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 Day 2014 – How can you help beat the disease?

April 25, 2014

Poster from BioMed Central:

Poster from BioMed Central for World Malaria Day 2014

Poster from BioMed Central for World Malaria Day 2014

Time for a big push to smash the disease’s hold on humanity, maybe eradicate it.  Are you in?

No, DDT is not the answer, not even much of AN answer.

How can you help, right now?

  1. Send $10 to Nothing But Nets. Bednets are dramatically more effective than just insecticides, in preventing malaria infections and saving lives.  Your $10 donation will save at least one life.
  2. Write to your Congressional delegation, and urge them to increase funding to the President’s Malaria Initiative. Malaria does well when people in non-malaria regions turn their backs on the problem.  Malaria declines with constant attention to nation-wide and continent-wide programs to prevent the disease, by diminishing habitat for mosquitoes, curing the disease in humans so mosquitoes have no well of disease to draw from, and preventing mosquitoes from biting humans, with window screens, education on when to stay indoors, and bednets.

More:


Nothing But Nets invites you to join in the fight against malaria, for World Malaria Day

April 3, 2014

I get e-mail from Nothing But Nets, in preparation for World Malaria Day, April 25, 2014:

Compete to Beat Malaria Header with credit

Dear Ed,

As you know, World Malaria Day is April 25, and supporters will be taking action throughout April to help us send 25,000 bed nets to families in Africa.

Are you in?

Our champions are holding basketball tournaments, soccer games, and running in 5K races to get their friends, families, and communities involved in the fight against malaria.Megan Walter Jumpology

Megan Walter, our supporter from Richmond, Virginia, organized a unique event in her hometown. She partnered with her local trampoline park to jump for nets – and they raised $10 for every jumper who participated. The event was a huge success, raising more than $2,000 to send 200 bed nets to families in Africa. What made it even better is that Megan had fun doing it!

There are lots of ways to raise money and send nets while doing what you love. Every $10 you raise helps us purchase and distribute life-saving bed nets with our UN partners.

What sports challenge will you do this April?

Join us in sending nets and saving lives for World Malaria Day! Together, we can defeat malaria.

Sincerely,

Liz Wing
Senior Grassroots Officer, Nothing But Nets

P.S. Whether you run, swim, or play basketball, you can help raise critical funds and save lives. Take a challenge.

 

Compete to Beat Malaria Footer

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© Copyright 2014 United Nations Foundation
1750 Pennsylvania Avenue NW, Suite 300,
Washington, DC 20006

You noted, of course:  No call for more DDT.  No slamming of science, scientists, medicine, medical workers, or Rachel Carson and environmental organizations.

This comes from people who fight malaria for a (meager) living, on non-profit basis, without political bias.  In short, these people need help, and consequently have no use for the pro-DDT, anti-Rachel Carson, anti-WHO, anti-science hoaxes.

Please give.  Every $10 can save a life.


Resources for World Malaria Day 2013

April 25, 2013

Not a word about condemning Rachel Carson.  No plea to use DDT to try to poison Africa or Asia to health.  That’s a great start.

More:

Mother and son under a protective bednet, the most efficient method to prevent malaria.  Columbia University MVSim image

Mother and son under a protective bednet, the most efficient method to prevent malaria. Columbia University MVSim image


Rachel Carson/DDT hoaxing from the Ayn Rand Institute

April 21, 2013

Welcome, refugees and truth-seekers from WUWT:  If this site seems a little unusual to you, you should know that at Millard Fillmore’s Bathtub we try to stick to science, and we don’t censor opposing opinions.  Genuinely interested in the DDT/Malaria issue?  See this collection.

______________

A couple of physicists get together in a podcast from the Ayn Rand Institute, Poke in Your Eye to Eye, and demonstrate that they don’t know biology well, they know less about history, but they don’t hesitate to tell whoppers about Rachel Carson and the value of DDT“Silent Spring 50 Years Later [a special Earth Day podcast].

English: An image of the main entrance of Rach...

A better indication of the legacy of Rachel Carson: Schools across America named after the woman, to inspire children to explore science, and to read and write. Here, the main entrance of Rachel Carson Middle School in Herndon, Virginia. (Photo: Wikipedia)

Earth Day must be coming up.  The usual suspects trot out their usual disinformation and hoax campaigns — and it will continue through Earth Day on April 22, International Malaria Day on April 25, through Rachel Carson’s birthday, and probably all summer.

Mencken warned us that hoaxes, once out of the bottle, can’t be put back.  Twain (and others) remind us that whopping falsehoods travel around the world “while truth is getting its boots on.”  Amanda Maxham, who is listed as an astrophysicist at the Rand site, interviewed physicist Keith Lockitch — and they repeat almost all the hoary old false fables invented by Gordon Edwards and Steven Milloy about malaria, DDT, and Rachel Carson.

A few of the errors committed by the polemicists at the Ayn Rand Institute:

  • ‘DDT doesn’t breed mosquitoes more resistant to the stuff, but instead weakens the population through reducing diversity.’  Absolutely wrong.  Turns out the new alleles mosquitoes pick up that makes them resistant and immune to DDT, are ALSO the alleles that make mosquitoes resistant to the whole class of chemicals, and thereby foul up efforts to develop new pesticides.

    Tanzania - Removing DDT

    Cleaning up DDT in Africa: 40 tons of 50 year old DDT were found in Menzel Bourguiba Hospital, Tanzania – FAO photo

  • ‘Rachel Carson didn’t account for the value of DDT in eradicating malaria.’  They start out claiming DDT ended malaria in the U.S. (it didn’t; CDC had won the fight will just mop up operations left, by 1939; DDT wasn’t even available for another seven years), and run through the false claim that DDT alone had almost eradicated malaria from Sri Lanka, but listening to Rachel Carson, the nation stopped spraying and malaria roared back (the nation stopped ALL of its malaria fighting efforts due to costs and civil war; when the fight was taken up again, DDT was not useful; largely without DDT, Sri Lanka has once again nearly wiped out malaria).
  • ‘Because of a lack of DDT use, malaria continues to ravage the world killing a million people a year.’  Actually, malaria is at the lowest level in human history, killing less than a million a year, with great progress being made against the disease using the methods Rachel Carson urged in 1962.  Had we listened to Carson earlier, we could have saved a few million more lives, and perhaps have eradicated malaria already.  Also, it’s important to remember that DDT was never banned in Africa nor Asia; the ban on use of DDT on cotton crops in the U.S. did not cause any increase in malaria anywhere; since the ban on DDT use in the U.S. malaria has constantly declined in incidence and deaths.
  • ‘DDT is very effective because it’s ALSO repellent to mosquitoes, after it ceases to kill them.’  So in the end, they urge the use of a poisonous-to-wildlife, mildly carcinogenic substance, because it repels mosquitoes?  Bednets are more effective, cheaper, not-poisonous to wildlife, and they aren’t even suspected of causing cancer.

Rachel Carson’s life is a model for budding scientists, aspiring journalists, and teachers of ethics.  That so many people spend so much time making up false claims against her, in favor of a deadly toxin, and against science, tells us much more about the subrosa intentions of the claim fakers than about Rachel Carson.

Want the facts about Rachel Carson?  Try William Souder’s marvelous biography from last year, On a Farther Shore.  Want facts on DDT?  Try EPA’s official DDT history online (or look at some of the posts here at Millard Fillmore’s Bathtub). Want the facts about malaria?  Check with the world’s longest running, most ambitious malaria fighting campaign operated by the good people at the World Health Organization, Roll Back Malaria,  or see Sonia Shah’s underappreciated history, The FeverHow malaria has ruled mankind for 500,000 years.

More:

Roll Back Malaria, World Malaria Day logo for 2013

Roll Back Malaria, World Malaria Day logo for 2013

Wall of Shame (hoax spreaders to watch out for this week):


NIH notes progress against malaria on World Malaria Day 2012

April 28, 2012

Press release from the National Institutes of Health, for World Malaria Day (April 25, 2012):

For Immediate Release
Tuesday, April 24, 2012

NIH statement on World Malaria Day – April 25, 2012

B. F. (Lee) Hall, M.D., Ph.D., and Anthony S. Fauci, M.D.
National Institute of Allergy and Infectious Diseases

On World Malaria Day, we stand at a critical juncture in our efforts to control a global scourge. This year’s theme “Sustain Gains, Save Lives: Invest in Malaria” stresses the crucial role of continued investment of resources to maintain hard-won gains. Lives have indeed been saved. According to World Health Organization (WHO) estimates, annual deaths from malaria decreased from roughly 985,000 in 2000 to approximately 655,000 in 2010. Improvements were noted in all regions that WHO monitors, and, since 2007, four formerly malaria-endemic countries — the United Arab Emirates, Morocco, Turkmenistan and Armenia — have been declared malaria-free. However, about half of the world’s population is at risk of contracting malaria, and the disease continues to exact an unacceptably high toll, especially among very young children and pregnant women.

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), is committed to maintaining the research momentum needed to eradicate this mosquito-borne parasitic disease. Our investments include programs designed to strengthen research capacity in those countries most affected by malaria. For example, through the 2010 International Centers of Excellence for Malaria Research initiative, NIAID has established 10 research centers in malaria-endemic regions around the world. NIAID also provides access for U.S. and international scientists to multiple research resources as well as training for new investigators. Additionally, NIAID supports the Global Malaria Action Plan (GMAP), an international framework for coordinated action designed to control, eliminate and eradicate malaria.

NIAID’s research portfolio includes an array of projects aimed at better understanding the disease process and finding new and improved ways to diagnose and treat people with malaria, control the mosquitoes that spread it, and prevent malaria altogether through vaccination.

Earlier this month, an international team including NIAID-funded investigators reported that resistance to artemisinin — a frontline malaria drug — has spread from Cambodia to the border of Thailand and Burma, underscoring the importance of continued efforts to detect artemisinin resistance and slow its spread. Other grantees have identified a major region of the malaria parasite genome associated with artemisinin resistance, raising the possibility that scientists will have a new way to monitor the spread of drug resistance in the field.

The spread of artemisinin-resistant malaria highlights the need for new and improved malaria drugs. Two recently completed drug screening projects offer some hope. In one project, NIH scientists screened nearly 3,000 chemicals, and found 32 that were highly effective at killing numerous genetically diverse malaria parasite strains. Another screening project identified a new class of compounds that inhibits parasites in both the blood stage and in the liver. The research could lead to the development of malaria drugs that attack the parasite at multiple stages in its lifecycle, which would hamper the parasite’s ability to develop drug resistance.

Work continues on a novel anti-malaria compound, NITD609, first described by NIAID-supported researchers in 2010. A mid-stage clinical trial to assess NITD609’s activity in people began in Thailand this year. Research on NITD609 is a continuing collaboration among NIH-funded scientists, the pharmaceutical company Novartis, and the nonprofit Medicines for Malaria Venture.

Because the risk of childhood malaria is related to exposure before birth to the malaria parasite through infected mothers, NIAID scientists recently initiated a program on malaria disease development in pregnant women and young children that could yield new preventive measures and treatments for these most vulnerable groups.

The mosquitoes that spread malaria are also the target of NIAID-supported science. In 2011, researchers identified bacteria that render mosquitoes resistant to malaria parasites. Further study is needed, but it may one day be possible to break the cycle of infection by reducing the mosquito’s ability to transmit malaria parasites to people.

A vaccine to prevent malaria has been frustratingly elusive, and so initial positive results reported last year by the PATH Malaria Vaccine Initiative, GlaxoSmithKline Biologicals and their collaborators came as welcome news. In a late-stage clinical trial in approximately 6,000 African children, the candidate vaccine, known as RTS,S, reduced malaria infections by roughly half. Currently, eight other vaccine candidates are being tested in NIAID-supported clinical trials. One of them uses live, weakened malaria parasites delivered intravenously to prompt an immune response against malaria. An early-stage clinical trial of this vaccine candidate began at NIH earlier this year.

Whether the remarkable returns on investment in malaria control will continue in years ahead depends on our willingness to commit needed financial and intellectual resources to the daunting challenges that remain. On World Malaria Day, we join with our global partners in affirming that commitment and rededicating ourselves to the efforts to defeat malaria worldwide.

For more information on malaria, visit NIAID’s malaria Web portal.

Lee Hall, M.D., Ph.D., is Chief of the Parasitology and International Programs Branch in the NIAID Division of Microbiology and Infectious Diseases. Anthony S. Fauci, M.D., is Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health


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