Steps towards the end of malaria

There was some hopeful news from Sri Lanka this month, as the WHO reported that Malaria has been eliminated in the country. There hasn’t been a locally transmitted case for over three years, down from over a quarter of a million cases a year at the turn of the millennium. It’s a major victory, the result of 25 years of concerted effort.

Disease eradication shows humanity at its best, in my opinion. It takes decades of global cooperation, combining science and medicine, politics and philanthropy, logistics and planning, research and innovation, and patient and painstaking field work. The elimination of smallpox is one of our greatest achievements, saving at least 60 million lives since 1977. Thanks to the tireless work of the Carter Center, guinea worm could be next: the number of cases has dropped from 3.5 million a year in the 1980s to just 22 last year. Polio has been pushed back to the very edges, endemic in just two countries.  Is it possible that we might see the end of malaria too?

Sri Lanka is certainly not the only country crossing the line. A dozen more countries have gone a year without an infection, on their way to the required three years to get the official pass. Twenty more expect to be malaria free by the end of the decade, including China.

One of the interesting aspects of Sri Lanka’s programme is a shift of focus from the vector to the parasite. A lot of early work on malaria eradication went after the mosquitos, draining swamps and spraying homes and villages with insecticide. This is effective at reducing or controlling insect populations, but it’s impossible to do in rural areas. (In Madagascar, people lived near their rice paddies, which are perfect mosquito breeding sites.) So Sri Lanka switched its attention to the parasite instead.

For malaria to continue to thrive, mosquitos need to bite an infected person and then bite someone else. If you can diagnose malaria cases early and isolate the patient, you reduce the opportunities for them to be bitten again. The disease doesn’t get passed on. Sri Lanka set up a 24/7 hotline so that new infections could be reported quickly, and mobile clinics were able to get to remote areas. As new technologies became available, the disease was also tracked online. By responding fast to every new case, the pool of infection was slowly reduced, one area at a time. With it now gone, it’s just a matter of watching for re-infection through travel to countries where it is still endemic.

Elsewhere, there is a long way to go yet. Half a million children still die of malaria every year. As always, it is poorer countries that are still struggling with the disease, particularly in sub-Saharan Africa. But an end is in sight. Malaria deaths have halved in the last 15 years. The UN and the Bill and Melinda Gates Foundation are aiming for a malaria free world by 2040. It might just be possible.


  • If you want to help, consider a donation to Against Malaria Foundation, a highly rated charity working very specifically in this field.

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