Several recent articles have reported on interesting developments in the fight against malaria. See below for a brief summary of these (with links if you are keen to do some further reading).
Efforts to eradicate malaria have significantly increased over the past decade. In 2011 alone, the three main donors, the WHO’s Roll Back Malaria Partnership, the Global Fund and the President’s Malaria Initiative, spent $2 billion on treatment and prevention. The increase in funding appears to have had a positive effect on the fight against the disease, according to WHO estimates there has been a 26% reduction in death rates since 2000. The UN has called for an even greater increase in funding. A $6.7 billion investment between 2012 and 2015 could prevent 640m malaria cases and 3m deaths. However, the prospects of malaria eradication, even given extra funding, might be less rosy than this picture suggests.
First of all, a recent study published in the Lancet has found that the WHO’s estimates of deaths from malaria might be too conservative. Based on statistics gathered from 105 countries since 1980, the study found that malaria accounted for 1.24m deaths in 2010, nearly double as many as the 655 000 reported by the WHO. Even if the WHO did significantly underestimate the number of deaths caused by malaria, this of course doesn’t mean that efforts to fight the disease haven’t been successful, but it might lead us to question the amount of money donors would need to invest in order to eradicate it.
A recent article in the Scientific American highlights a second potential concern. One of the principle ways of preventing malarial infections, bed nets, might not be as successful as it seems. Nets are treated with synthetic insecticides which repel mosquitoes and kill the ones that land. Bed nets also provide a mechanical barrier between the sleeper and insects. One of the reasons why bed nets work so well is that the periods of the day when they are in use coincide with periods when mosquitoes, including malaria carrying ones, are the most active as mosquitoes tend to be nocturnal. It has been known for some time that mosquitoes can evolve to resist the insecticide that the bed nets are coated with, however a recent study has found that some mosquitoes have started adapting their feeding times too. The study found that over a period of three years mosquitoes changed their feeding times from around 2 to 3 am to 5 am. The study was fairly comprehensive, it was conducted at two different locations in Benin and samples were collected before, during and after bed nets were distributed. What are the potential consequences of this for humans? Worryingly, people are more likely to be out and about during the new feeding times, and therefore are more likely to be bitten and potentially infected. On the other hand, mosquitoes that feed on humans during daytime are also more likely to be spotted by the victim. Furthermore, mosquitoes feeding at dawn might also be faced with new predators, such as frogs and lizards. Given the uncertainties surrounding the consequences of the findings of this study, bed nets still remain to be one of the most effective ways of fighting malaria.
Even if the mechanical effectiveness of bed nets is reduced by behavioural changes in mosquitoes, luckily bed nets are not the only card up the sleeve of those battling malaria. The BBC reported last week that a recent study in the Lancet has come up with encouraging results when researching the effectiveness of a new anti-malaria drug scheme. The Affordable Medicine Facility for malaria set up by the Global Fund, subsidises drugs in 7 African countries. The study has found, that although the scheme had a low effect in Niger and Madagascar, it reduced the price of drugs in the other countries it was trialled in. Less encouragingly, the scheme has been criticised, most notably by Oxfam, for limitng access and for diverting attention from more established methods of fighting the disease.
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