because, as colleagues running national malaria programs are quick to emphasize, doing this at a national scale, given the millions of people infected, is really an uphill task. Besides the complexity of the parasite that causes malaria, the capacity of both the parasite and mosquitoes to develop resistance to widely used drugs and insecticides, the variability of the immune responses - the list goes on –, there exists an uneasy truce between the parasite and humans, developed over thousands of years. Most infections actually do not result in death, particularly in the case of adults who have some level of immunity from prior infections. If left unchecked, however, malaria has shown it can make a comeback, as it did in the 1990s, when deaths increased to about a million per year - mostly children, mostly in Africa. If merely controlled, the entire package of tools, systems and trained staff need to remain in place forever.
