World Malaria Day was April 25: WHO’s fact sheet

April 26, 2021

Preparing for World Malaria Day the World Health Organization (WHO) put out a fact sheet on malaria and status of current work to fight it. Technically it’s nothing new — but much of the material is news to the general public who get the politicized versions of the stories.

World Malaria Day 2021 logo from Roll Back Malaria via BioMed Central

World Malaria Day 2021 logo from Roll Back Malaria via BioMed Central

WHO’s analysis shows malaria declines, but the rates of decline are not so steep as desired. Developed nations get distracted in providing funds to fight malaria. 2020 was an outstanding year of distraction of the malaria fight, now complicated by spread of COVID-19 viruses.

Notable:

  • No call for DDT; pesticide resistance remains a problem, but it’s a problem DDT cannot solve.
  • Malaria remains near all-time lows in humans, with 229 million cases worldwide.
  • Malaria still kills kids predominantly, and African kids make up most of those deaths.
  • 15 years ago there was hope of eradicating malaria from many countries by 2020; that goal will be missed in several nations.

The fact sheet:

Key facts

  • Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.
  • In 2019, there were an estimated 229 million cases of malaria worldwide.
  • The estimated number of malaria deaths stood at 409 000 in 2019.
  • Children aged under 5 years are the most vulnerable group affected by malaria; in 2019, they accounted for 67% (274 000) of all malaria deaths worldwide.
  • The WHO African Region carries a disproportionately high share of the global malaria burden. In 2019, the region was home to 94% of malaria cases and deaths.
  • Total funding for malaria control and elimination reached an estimated US$ 3 billion in 2019. Contributions from governments of endemic countries amounted to US$ 900 million, representing 31% of total funding.

Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called “malaria vectors.” There are 5 parasite species that cause malaria in humans, and 2 of these species – P. falciparum and P. vivax – pose the greatest threat.

In 2018, P. falciparum accounted for 99.7% of estimated malaria cases in the WHO African Region 50% of cases in the WHO South-East Asia Region, 71% of cases in the Eastern Mediterranean and 65% in the Western Pacific.

P. vivax is the predominant parasite in the WHO Region of the Americas, representing 75% of malaria cases.

Symptoms

Malaria is an acute febrile illness. In a non-immune individual, symptoms usually appear 10–15 days after the infective mosquito bite. The first symptoms – fever, headache, and chills – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness, often leading to death.

Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ failure is also frequent. In malaria endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur.

Who is at risk?

In 2019, nearly half of the world’s population was at risk of malaria. Most malaria cases and deaths occur in sub-Saharan Africa. However, the WHO regions of South-East Asia, Eastern Mediterranean, Western Pacific, and the Americas are also at risk.

Some population groups are at considerably higher risk of contracting malaria, and developing severe disease, than others. These include infants, children under 5 years of age, pregnant women and patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers. National malaria control programmes need to take special measures to protect these population groups from malaria infection, taking into consideration their specific circumstances.

Disease burden

According to the latest  World malaria report, released on 30 November 2020, there were 229 million cases of malaria in 2019 compared to 228 million cases in 2018. The estimated number of malaria deaths stood at 409 000 in 2019, compared with 411 000 deaths in 2018.

The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2019, the region was home to 94% of all malaria cases and deaths.

In 2019, 6 countries accounted for approximately half of all malaria deaths worldwide: Nigeria (23%), the Democratic Republic of the Congo (11%), United Republic of Tanzania (5%), Burkina Faso (4%), Mozambique (4%) and Niger (4% each).

Children under 5 years of age are the most vulnerable group affected by malaria; in  2019  they accounted for 67% (274 000) of all malaria deaths worldwide.

Transmission

In most cases, malaria is transmitted through the bites of female Anopheles mosquitoes. There are more than 400 different species of Anopheles mosquito; around 30 are malaria vectors of major importance. All of the important vector species bite between dusk and dawn. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment.

Anopheles mosquitoes lay their eggs in water, which hatch into larvae, eventually emerging as adult mosquitoes. The female mosquitoes seek a blood meal to nurture their eggs. Each species of Anopheles mosquito has its own preferred aquatic habitat; for example, some prefer small, shallow collections of fresh water, such as puddles and hoof prints, which are abundant during the rainy season in tropical countries.

Transmission is more intense in places where the mosquito lifespan is longer (so that the parasite has time to complete its development inside the mosquito) and where it prefers to bite humans rather than other animals. The long lifespan and strong human-biting habit of the African vector species is the main reason why approximately 90% of the world’s malaria cases are in Africa.

Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.

Human immunity is another important factor, especially among adults in areas of moderate or intense transmission conditions. Partial immunity is developed over years of exposure, and while it never provides complete protection, it does reduce the risk that malaria infection will cause severe disease. For this reason, most malaria deaths in Africa occur in young children, whereas in areas with less transmission and low immunity, all age groups are at risk.

Prevention

Vector control is the main way to prevent and reduce malaria transmission. If coverage of vector control interventions within a specific area is high enough, then a measure of protection will be conferred across the community.

WHO recommends protection for all people at risk of malaria with effective malaria vector control. Two forms of vector control – insecticide-treated mosquito nets and indoor residual spraying – are effective in a wide range of circumstances.

Insecticide-treated mosquito nets

Sleeping under an insecticide-treated net (ITN) can reduce contact between mosquitoes and humans by providing both a physical barrier and an insecticidal effect. Population-wide protection can result from the killing of mosquitoes on a large scale where there is high access and usage of such nets within a community.

In 2019, an estimated 46% of all people at risk of malaria in Africa were protected by an insecticide-treated net, compared to 2% in 2000. However, ITN coverage has been at a standstill since 2016.Indoor spraying with residual insecticides

Indoor residual spraying (IRS) with insecticides is another powerful way to rapidly reduce malaria transmission. It involves spraying the inside of housing structures with an insecticide, typically once or twice per year. To confer significant community protection, IRS should be implemented at a high level of coverage.

Globally, IRS protection declined from a peak of 5% in 2010 to 2% in 2019, with decreases seen across all WHO regions, apart from the WHO Eastern Mediterranean Region. The declines in IRS coverage are occurring as countries switch from pyrethroid insecticides to more expensive alternatives to mitigate mosquito resistance to pyrethroids.

Antimalarial drugs

Antimalarial medicines can also be used to prevent malaria. For travellers, malaria can be prevented through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby preventing malaria disease. For pregnant women living in moderate-to-high transmission areas, WHO recommends at least 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine at each scheduled antenatal visit after the first trimester. Similarly, for infants living in high-transmission areas of Africa, 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine are recommended, delivered alongside routine vaccinations.

Since 2012, WHO has recommended seasonal malaria chemoprevention as an additional malaria prevention strategy for areas of the Sahel sub-region of Africa. The strategy involves the administration of monthly courses of amodiaquine plus sulfadoxine-pyrimethamine to all children under 5 years of age during the high transmission season.

Insecticide resistance

Since 2000, progress in malaria control has resulted primarily from expanded access to vector control interventions, particularly in sub-Saharan Africa. However, these gains are threatened by emerging resistance to insecticides among Anopheles mosquitoes.  According to the latest  World malaria report, 73 countries reported mosquito resistance to at least 1 of the 4 commonly-used insecticide classes in the period 2010-2019. In 28 countries, mosquito resistance was reported to all of the main insecticide classes.

Despite the emergence and spread of mosquito resistance to pyrethroids, insecticide-treated nets continue to provide a substantial level of protection in most settings. This was evidenced in a  large 5-country study coordinated by WHO between 2011 and 2016.

While the findings of this study are encouraging, WHO continues to highlight the urgent need for new and improved tools in the global response to malaria. To prevent an erosion of the impact of core vector control tools, WHO also underscores the critical need for all countries with ongoing malaria transmission to develop and apply effective insecticide resistance management strategies.

Diagnosis and treatment

Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to reducing malaria transmission. The best available treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT).

WHO recommends that all cases of suspected malaria be confirmed using parasite-based diagnostic testing (either microscopy or rapid diagnostic test) before administering treatment. Results of parasitological confirmation can be available in 30 minutes or less. Treatment, solely on the basis of symptoms should only be considered when a parasitological diagnosis is not possible. More detailed recommendations are available in the third edition of the “WHO Guidelines for the treatment of malaria”, published in April 2015.

Antimalarial drug resistance

Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum malaria parasites to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1950s and 1960s, undermining malaria control efforts and reversing gains in child survival.

Protecting the efficacy of antimalarial medicines is critical to malaria control and elimination. Regular monitoring of drug efficacy is needed to inform treatment policies in malaria-endemic countries, and to ensure early detection of, and response to, drug resistance.

In 2013, WHO launched the Emergency response to artemisinin resistance (ERAR) in the Greater Mekong subregion (GMS), a high-level plan of attack to contain the spread of drug-resistant parasites and to provide life-saving tools for all populations at risk of malaria. But even as this work was under way, additional pockets of resistance emerged independently in new geographic areas of the subregion. In parallel, there were reports of increased resistance to ACT partner drugs in some settings. A new approach was needed to keep pace with the changing malaria landscape.

At the World Health Assembly in May 2015, WHO launched the  Strategy for malaria elimination in the Greater Mekong subregion (2015–2030), which was endorsed by all the countries in the subregion. Urging immediate action, the strategy calls for the elimination of all species of human malaria across the region by 2030, with priority action targeted to areas where multidrug resistant malaria has taken root.

With technical guidance from WHO, all countries in the region have developed national malaria elimination plans. Together with partners, WHO is providing ongoing support for country elimination efforts through the Mekong Malaria Elimination programme, an initiative that evolved from the ERAR

Surveillance

Surveillance entails tracking of the disease and programmatic responses, and taking action based on the data received. Currently, many countries with a high burden of malaria have weak surveillance systems and are not in a position to assess disease distribution and trends, making it difficult to optimize responses and respond to outbreaks.

Effective surveillance is required at all points on the path to malaria elimination. Stronger malaria surveillance systems are urgently needed to enable a timely and effective malaria response in endemic regions, to prevent outbreaks and resurgences, to track progress, and to hold governments and the global malaria community accountable.

In March 2018, WHO released a  reference manual on malaria surveillance, monitoring and evaluation, monitoring and evaluation. The manual provides information on global surveillance standards and guides countries in their efforts to strengthen surveillance systems.

Elimination

Malaria elimination is defined as the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities. Continued measures are required to prevent re-establishment of transmission. Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by human malaria parasites as a result of deliberate activities. Interventions are no longer required once eradication has been achieved.

Globally, the elimination net is widening, with more countries moving towards the goal of zero malaria. In 2019, 27 countries reported fewer than 100 indigenous cases of the disease, up from 6 countries in 2000.

Countries that have achieved at least 3 consecutive years of 0 indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination. Over the last two decades, 11 countries have been certified by the WHO Director-General as malaria-free: United Arab Emirates (2007),  Morocco (2010), Turkmenistan (2010), Armenia (2011), Sri Lanka (2016), Kyrgyzstan (2016), Paraguay (2018), Uzbekistan (2018), Algeria (2019), Argentina (2019) and El Salvador (2021). The WHO Framework for malaria elimination (2017) provides a detailed set of tools and strategies for achieving and maintaining elimination. In January 2021, WHO published a new manual, Preparing for certification of malaria elimination, with extended guidance for countries that are approaching elimination or preparing for elimination certification.

Vaccines against malaria

RTS,S/AS01 (RTS,S) is the first and, to date, the only vaccine to show that it can significantly reduce malaria, and life-threatening severe malaria, in young African children. It acts against P. falciparum, the most deadly malaria parasite globally and the most prevalent in Africa. Among children who received 4 doses in large-scale clinical trials, the vaccine prevented approximately 4 in 10 cases of malaria over a 4-year period.

In view of its public health potential, WHO’s top advisory bodies for malaria and immunization have jointly recommended phased introduction of the vaccine in selected areas of sub-Saharan Africa. Three countries – Ghana, Kenya and Malawi – began introducing the vaccine in selected areas of moderate and high malaria transmission in 2019. Vaccinations are being provided through each country’s routine immunization programme.

The pilot programme will address several outstanding questions related to the public health use of the vaccine. It will be critical for understanding how best to deliver the recommended 4 doses of RTS,S; the vaccine’s potential role in reducing childhood deaths; and its safety in the context of routine use.

This WHO-coordinated programme is a collaborative effort with Ministries of Health in Ghana, Kenya and Malawi and a range of in-country and international partners, including PATH, a non-profit organization, and GSK, the vaccine developer and manufacturer.

Financing for the vaccine programme has been mobilized through a collaboration between 3 major global health funding bodies: Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Unitaid.

WHO response

WHO Global technical strategy for malaria 2016-2030

The WHO  Global technical strategy for malaria 2016-2030 – adopted by the World Health Assembly in May 2015 – provides a technical framework for all malaria-endemic countries. It is intended to guide and support regional and country programmes as they work towards malaria control and elimination.

The Strategy sets ambitious but achievable global targets, including:

  • reducing malaria case incidence by at least 90% by 2030;
  • reducing malaria mortality rates by at least 90% by 2030;
  • eliminating malaria in at least 35 countries by 2030;
  • preventing a resurgence of malaria in all countries that are malaria-free.

This Strategy was the result of an extensive consultative process that spanned 2 years and involved the participation of more than 400 technical experts from 70 Member States.

The Global Malaria Programme

The  WHO Global Malaria Programme coordinates WHO’s global efforts to control and eliminate malaria by:

  • setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies, and guidelines;
  • keeping independent score of global progress;
  • developing approaches for capacity building, systems strengthening, and surveillance; and
  • identifying threats to malaria control and elimination as well as new areas for action.

The Programme is supported and advised by the Malaria Policy Advisory Committee (MPAC), a group of global malaria experts appointed following an open nomination process. The mandate of MPAC is to provide strategic advice and technical input, and extends to all aspects of malaria control and elimination, as part of a transparent, responsive and credible policy-setting process.

“High burden high impact approach”

At the World Health Assembly in May 2018, the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, called for an aggressive new approach to jump-start progress against malaria. A new country-driven response – “  High burden to high impact” – was launched in Mozambique in November 2018.

The approach is currently being driven by the 11 countries that carry a high burden of the disease (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania). Key elements include:

  1. political will to reduce the toll of malaria;
  2. strategic information to drive impact;
  3. better guidance, policies and strategies; and
  4. a coordinated national malaria response.

Catalysed by WHO and the RBM Partnership to End Malaria, “High burden to high impact” builds on the principle that no one should die from a disease that can be prevented and diagnosed, and that is entirely curable with available treatments.


World Malaria Report 2020: Governments fell short of pledges, malaria poised to make a comeback.

December 1, 2020

World Malaria Report 2020 carries bad news. Despite remarkable progress against malaria, despite being on the verge of beating the disease and eradicating it from the planet, governments stopped supporting anti-malaria work.

Malaria is poised to come roaring back to kill millions.

COVID-19 complicates fighting malaria. But the real enemy of the fight against malaria is apathy, neglect and ignorance.

Cover of World Malaria Report 2020, WHO's annual accounting of the fight to eradicate malaria.

Cover of World Malaria Report 2020, WHO’s annual accounting of the fight to eradicate malaria.

Below, the full press release from the World Health Organization (WHO) on the 2020 accounting of the war against malaria.

____________________________

WHO calls for reinvigorated action to fight malaria

Global malaria gains threatened by access gaps, COVID-19 and funding shortfalls

30 November 2020
News release
Reading time: 6 min (1645 words)

The World Health Organization (WHO) is calling on countries and global health partners to step up the fight against malaria, a preventable and treatable disease that continues to claim hundreds of thousands of lives each year. A better targeting of interventions, new tools and increased funding are needed to change the global trajectory of the disease and reach internationally-agreed targets.

According to WHO‘s latest World malaria report, progress against malaria continues to plateau, particularly in high burden countries in Africa. Gaps in access to life-saving tools are undermining global efforts to curb the disease, and the COVID-19 pandemic is expected to set back the fight even further.

“It is time for leaders across Africa – and the world – to rise once again to the challenge of malaria, just as they did when they laid the foundation for the progress made since the beginning of this century,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Through joint action, and a commitment to leaving no one behind, we can achieve our shared vision of a world free of malaria.”

In 2000, African leaders signed the landmark Abuja Declaration pledging to reduce malaria deaths on the continent by 50% over a 10-year period. Robust political commitment, together with innovations in new tools and a steep increase in funding, catalyzed an unprecedented period of success in global malaria control. According to the report, 1.5 billion malaria cases and 7.6 million deaths have been averted since 2000.

A plateau in progress

In 2019, the global tally of malaria cases was 229 million, an annual estimate that has remained virtually unchanged over the last 4 years. The disease claimed some 409 000 lives in 2019 compared to 411 000 in 2018.

As in past years, the African Region shouldered more than 90% of the overall disease burden. Since 2000, the region has reduced its malaria death toll by 44%, from an estimated 680 000 to 384 000 annually. However, progress has slowed in recent years, particularly in countries with a high burden of the disease.

A funding shortfall at both the international and domestic levels poses a significant threat to future gains. In 2019, total funding reached US $3 billion against a global target of $5.6 billion. Funding shortages have led to critical gaps in access to proven malaria control tools.

COVID-19 an added challenge

In 2020, COVID-19 emerged as an additional challenge to the provision of essential health services worldwide. According to the report, most malaria prevention campaigns were able to move forward this year without major delays. Ensuring access to malaria prevention – such as insecticide-treated nets and preventive medicines for children – has supported the COVID-19 response strategy by reducing the number of malaria infections and, in turn, easing the strain on health systems. WHO worked swiftly to provide countries with guidance to adapt their responses and ensure the safe delivery of malaria services during the pandemic.

However, WHO is concerned that even moderate disruptions in access to treatment could lead to a considerable loss of life. The report finds, for example, that a 10% disruption in access to effective antimalarial treatment in sub-Saharan Africa could lead to 19 000 additional deaths. Disruptions of 25% and 50% in the region could result in an additional 46 000 and 100 000 deaths, respectively.

“While Africa has shown the world what can be achieved if we stand together to end malaria as a public health threat, progress has stalled,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “COVID-19 threatens to further derail our efforts to overcome malaria, particularly treating people with the disease. Despite the devastating impact COVID-19 has had on African economies, international partners and countries need to do more to ensure that the resources are there to expand malaria programmes which are making such a difference in people’s lives.”

WHO response

A key strategy to reignite progress is the “High burden to high impact” (HBHI) response, catalyzed in 2018 by WHO and the RBM Partnership to End Malaria. The response is led by 11 countries – including 10 in sub-Saharan Africa – that account for approximately 70% of the world’s malaria burden.

Over the last 2 years, HBHI countries have been moving away from a “one-size-fits all” approach to malaria control – opting, instead, for tailored responses based on local data and intelligence. A recent analysis from Nigeria, for example, found that through an optimized mix of interventions, the country could avert tens of millions of additional cases and thousands of additional deaths by the year 2023, compared to a business-as-usual approach.

While it is too early to measure the impact of the HBHI approach, the report finds that deaths in the 11 countries were reduced from 263 000 to 226 000 between 2018 and 2019.  India continued to make impressive gains, with reductions in cases and deaths of 18% and 20%, respectively, over the last 2 years. There was, however, a slight increase in the total number of cases among HBHI countries, from an estimated 155 million in 2018 to 156 million in 2019.

Meeting global malaria targets

This year’s report highlights key milestones and events that helped shape the global response to the disease in recent decades. Beginning in the 1990s, leaders of malaria-affected countries, scientists and other partners laid the groundwork for a renewed malaria response that contributed to one of the biggest returns on investment in global health.

According to the report, 21 countries eliminated malaria over the last 2 decades; of these, 10 countries were officially certified as malaria-free by WHO. In the face of the ongoing threat of antimalarial drug resistance, the 6 countries of the Greater Mekong subregion continue to make major gains towards their goal of malaria elimination by 2030.

But many countries with a high burden of malaria have been losing ground.  According to WHO global projections, the 2020 target for reductions in malaria case incidence will be missed by 37% and the mortality reduction target will be missed by 22%.

Note to editors

WHO’s work on malaria is guided by the Global technical strategy for malaria 2016-2030 (GTS), approved by the World Health Assembly in May 2015. The strategy includes four global targets for 2030, with milestones along the way to track progress. The 2030 targets are: 1) reducing malaria case incidence by at least 90%; 2) reducing malaria mortality rates by at least 90%; 3) eliminating malaria in at least 35 countries; and
4) preventing a resurgence of malaria in all countries that are malaria-free.

Near-term GTS milestones for 2020 include global reductions in malaria case incidence and death rates of at least 40% and the elimination of malaria in at least 10 countries. According to the report, the 2020 milestones for malaria case incidence and mortality rates will be missed:
Case incidence:  WHO projects that, in 2020, there were an estimated 56 malaria cases for every 1000 people at risk of the disease against a GTS target of 35 cases. The GTS milestone will be missed by an estimated 37%.
Mortality rate: The estimate for globally projected malaria deaths per 100 000 population at risk was 9.8 in 2020 against a GTS target of 7.2 deaths. The milestone will be missed by an estimated 22%.

WHO African Region Since 2014, the rate of progress in both cases and deaths in the region has slowed, attributed mainly to the stalling of progress in several countries with moderate or high transmission. In 2019, six African countries accounted for 50% of all malaria cases globally: Nigeria (23%), the Democratic Republic of the Congo (11%), United Republic of Tanzania (5%), Niger (4%), Mozambique (4%) and Burkina Faso (4%). In view of recent trends, the African Region will miss the GTS 2020 milestones for case incidence and mortality by 37% and 25%, respectively.

 “High burden to high impact” (HBHI) Launched in November 2018, HBHI builds on the principle that no one should die from a disease that is preventable and treatable. It is led by 11 countries that, together, accounted for approximately 70% of the world’s malaria burden in 2017: Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania. Over the last two years, all 11 HBHI countries have implemented activities across four response elements: 1) political will to reduce the toll of malaria; 2) strategic information to drive impact; 3) better guidance, policies and strategies; and 4) a coordinated national malaria response

Malaria elimination – Between 2000 and 2019, 10 countries received the official WHO certification of malaria elimination: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Kyrgyzstan (2016), Sri Lanka (2016), Uzbekistan (2018), Paraguay (2018), Argentina (2019) and Algeria (2019). In 2019, China reported zero indigenous cases of malaria for the third consecutive year; the country recently applied for the official WHO certification of malaria elimination. In 2020, El Salvador became the first country in Central America to apply for the WHO malaria-free certification

In the six countries of the Greater Mekong subregion – Cambodia, China (Yunnan Province), Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam – the reported number of malaria cases fell by 90% from 2000 to 2019, while P. falciparum (Pf) cases fell by 97% in the same time period. This accelerated decrease in Pf malaria is notable in view of the threat posed by antimalarial drug resistance in the subregion.

A call for innovation Eliminating malaria in all countries, especially those with a high disease burden, will likely require tools that are not available today. In September 2019, the WHO Director-General issued a “malaria challenge,” calling on the global health community to ramp up investment in the research and development of new malaria-fighting tools and approaches. This message was further reinforced in the April 2020 report of the WHO Strategic advisory group on malaria eradication.


World Malaria Report 2018: Quick blueprint for action, no standing still

December 27, 2018

No standing still with malaria, fighting the disease must continue or progress can be quickly lost. Still from WHO film on World Malaria Report 2018 call to action.

No standing still with malaria, fighting the disease must continue or progress can be quickly lost. Still from WHO film on World Malaria Report 2018 call to action.

World Health Organization’s (WHO) World Malaria Report 2018 dropped on November 19, a month earlier than usual (but about the same time as 2017). With an additional few weeks to plug it, it still sank without big ripples in world media.

WHO adds a shorter version, an “executive version” — that still doesn’t get the attention it should.

This is prelude to a tragedy if industrialized and wealthy nations of the world pay no heed, and continue to cut budgets to fight malaria for whatever bad reason some crabby, brown Earth policy maker invents.

Ever optimistic, WHO gives a plan for action to continue to reduce malaria deaths and infections, even with reduced funding. None of the proposed actions involves more DDT to poison poor people in poor countries, however, so it is unlikely to find favor with the crabby policy people now in charge of fixing world problems in the increasingly isolationist West (including the U.S.).

Please watch the video. What is your country doing to eradicate malaria? How can you prod politicians to do more?
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World Malaria Report 2018: World looks away as malaria bounces back

December 7, 2018

Covers of the last four World Malaria Reports. World Health Organization (WHO)

Covers of the last four World Malaria Reports. World Health Organization (WHO)

It’s a common tale but true: In any period when nations collaborate to defeat or eradicate malaria, funders of the programs get board and cut funding.

Malaria roars back.

This cycle has nothing to do with pesticides or medicines, mostly. Especially it’s not a problem that can be fixed with more DDT.

When a nation focuses on beating malaria, progress occurs. When nations lose their focus, malaria strikes back.

After great progress reducing malaria infections and malaria deaths between 1999 and 2017, nations including the U.S. lost focus. International donors failed to contribute enough money to keep the fight going.

World Malaria Report 2018 notes the striking back by malaria.

One other thing we can be quite sure of: Almost all mass media will ignore this report.

What will you do to change things?

You can help by donating $10 to a charity that delivers bednets to people who need them in Asia and Africa. You can help by writing letters to your local newspapers, to your Congressional representatives, and to the President. Every little bit helps.

Here’s the press release on World Malaria Report 2018, which was released by the World Health Organization (WHO) on November 19, 2018.

WHO and partners launch new country-led response to put stalled malaria control efforts back on track

19 November 2018
News Release

Maputo/Geneva

Reductions in malaria cases have stalled after several years of decline globally, according to the new World malaria report 2018. To get the reduction in malaria deaths and disease back on track, WHO and partners are joining a new country-led response, launched today, to scale up prevention and treatment, and increased investment, to protect vulnerable people from the deadly disease.

For the second consecutive year, the annual report produced by WHO reveals a plateauing in numbers of people affected by malaria: in 2017, there were an estimated 219 million cases of malaria, compared to 217 million the year before. But in the years prior, the number of people contracting malaria globally had been steadily falling, from 239 million in 2010 to 214 million in 2015.

“Nobody should die from malaria. But the world faces a new reality: as progress stagnates, we are at risk of squandering years of toil, investment and success in reducing the number of people suffering from the disease,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “We recognise we have to do something different – now. So today we are launching a country-focused and -led plan to take comprehensive action against malaria by making our work more effective where it counts most – at local level.”

Where malaria is hitting hardest

In 2017, approximately 70% of all malaria cases (151 million) and deaths (274 000) were concentrated in 11 countries: 10 in Africa (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania) and India. There were 3.5 million more malaria cases reported in these 10 African countries in 2017 compared to the previous year, while India, however, showed progress in reducing its disease burden.

Despite marginal increases in recent years in the distribution and use of insecticide-treated bed nets in sub-Saharan Africa – the primary tool for preventing malaria – the report highlights major coverage gaps. In 2017, an estimated half of at-risk people in Africa did not sleep under a treated net. Also, fewer homes are being protected by indoor residual spraying than before, and access to preventive therapies that protect pregnant women and children from malaria remains too low.

High impact response needed

In line with WHO’s strategic vision to scale up activities to protect people’s health, the new country-driven “High burden to high impact” response plan has been launched to support nations with most malaria cases and deaths. The response follows a call made by Dr Tedros at the World Health Assembly in May 2018 for an aggressive new approach to jump-start progress against malaria. It is based on four pillars:

  • Galvanizing national and global political attention to reduce malaria deaths;
  • Driving impact through the strategic use of information;
  • Establishing best global guidance, policies and strategies suitable for all malaria endemic countries; and
  • Implementing a coordinated country response.

Catalyzed by WHO and the RBM Partnership to End Malaria, “High burden to high impact” builds on the principle that no one should die from a disease that can be easily prevented and diagnosed, and that is entirely curable with available treatments.

“There is no standing still with malaria. The latest World malaria report shows that further progress is not inevitable and that business as usual is no longer an option,” said Dr Kesete Admasu, CEO of the RBM Partnership. “The new country-led response will jumpstart aggressive new malaria control efforts in the highest burden countries and will be crucial to get back on track with fighting one of the most pressing health challenges we face.”

Targets set by the WHO Global technical strategy for malaria 2016–2030 to reduce malaria case incidence and death rates by at least 40% by 2020 are not on track to being met.

Pockets of progress

The report highlights some positive progress. The number of countries nearing elimination continues to grow (46 in 2017 compared to 37 in 2010). Meanwhile in China and El Salvador, where malaria had long been endemic, no local transmission of malaria was reported in 2017, proof that intensive, country-led control efforts can succeed in reducing the risk people face from the disease.

In 2018, WHO certified Paraguay as malaria free, the first country in the Americas to receive this status in 45 years. Three other countries – Algeria, Argentina and Uzbekistan – have requested official malaria-free certification from WHO.

India – a country that represents 4% of the global malaria burden – recorded a 24% reduction in cases in 2017 compared to 2016. Also in Rwanda, 436 000 fewer cases were recorded in 2017 compared to 2016. Ethiopia and Pakistan both had estimated decreases of more than  240 000 in the same period.

“When countries prioritize action on malaria, we see the results in lives saved and cases reduced,” says Dr Matshidiso Moeti, WHO Regional Director for Africa. “WHO and global malaria control partners will continue striving to help governments, especially those with the highest burden, scale up the response to malaria.”

Domestic financing is key

As reductions in malaria cases and deaths slow, funding for the global response has also shown a levelling off, with US$ 3.1 billion made available for control and elimination programmes in 2017 including US$ 900 million (28%) from governments of malaria endemic countries.  The United States of America remains the largest single international donor, contributing US$ 1.2 billion (39%) in 2017.

To meet the 2030 targets of the global malaria strategy, malaria investments should reach at least US$6.6 billion annually by 2020 – more than double the amount available today.

Editors note

Download the WHO World malaria report 2018 app for an interactive experience with the report’s country data: App Store (iOS devices) | Google Play (Android devices).


Ban of DDT did not cause a rise in malaria, or malaria deaths

October 23, 2018

Time to put that old canard to bed.

Malaria distribution was greatly reduced in the 20th century, reversing centuries of spreading. But malaria persisted into the 21st century. DDT helped reduce malaria, but the U.S. ban on DDT did not cause a rise in malaria infections or deaths. From a paper by Michael Palmer, M.D,. at Waterloo University.

Malaria distribution was greatly reduced in the 20th century, reversing centuries of spreading. But malaria persisted into the 21st century. DDT helped reduce malaria, but the U.S. ban on DDT did not cause a rise in malaria infections or deaths. From a paper by Michael Palmer, M.D,. at Waterloo University.

The U.S. ban on DDT in 1972 did not cause millions of unnecessary deaths to malaria. In fact, the worldwide death toll to malaria dropped for at least 18 years after the ban, plateaued for most of a decade, and dropped from 1999 to 2017. Malaria deaths fell dramatically, after the U.S. banned DDT from U.S. farms.

Not sure why Dr. Palmer wrote his essay in 2013, but he got most of the major sources and got most of the history accurately, His title, “The ban of DDT did not cause millions to die from malaria.”

It’s a good paper to bookmark, because it doesn’t always show up in Google searches in the U.S. — Waterloo being a university in Canada, in Waterloo, Ontario

www.science.uwaterloo.ca/~mpalmer/stuff/DDT-myth.pdf


Annals of DDT: When they sprayed DDT from airplanes to stop polio

August 10, 2018

March of Dimes Foundation photo:

March of Dimes Foundation photo: “Nurses tended to polio patients in iron lung respirators at the Robert B. Green Memorial Hospital polio ward in San Antonio in 1950. It was a common scene throughout the polio crisis that swept Texas.” From the San Antonio Express-News article on the history of polio in the city.

It didn’t work.

In a desperate move to stop polio epidemics, after World War II but before the Salk polio vaccine was available, some American towns authorized aerial spraying of DDT over their cities.

Of course, DDT doesn’t stop viruses, and polio is a virus. Polio virus is not spread by a vector, an insect or other creature which might have been stopped by DDT, as mosquitoes spread malaria parasites and West Nile virus.

Aerial spraying of DDT against polio did not one thing.

A podcast from the Science History Institute discussed these misdirected events recently, and someone there did a sharp, short video to explain the issue.

YouTube explanation:

An animation drawn from episode 207 of Distillations podcast, DDT: The Britney Spears of Chemicals.

The podcast is a short 15 minutes, and fun, “Distillations.”

Americans have had a long, complicated relationship with the pesticide DDT, or dichloro-diphenyl-trichloroethane, if you want to get fancy. First we loved it, then we hated it, then we realized it might not be as bad as we thought. But we’ll never restore it to its former glory. And couldn’t you say the same about America’s once-favorite pop star?

We had a hunch that the usual narrative about DDT’s rise and fall left a few things out, so we talked to historian and CHF fellow Elena Conis. She has been discovering little-known pieces of this story one dusty letter at a time.

But first our associate producer Rigoberto Hernandez checks out some of CHF’s own DDT cans—that’s right, we have a DDT collection—and talks to the retired exterminator who donated them.

I bring it up here because in recent weeks there’s been a little surge on Twitter, and probably on Facebook and other places, in people claiming DDT causes polio, or causes symptoms so close to polio that physicians could never tell the difference. A lot of anti-vaccine advocates pile on, claiming that this would prove that the polio vaccine doesn’t work.

That’s all quite hooey-licious, off course. Polio’s paralysis of muscles in almost no way resembles acute DDT poisoning, which causes muscle misfiring instead of paralysis. As with almost every other disease, acute DDT poisoning can cause nausea; but DDT poisoning either kills its victim rather quickly, or goes away after a couple of weeks.

Polio doesn’t do that.

In the podcast, you’ll hear the common story of kids running behind DDT fogging trucks, because people thought DDT was harmless. In the concentrations in the DDT fogs, it would be almost impossible to ingest the 4 ounces or so of DDT required to get acute poisoning.

In any case, it’s one more odd facet of a long story of human relations to DDT and diseases. It’s worth a listen for history’s sake. But in this case, it’s entertaining, too. You’ll hear stories of people who opposed government actions to spray DDT, and who thought the government was too lax in its regulation and use of DDT.

More:

San Antonio Express-News file photo.

San Antonio Express-News file photo. “A young boy gets polio vaccine in this undated photo.”

Tip of the old scrub brush to Science History Institute (@SciHistoryOrg on Twitter).


Historic Deltoid: Indur Goklany on DDT, corrections from Tim Lambert

April 10, 2018

I’ll have to beg forgiveness from Tim Lambert, but in the interest of accuracy and good history, I have captured below the post Tim Lambert had on the old Deltoid blog (at the Seed Science Blogs site), dealing with Indur Goklany’s errors on DDT.

A bit of other history: Anthony Watts despises my posts (me, too, probably) and I am banned from his site for various sins including calling him out for suggesting Rachel Carson and President John F. Kennedy had more than an occasional handshake personal relationship (a bizarre charge Christopher Monckton repeats and exaggerates on in slightly different ways). Watts and I disagree on what we should regard as facts; I take the old collegiate debate and Scout Law positions, he sides with the Heartland Institute parody/comedy/hoax troupe.

Watts was having none of my corrections. Tim Lambert, who has researched this particular area of pro-DDT hoaxing more than anyone else, was kind enough to respond.

This is borrowed from the Internet Archive’s Wayback Machine, until, and then maybe a supplement to, the reappearance of Deltoid’s archives at the new site. As of April 10, 2018, I have not checked the links. If links don’t work, please tell me in comments, and I’ll work to get a new link to the old information where possible.

You should also know that Sri Lanka today is certified to be malaria-free, without DDT.

Below, Tim Lambert’s post on Indur Goklany’s errors about DDT history:

 

Indur Goklany, DDT and Malaria

More »

Ed Darrell points to a WUWT post by Indur Goklany which promotes the use of DDT to fight malaria instead of more effective measures. As with most of the DDT promoters, Goklany carefully avoids mentioning the way mosquitoes evolve resistance to insecticides. For example, here’s what he has on Sri Lanka:

For instance, malaria incidences in Sri Lanka (Ceylon) dropped from 2.8 million in the 1940s to less than 20 in 1963 (WHO 1999a, Whelan 1992). DDT spraying was stopped in 1964, and by 1969 the number of cases had grown to 2.5 million.

Now compare this with what really happened in Sri Lanka:

With widespread resistance of A. culicifacies to DDT, malathion spraying was introduced in 1975 in areas of P.falciparum transmission affording protection to nearly one million people. Towards the end of 1976 DDT spraying was completely discontinued and during 1977 exclusively malathion was used as an adulticide.

i-888470655207729222fb0f61fe5fa18a-oth_mal_cases_srl60-08.png

Note that the scale for malaria cases is logarithmic, so there was a factor of ten reduction in the number of cases in a few years after DDT spraying was discontinued.

The misinformation about DDT and malaria that Goklany spreads is harmful and could kill people. DDT still has a place in the fight against malaria (because of insecticide resistance we need as many different insecticides as possible), but there are more effective means available, and by trying to undercut the use of the best methods for fighting malaria, Goklany will be responsible for people dying from malaria.

[End, quote from Tim Lambert’s old Deltoid blog]

Now, is it possible that the comments will copy as well as the blog post? There are some good ones in there.

Here’s a try at copying the comments, below the fold.

 

Read the rest of this entry »


‘DDT has become harmless to mosquitoes today’

March 29, 2018

From India today, not news to anyone who follows the fight against malaria, and the fight to save a part of the planet to preserve human life.

DDT resistance prompted India to agree to stop production of DDT by 2020 — the last DDT factory remaining. India’s disease fighters tell of frustration trying to control malaria, because abuse of DDT has bred DDT resistant and immune mosquitoes. This is not news.

But India Today has a news hole to fill, and the continuing crises of vector-borne diseases force public health agencies to turn to “fourth generation” pesticides, as insects are now resistant to DDT and malathion.

The story out of New Delhi on March 13 almost adds some poetry to the issue. I repeat the story from India Today in full, partly because I love the lilt of Indian English, and because it tells the story of continuing attempts to get ahead of pesticide resistance in pests, attempts that just don’t seem to be doing the job.

Delhi’s civic agencies asked to use fourth generation pesticides to kill chemical-resistant insects

A small vehicle fogging streets of Delhi, India, with DDT, to fight mosquitoes. File photo from India Today, used to illustrate the story only.

A small vehicle fogging streets of Delhi, India, with DDT, to fight mosquitoes. File photo from India Today, used to illustrate the story only.

Pesticides such as DDT and malathion, which were once super weapons in the fight against mosquitoes, now seem to have become harmless perfume-like sprays for the blood-sucking parasites.

Scientists at the National Vector Borne Disease Control Programme (NVBDCP), Delhi which is the central nodal agency for prevention of diseases like malaria, dengue, filariasis, kala-azar, Japanese encephalitis and chikungunya, etc, in India has now recommended municipalities in the Capital and other parts of the country to shift to the 4th generation of pesticides that is also the last in the row.

These constitute certain bio-larvicides and insect growth regulators that stop the synthesis of critical hormones in mosquito larvae to prevent them from becoming adult. Only after attaining maturity, do the female Anopheles and Aedes Aegypti mosquitoes suck blood to get protein nutrition to lay eggs.

Scientists explain that the first generation of pesticides was DDT, used since World War II on soldiers in 1940s up till now, as its a powerful poison against mosquitoes. Later, its environmental effects, specifically on birds like vultures, reduced its usage globally.

Then came malathion, which had to be applied in huge quantities, paving the way for 3rdgeneration pesticides like synthetic pyrethroids and temephos. But with reports of mosquitoes developing tolerance towards all of these gradually, scientists are now recommending mixed and increased usage of the fourth generation of pesticides that is also the last line of defence in this class.

Experiments are still going on with genetically modified mosquitoes and introducing batches of mosquitoes injected with wolbachia bacteria in the wild to produce sterile eggs. A senior scientist with the NVBDCP, Civil Lines, said, Just like humans develop resistance towards antibiotics, mosquitoes have also evolved over the past 20-30 years to grow natural defence against DDT, malathion, etc. We are still using these two in virgin areas like forests of northeast India, Odisha, etc. successfully. But we have begun getting reports that even temephos and synthetic pyrethroids have stopped receiving the desired results against mosquitoes.

A pesticide is said to be successful when it kills over 90 per cent of the targeted insect or pest population. Over 3,500 species of mosquitoes, which play host to a number of disease-causing vectors such as zika, yellow fever, west Nile virus, etc. are said to be the deadliest animal family in the world. They kill 700 million people annually world over.
In Delhi itself, at least 10 people died of dengue last year and 9,271 people were affected.

The numbers of malaria and chikungunya cases recorded in 2017 stood at 1,142 and 940. In 2016, at least 21 dengue deaths were reported from various city hospitals. And this year, an early onset of the deadly trio dengue, malaria and chikungunya is expected with summer-like weather conditions already.

High temperature and presence of clear water in desert coolers, flower pots, coconut shells, etc, act as excellent breeding sites for the menacing insects.

We have asked municipalities to even use the fourth generation of pesticides pirimiphos-methyl and diflubenzuron in a mix with the previous generation pesticides to delay mosquitoes developing tolerance towards this in the future, the scientist explained. He said, over the years, the pesticides must be rotated in use so that their effectiveness on hardy mosquitoes does not go down.

Dr Himmat Singh, senior scientist at the National Institute of Malaria Research (NIMR), Dwarka, said, The benefit with these two latest pesticides is that they are only hormone-inhibitors, not poisons, and specific to mosquitoes. So they wouldnt have any effect on other insects, birds, mammals, fishes, etc. They are categorised as non-hazardous by WHO. However, their cost has been prohibitive so far, he said.

Delhi municipalities have begun their use after a meeting of scientists and bureaucrats of NVBDCP, NIMR, ministry of health and family welfare and the Central Insecticide Board (CIB) authorised their application in January, sources said.

Dr NR Das, head of the department of Public Health in east MCD said, We have already procured diflubenzuron on NVBDCP directions and been using it for one month satisfactorily. However, we will be able to ascertain its degree of effectiveness only after two to three months.

For at least a decade, India has been the world’s largest producer of DDT, and the largest user, spraying more DDT than the rest of the world together. China and North Korea were the only two other nations making DDT at the end of the 20th century, but both cut off production. Counter to popular conceptions, India has struggled to control malaria, often being the only nation in the world to account increases in the disease from year to year, since 2001. Malaria increased despite increasing DDT application.

To fight malaria effectively DDT spraying should be limited to Indoor Residual Spraying (IRS), which leaves a fine coat of DDT on the walls of sleeping rooms, where malaria-carrying mosquitoes bite humans, then pause on the walls to squeeze water out of the blood they’ve fed on, to reduce weight to fly. Broadscale spraying of DDT only speeds development of resistance in all mosquito species, and many other pests.

India is catching up with the rest of the world on DDT.

Tip of the old scrub brush to India Today’s Twitter feed.

 

 


Sri Lanka declared malaria-free, without DDT

March 6, 2018

Chart from the India Foundation shows the ups and downs of fighting malaria in Sri Lanka in the 20th and 21st centuries. Sri Lanka is malaria-free since 2016.
Chart from the India Foundation shows the ups and downs of fighting malaria in Sri Lanka in the 20th and 21st centuries. Sri Lanka is malaria-free since 2016.

Sri Lanka pushed malaria out of the country, and is certified by the World Health Organization (WHO) as malaria-free, as of September 2016.

If you follow the fight against malaria, this may not be news to  you. If you’re a victim of the pro-DDT, anti-WHO and anti-Rachel Carson hoaxes, you may be surprised.

Sri Lanka once got malaria to almost nothing, with heavy use of DDT in Indoor Residual Spraying. Then the budget hawks stopped the anti-malaria program (“Success!”) to save money. Malaria came roaring back as it will when vigilance relaxes — but by then the mosquitoes were mostly resistant to DDT, and a civil war kept the nation from mounting any public health campaigns in much of the country.

With the advent of new medicines, ABC therapy, and new methods to diagnose the disease, and using bednets and targeted pesticides other than DDT, Sri Lanka beat the disease. The news was carried in Britain’s The Guardian.

The World Health Organisation has certified that Sri Lanka is a malaria-free nation, in what it called a truly remarkable achievement.

WHO regional director Poonam Khetrapal Singh said in a statement that Sri Lanka had been among the most malaria-affected countries in the mid-20th century.

But, the WHO said, the country had begun an anti-malaria campaign that successfully targeted the mosquito-borne parasite that causes the disease, not just mosquitoes. Health education and effective surveillance also helped the campaign.

https://www.theguardian.com/society/2016/sep/05/sri-lanka-malaria-free-world-health-organisation

This is a blow to the anti-WHO pro-DDT forces. Sri Lanka has been a key story in their tales of how only DDT could fix malaria, stories told long after DDT stopped working. One more example shot down.

More:

Tip of the old scrub brush to The Guardian.


Bad news from World Malaria Report 2017: Malaria fight stalled

December 20, 2017

Cover of World Malaria Report 2017. The fight against malaria is at a crossroads, WHO reports.

Cover of World Malaria Report 2017. The fight against malaria is at a crossroads, WHO reports.

This is the press release from the World Health Organization on the release of World Malaria Report 2017, on November 29, 2017:

Global response to malaria at crossroads

WHO report shows gains are levelling

News release

After unprecedented global success in malaria control, progress has stalled, according to the World malaria report 2017. There were an estimated 5 million more malaria cases in 2016 than in 2015. Malaria deaths stood at around 445 000, a similar number to the previous year.

“In recent years, we have made major gains in the fight against malaria,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “We are now at a turning point. Without urgent action, we risk going backwards, and missing the global malaria targets for 2020 and beyond.”

The WHO Global Technical Strategy for Malaria calls for reductions of at least 40% in malaria case incidence and mortality rates by the year 2020. According to WHO’s latest malaria report, the world is not on track to reach these critical milestones.

A major problem is insufficient funding at both domestic and international levels, resulting in major gaps in coverage of insecticide-treated nets, medicines, and other life-saving tools.

Funding shortage

An estimated US$ 2.7 billion was invested in malaria control and elimination efforts globally in 2016. That is well below the US $6.5 billion annual investment required by 2020 to meet the 2030 targets of the WHO global malaria strategy.

In 2016, governments of endemic countries provided US$ 800 million, representing 31% of total funding. The United States of America was the largest international funder of malaria control programmes in 2016, providing US$1 billion (38% of all malaria funding), followed by other major donors, including the United Kingdom of Great Britain and Northern Ireland, France, Germany and Japan.

The global figures

The report shows that, in 2016, there were an estimated 216 million cases of malaria in 91 countries, up from 211 million cases in 2015. The estimated global tally of malaria deaths reached 445 000 in 2016 compared to 446 000 the previous year.

While the rate of new cases of malaria had fallen overall, since 2014 the trend has levelled off and even reversed in some regions. Malaria mortality rates followed a similar pattern.

The African Region continues to bear an estimated 90% of all malaria cases and deaths worldwide. Fifteen countries – all but one in sub-Saharan Africa – carry 80% of the global malaria burden.

“Clearly, if we are to get the global malaria response back on track, supporting the most heavily affected countries in the African Region must be the primary focus,” said Dr Tedros.

Controlling malaria

In most malaria-affected countries, sleeping under an insecticide-treated bednet (ITN) is the most common and most effective way to prevent infection. In 2016, an estimated 54% of people at risk of malaria in sub-Saharan Africa slept under an ITN compared to 30% in 2010. However, the rate of increase in ITN coverage has slowed since 2014, the report finds.

Spraying the inside walls of homes with insecticides is another effective way to prevent malaria. The report reveals a steep drop in the number of people protected from malaria by this method – from an estimated 180 million in 2010 to 100 million in 2016 – with the largest reductions seen in the African Region.

The African Region has seen a major increase in diagnostic testing in the public health sector: from 36% of suspected cases in 2010 to 87% in 2016. A majority of patients (70%) who sought treatment for malaria in the public health sector received artemisinin-based combination therapies (ACTs) – the most effective antimalarial medicines.

However, in many areas, access to the public health system remains low. National-level surveys in the African Region show that only about one third (34%) of children with a fever are taken to a medical provider in the public health sector.

Tackling malaria in complex settings

The report also outlines additional challenges in the global malaria response, including the risks posed by conflict and crises in malaria endemic zones. WHO is currently supporting malaria responses in Nigeria, South Sudan, Venezuela (Bolivarian Republic of) and Yemen, where ongoing humanitarian crises pose serious health risks. In Nigeria’s Borno State, for example, WHO supported the launch of a mass antimalarial drug administration campaign this year that reached an estimated 1.2 million children aged under 5 years in targeted areas. Early results point to a reduction in malaria cases and deaths in this state.

A wake-up call

“We are at a crossroads in the response to malaria,” said Dr Pedro Alonso, Director of the Global Malaria Programme, commenting on the findings of this year’s report. “We hope this report serves as a wake-up call for the global health community. Meeting the global malaria targets will only be possible through greater investment and expanded coverage of core tools that prevent, diagnose and treat malaria. Robust financing for the research and development of new tools is equally critical.”

Details of DDT use in the past year usually show up in the bowels of the report.


Mozambique uses 4 million mosquito nets in turn from pesticide, in war on malaria

June 20, 2017

Mozambique’s National Malaria Control Programme distributed 4 million LLIN, insecticide-impregnated nets, to protect children and others from malaria as they sleep, the time most malaria-infecting mosquito bites occur. Malaria Consortium photo

Mozambique’s National Malaria Control Programme distributed 4 million LLIN, insecticide-impregnated nets, to protect children and others from malaria as they sleep, the time most malaria-infecting mosquito bites occur. Malaria Consortium photo

Mozambique is one of only ten nations still using DDT for Indoor Residual Spraying (IRS) to fight malaria.

But DDT’s effectiveness diminishes rapidly, as does the effectiveness of the other eleven insecticides generally used for IRS against malaria or other vector-borne diseases. Insecticides are sprayed indoors, and not outdoors, to provide protection where humans are most often bitten, and to prevent non-target mosquitoes and other creatures from being exposed to the insecticides. This prevents harmful pests from developing resistance to the insecticides, and diminishes damage to beneficial species, like food fish.

Instead of spraying, malaria fighters turn increasingly to bednets impregnated with insecticide, known as Long-Lasting Insecticide-impregnated Nets (LLIN). A net provides closer to 100% protection from bites than IRS. A net immediately protects anyone sleeping under it, while IRS must treat at least 80% of nearby homes to achieve more than 50 percent prevention.

While still using IRS, Mozambique stakes its future malaria fighting on nets.

The Malaria Consortium aided in the recent distribution of nets.

Malaria Consortium has successfully completed a mass distribution campaign of over four million long-lasting insecticidal nets (LLINs) across Nampula and Niassa provinces in Mozambique. The nets were distributed almost simultaneously across all districts of each province – 23 districts in Nampula in November 2016, and 16 districts in Niassa in May 2017 – using a new operational model aimed at optimising resources.

Throughout the campaigns, Mozambique’s National Malaria Control Programme was responsible for the LLIN acquisition and led overall planning and implementation through the decentralised structures of the health system. Malaria Consortium’s role consisted of operational support, which included financial management, transport, procurement, logistics, training, management of service providers, efficient use of resources and effective coordination at provincial, district and field levels.

Sonia Gwesela, Malaria Consortium Mozambique Country Director said, “In Nampula Province, a major achievement was that 99 percent of households collected their nets. We successfully delivered 98 percent of the nets in both provinces, coming well above the 90 percent target set by the National Malaria Control Programme.

“With the successful completion of the distribution, we can now focus on a post-distribution communications campaign about the correct use of LLINs,” she concluded.

The Malaria Prevention and Control Project is funded by the Global Fund to Fight AIDS, TB and Malaria and supports the efforts of the Mozambican government to reduce malaria throughout the country through scale up of prevention and control efforts with community involvement. Malaria Consortium is working in partnership with World Vision, Fundacao para o Desenvolvimento da Comunidadeo, International Relief and Development, and the Mozambique Ministry of Health.

Bednets can be twice as effective as IRS in preventing the spread of malaria. Beating malaria also requires upgrading health care for quick diagnoses and quick, complete treatment of malaria in humans, and prevention projects to drain mosquito-breeding places within 50 yards of homes; more prevention of bites means less medical treatment is required.

WHO estimated 5 million people died of malaria in the 1950s into the 1960s. WHO’s Malaria Report 2016 reported malaria deaths fell to less than 430,000 world wide, a more than 90 percent reduction since 1963, mostly accomplished without DDT.

Malaria Consortium on Twitter, @FightingMalaria.

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Malaria uptick in Botswana: No, more DDT can’t help

March 28, 2017

Health workers in Botswana use a cell phone to report malaria diagnoses and commencement of treatment, enabling real-time tracking of malaria outbreaks and rapid public health service responses. Photo from MalariaNoMore.
Health workers in Botswana use a cell phone to report malaria diagnoses and commencement of treatment, enabling real-time tracking of malaria outbreaks and rapid public health service responses. Photo from MalariaNoMore.

Interested, and interesting, to discover Botswana has a Facebook page where it appears is posted almost every press release or news item from the government.

I found it because some wag claimed on Twitter that Botswana faces a malaria crisis, and therefore DDT should be ‘brought back from the dead.’

Botswana did post about a malaria outbreak, but the nation appears to have good sense about how to fight malaria. The Tweeter missed that Botswana is already doing what a nation would use DDT for, Indoor Residual Spraying (IRS), and that phrase alone means Botswana’s malaria fighters are alert to any need for DDT should it arise, but also to the severe limitations on DDT use. DDT doesn’t work in about 95% of the nations on Earth.

Botswana is among the ten nations remaining on Earth who use DDT when and where they find a population of mosquitoes still susceptible to DDT. Almost all nations on Earth signed the Persistent Organic Pollutants Treaty (POPs, or Stockholm Agreement), which requires annual reporting of DDT use. But there are 11 other pesticides the World Health Organization (WHO) recommends for IRS. Botswana is unlikely to use DDT where it won’t work, which is most places.

Botswana is one of the DDT Ten in 2016, too. But this is down from 43 nations in 2001. DDT’s effectiveness and time as a tool to fight malaria is mostly gone, vanishing quickly.

Botswana has DDT if it can find a use for it; no more DDT is needed. A malaria outbreak in Botswana is no reason to remove the ban on DDT use on U.S. farms.

Here is the story/press release from Botswana’s government:

MALARIA CASES RISE IN OKAVANGO

North West District has been hard hit by a malaria epidemic with 670 recorded cases and five deaths since the beginning of the rainy season.

Head of the District Health Management Team, Dr Malebogo Pusoentsi revealed this at a press conference aimed at evaluating efforts made in the district to control the disease, recently.

A task force was in the district to assess and appreciate the situation as well as discuss what more could be done going forward.

Dr Pusoentsi said the highly affected region was Okavango which recorded over 90 per cent of the cases.

Highly affected areas include Shakawe, Xakao and Seronga in the Okavango District while in Ngami, Tsau and Mababe were the most affected.

Out of the affected people, it was reported that males were mostly affected as compared to females, and that more than 30 per cent of the affected were children. The most affected areas were said to be schools.

Dr Pusoentsi explained that malaria infection in humans was mainly transmitted through the sting of the female anopheles mosquito, adding that the disease in people could present clinically as either uncomplicated, complicated or asymptomatic, especially for people living in malaria endemic areas.

She stated that prevention of malaria remained a priority with strategies aimed at vector control. She said two strategies have been used to control mosquitoes in the area such as indoor residual spraying and the distribution of the long lasting insecticide treated nets. She added that 57 000 nets having been distributed across the country.

Regarding indoor spraying, Dr Pusoentsi revealed that for the transmission period of 2016/17, the district achieved an average of 69 per cent coverage as compared to the 85 per cent target.

Asked if the district was winning the battle, she said they were on the right track as health officials have doubled up efforts to tackle the epidemic.

She said social mobilisation was effective as the community and leadership were taught to make malaria a priority in their agenda, adding that if one member of a family was affected, chances were high that the rest of the family were also at risk.

Furthermore, Dr Pusoentsi explained that many opportunities still existed at community level to effectively control the spread of malaria, citing the cleaning of surroundings to minimise the breeding spaces for the mosquitoes.

Another strategy was to work collaboratively to ensure community knowledge and participation during the epidemic period. She urged the community to visit health facilities if they experience any symptoms of malaria so that they could be assisted on time.

She noted that common signs and symptoms include high temperature, headache and rigors, pallor and vomiting.

Dr Pusoentsi also noted that Botswana was among the countries which were aiming to eliminate malaria by 2018, adding that as part of the strategy, all efforts and investments had been put in place to control the spread.

Effective surveillance mechanism, she said had been put in place to monitor the disease burden and response efficiency at all times.

In addition, she pointed out that case management and drug supply had been strengthened to ensure quality management of cases of malaria to avoid deaths. (BOPA)

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Disney showed how to beat malaria in the Americas, without DDT

February 26, 2017

Still photo from Walt Disney's "Winged Scourge," a wanted poster for "Anopheles, alias Malaria Mosquito." The 1943 film short suggested ways to cut populations of the malaria-spreading mosquitoes of the genus Anopheles. Disease prevention would aid the war effort in 1943, it was hoped.

Still photo from Walt Disney’s “Winged Scourge,” a wanted poster for “Anopheles, alias Malaria Mosquito.” The 1943 film short suggested ways to cut populations of the malaria-spreading mosquitoes of the genus Anopheles. Disease prevention would aid the war effort in 1943, it was hoped.

Malaria’s scourge hobbled economic progress across the Americas, and critically in World War II, that hobbled the war effort to defeat the Axis powers, Germany and Japan.

U.S. government recruiting of Hollywood film makers to produce propaganda films hit a zenith in the war. Even animated characters joined in. Cartoonists produced short subject cartoons on seeveral topics.

In 1943 the Disney studios distributed this film starring the Seven Dwarfs, among the biggest Disney stars of the time. The film was aimed at Mexico, Central America and South America, suggesting ways people could actually fight malaria. Versions were made in Spanish and English (I have found no Portuguese version for Brazil, but I’m still looking.)

the lost Disney described the film:

The first of a series of health-related educational shorts produced by the Disney studios and the Coordinator of Inter-American Affairs for showing in Latin America. It was also the only one to use established Disney characters (the Seven Dwarfs).

In this propaganda short, the viewers are taught about how the mosquito can spread malaria. A young mosquito flies into a house and consumes the blood of an infected human. She then consumes the blood of a healthy human, transmitting the disease into him. It turns out that this is actually a film within a film and the Seven Dwarves are watching it. They volunteer to get rid of the mosquito by destroying her breeding grounds.

A Spanish-language version of the film:

Fighting malaria in the U.S. became a grand campaign in Franklin Roosevelt’s administration. Roosevelt administration officials saw malaria as a sapper of wealth, especially in the rural south. Part of the charge of the Tennessee Valley Authority was to wipe out malaria. By 1932, public health agencies in malaria-affected counties were beefed up to be able to promptly diagnose and treat human victims of malaria. TVA taught methods of drying up mosquito breeding places around homes and outdoor work areas. Sustained campaigns urged people to make their homes tighter, against weather, and to install screens on windows and doors to prevent mosquito entry especially at peak biting periods, dusk to after midnight.

U.S. malaria deaths and infections plunged by 90% between 1933 and 1942 — just in time to allow southern military bases to be used for training activities for World War II. After the war, the malaria-fighting forces of the government became the foundation for the Centers for Disease Control (CDC). With the introduction of DDT after 1945, CDC had another weapon to completely wipe out the remaining 10% of malaria cases and deaths.

It’s worth noting that in the end, it is the disease malaria that is eradicated, not the mosquitoes. In most places in the world, eradication of a local population of disease carriers is a temporary thing. A few remaining, resistant-to-pesticide-or-method mosquitoes can and do quickly breed a new population of hardier insects, and often surrounding populations will contribute new genetic material. Eradication of a vector-borne disease requires curing the disease in humans, so that when the mosquitoes come roaring back, they have no well of disease from which to draw new infection.

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No, Rachel Carson didn’t cause an increase in malaria; bonus film to WGBH American Experience “Rachel Carson”

February 7, 2017

Rachel Carson at a microscope, American Experience/RetroReport image. Did Carson's work cause an increase in malaria? Is she to blame for continued malaria deaths? No, answers a short film bonus to "Rachel Carson," the 2017 PBS film.

Rachel Carson at a microscope, American Experience/RetroReport image. Did Carson’s work cause an increase in malaria? Is she to blame for continued malaria deaths? No, answers a short film bonus to “Rachel Carson,” the 2017 PBS film.

A straight up, historic look at the question of Rachel Carson’s fault in stopping malaria.

Anti-environmentalists and corporate hoaxsters argue that Rachel Carson should be blamed for an imaginary increase in malaria deaths, after the U.S. banned DDT use on crops.

In conjunction with WGBH’s American Experience film on Carson released early in 2017, this short film focusing on malaria as a continuing plague puts to rest the idea that Carson should be blamed at all.

Soaking in the bathtub, we find the film not strident enough in defense of Carson; but for those strident nuts who claim Carson a murderer, it may have some good effect. And of course, you, intelligent dear reader, will be persuaded more gently.

Where malaria is the question, DDT is not the answer. Where malaria still exists, it’s not Rachel Carson’s fault.

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Fact sheet for World Malaria Report 2016

December 16, 2016

A woman shows the mosquito net that protects her and her family from malaria transmission, in India. India remains the world's top DDT user, but is switching to nets in an effort to bring malaria rates down and set up malaria eradication before the end of DDT in 2020. WHO image.

A woman shows the mosquito net that protects her and her family from malaria transmission, in India. India remains the world’s top DDT user, but is switching to nets in an effort to bring malaria rates down and set up malaria eradication before the end of DDT in 2020. WHO image.

World Health Organization publishes an annual World Malaria Report, with the year appended to the title. It summarizes the state of the fight against malaria worldwide, recording progress and setbacks.

In the tally of progress we get a clear indication of what is needed to continue or increase that progress, with the ultimate goal of controlling malaria to the point it poses no great economic risk, or health risk, to any nation, or better that human malaria is eradicated.

World Malaria Report 2016 is 184 pages, shorter than some previous reports but packed with figures and history, some of which requires greater background to understand completely.

For example, the 2016 publication notes that about 412,000 people died from malaria in 2016. This is a shocking figure. Most of the news coverage of the report mentions this death toll in the first paragraph.

It’s too many deaths. But it’s a more than 50% reduction in deaths from 1990s rates, and it’s a more than 90% reduction from the annual death tolls that shocked the world to concerted action after World War II. Most estimates are that about 5 million people a year died from malaria through the 1950s, and into the 1960s.

WHO concentrates on the malaria fight, and plays down the political aspects to encourage international cooperation to help fight the disease. But there are political statements made, if one has the background to understand them. There remains controversy over the use of DDT, with many people yelling far and wide that if ‘bans on DDT were removed’ then malaria would quickly become an eradicated disease. This position ignores the facts, that there were still 5 million people dying each year during peak DDT use; that death tolls plunged after the U.S. banned DDT use on crops; that the U.S. ban covered only crop use, and that DDT use against disease has never been banned anywhere in the world; and that DDT use continued long after the U.S. banned DDT, around the world. DDT use never stopped.

Taken together, we would understand that the 90% reduction in malaria deaths from peak DDT use years, was accomplished mostly without DDT, and that therefore DDT is not a panacea.

World Malaria Report 2016 also tallies the slow demise of DDT. Mosquito resistance to pesticides, especially DDT, is a major problem in the fight against the disease. But more DDT can’t fix that problem now that every mosquito on Earth carries alleles that make them resistant and wholly immune to the stuff. DDT will probably never be a panacea, even were its manufacture not scheduled to stop very soon.

History, and a complete assessment of the science and current conditions in the frontlines of the malaria fight, can help us put these things in perspective.

So far, only the Los Angeles Times in the U.S. provided any in-depth reporting on World Malaria Report 2016. We hope other media will take up the challenge to inform. They will find WHO’s Fact Sheet useful.

With that warning in mind, it’s good to look at the broad outlines of the report, which WHO has packaged into a fact sheet for our convenience.

Fact Sheet: World Malaria Report 2016

13 December 2016

The World Malaria Report, published annually by WHO, tracks progress and trends in malaria control and elimination across the globe. It is developed by WHO in collaboration with ministries of health and a broad range of partners. The 2016 report draws on data from 91 countries and areas with ongoing malaria transmission.

Global progress and disease burden (2010–2015)

According to the report, there were 212 million new cases of malaria worldwide in 2015 (range 148–304 million). The WHO African Region accounted for most global cases of malaria (90%), followed by the South-East Asia Region (7%) and the Eastern Mediterranean Region (2%).

In 2015, there were an estimated 429 000 malaria deaths (range 235 000–639 000) worldwide. Most of these deaths occurred in the African Region (92%), followed by the South-East Asia Region (6%) and the Eastern Mediterranean Region (2%).

Between 2010 and 2015, malaria incidence rates (new malaria cases) fell by 21% globally and in the African Region. During this same period, malaria mortality rates fell by an estimated 29% globally and by 31% in the African Region.

Between 2010 and 2015, malaria incidence rates (new malaria cases) fell by 21% globally and in the African Region. During this same period, malaria mortality rates fell by an estimated 29% globally and by 31% in the African Region.

Other regions have achieved impressive reductions in their malaria burden. Since 2010, the malaria mortality rate declined by 58% in the Western Pacific Region, by 46% in the South-East Asia Region, by 37% in the Region of the Americas and by 6% in the Eastern Mediterranean Region. In 2015, the European Region was malaria-free: all 53 countries in the region reported at least 1 year of zero locally-acquired cases of malaria.

Children under 5 are particularly susceptible to malaria illness, infection and death. In 2015, malaria killed an estimated 303 000 under-fives globally, including 292 000 in the African Region. Between 2010 and 2015, the malaria mortality rate among children under 5 fell by an estimated 35%. Nevertheless, malaria remains a major killer of under-fives, claiming the life of 1 child every 2 minutes.

Trends in the scale-up of malaria interventions

Vector control is the main way to prevent and reduce malaria transmission. Two forms of vector control are effective in a wide range of circumstances: insecticide-treated mosquito nets (ITNs) and indoor residual spraying (IRS).

ITNs are the cornerstone of malaria prevention efforts, particularly in sub-Saharan Africa. Over the last 5 years, the use of treated nets in the region has increased significantly: in 2015, an estimated 53% of the population at risk slept under a treated net compared to 30% in 2010.

Indoor residual spraying of insecticides (IRS) is used by national malaria programmes in targeted areas. In 2015, 106 million people globally were protected by IRS, including 49 million people in Africa. The proportion of the population at risk of malaria protected by IRS declined from a peak of 5.7% globally in 2010 to 3.1% in 2015.

Diagnostics

WHO recommends diagnostic testing for all people with suspected malaria before treatment is administered. Rapid diagnostic testing (RDTs), introduced widely over the past decade, has made it easier to swiftly distinguish between malarial and non-malarial fevers, enabling timely and appropriate treatment.

New data presented in the report show that, in 2015, approximately half (51%) of children with a fever who sought care at a public health facility in 22 African countries received a malaria diagnostic test compared to 29% in 2010. Sales of RDTs reported by manufacturers rose from 88 million globally in 2010 to 320 million in 2013, but fell to 270 million in 2015.

Treatment

Artemisinin-based combination therapies (ACTs) are highly effective against P. falciparum, the most prevalent and lethal malaria parasite affecting humans. Globally, the number of ACT treatment courses procured from manufacturers increased from 187 million in 2010 to a peak of 393 million in 2013, but subsequently fell to 311 million in 2015.

Prevention in pregnancy

Malaria infection in pregnancy carries substantial risks for the mother, her fetus and the newborn child. In Africa, the proportion of women who receive intermittent preventive treatment in pregnancy (IPTp) for malaria has been increasing over time, but coverage levels remain below national targets.

IPTp is given to pregnant women at scheduled antenatal care visits after the first trimester. It can prevent maternal death, anaemia and low birth weight, a major cause of infant mortality. Between 2010 and 2015, there was a five-fold increase in the delivery of 3 or more doses of IPTp in 20 of the 36 countries that have adopted WHO’s IPTp policy – from 6% coverage in 2010 to 31% coverage in 2015.

Insecticide and drug resistance

In many countries, progress in malaria control is threatened by the rapid development and spread of antimalarial drug resistance. To date, parasite resistance to artemisinin – the core compound of the best available antimalarial medicines – has been detected in 5 countries of the Greater Mekong subregion.

Mosquito resistance to insecticides is another growing concern. Since 2010, 60 of the 73 countries that monitor insecticide resistance have reported mosquito resistance to at least 1 insecticide class used in nets and indoor spraying; of these, 50 reported resistance to 2 or more insecticide classes.

Progress towards global targets

To address remaining challenges, WHO has developed the Global Technical Strategy for Malaria 2016-2030 (GTS). The Strategy was adopted by the World Health Assembly in May 2015. It provides a technical framework for all endemic countries as they work towards malaria control and elimination.

This Strategy sets ambitious but attainable goals for 2030, with milestones along the way to track progress. The milestones for 2020 include:

  • Reducing malaria case incidence by at least 40%;
  • Reducing malaria mortality rates by at least 40%;
  • Eliminating malaria in at least 10 countries;
  • Preventing a resurgence of malaria in all countries that are malaria-free.

Progress towards the GTS country elimination milestone is on track: In 2015, 10 countries and areas reported fewer than 150 locally-acquired cases of malaria. A further 9 countries reported between 150 and 1000 cases.

However, progress towards other GTS targets must be accelerated. Less than half (40) of the 91 malaria-endemic countries are on track to meet the GTS milestone of a 40% reduction in malaria case incidence by 2020. Progress has been particularly slow in countries with a high malaria burden.

Forty-nine countries are on track to achieve the milestone of a 40% reduction in malaria mortality; this figure includes 10 countries that reported zero malaria deaths in 2015.

Funding trends

In 2015, malaria funding totalled US$ 2.9 billion, representing only 45% of the GTS funding milestone for 2020. Governments of malaria-endemic countries provided 32% of total funding. The United States of America and the United Kingdom are the largest international funders of malaria control and elimination programmes, contributing 35% and 16% of total funding, respectively. If the 2020 targets of the GTS are to be achieved, total funding must increase substantially.

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