Malaria, described by Hippocrates in the fourth century B.C is almost certainly one of the most ancient diseases of man. Indeed, it is reasonable to suppose that it is older than we, that our primate ancestors were recognizably malarious before they were recognizably human, that the parasite which causes the fever and the mosquito which transfers it from one person to another have accompanied us throughout the Darwinian descent. But is less than a hundred years since the beginning of this century that people have begun systematically to attack it and its insect propagators. From small and scattered raids prior to world war I the fight against malaria and malarious mosquitoes grew into a global campaign after world war II. Fifty years ago victory in all continents except Africa seemed in sight. Today the armies of people everywhere are in retreat as warlords ceaselessly discover various techniques to keep them abate.
But the fact still remains, malaria is resurgent, finding various method to shield man’s attack on it, most tragically in Asia where the battle had seemed almost won.
In India, malaria cases, which were reduced to 50,000 in 1961, soared in 1977 to 30 million or more.
Classically one of the greatest if least spectacular of the killers, malaria may become that once more what happened and why are the subject of this history?
The war on mosquitoes began in the high noon of white man’s empire, at the end of nineteen century. At the time when Ronald Ross in colonial India discovered that mosquitoes transmit malaria. After his discovery, man’s dominant view of malaria and mosquitoes has been that they are unqualified and unnecessary evils; and his dominant aim has been simply to get rid of them. Each time a new offensive weapon offered new hope, enthusiasts imagined that malaria would soon be wiped out. Only when the latest hope lay dashed did any considerable numbers of malariologists shift their thinking from an adversary to be conquered to an adversity to be tamed, mitigated and live with.
The question now is, does it mean that malaria cannot be totally eradicated?
Those who hold with militant view will see this history as a record of a war lost despite important victories on some battle fields. Many of those who took part in the most recent battles do in fact now suffer a sense of defeat. In extenuation some of them point out that their failure is not unique, that in fact one can find very few grand victories in such grand under-takings. That is true but it may also be instructive. Failure so universal, so apparently ineluctable, must be trying to tell us something. The lesson could be of course that we have proved incompetent warriors. It could so be that we have misconstrued the problem.
A lot of factors may have contributed to the resurgence, and this, of which poverty makes a lead. Drug compliance will surely lead to drug resistance by the enemies of man if taken incautiously.
The cause of malaria resurgence may also be as a result of neglect from the people who are supposed to celebrate the success thereby leaving problem to the course of the war lord’s to tackle it alone. This is why Malaria Eradication and Safe Health Initiative (MESHI), is currently undergoing a one day sensitization program in secondary schools in Awka.
•Malaria Eradication and Safe Health Initiative (MESHI), Awka
Dr. D.N. Aribodor PhD
The world's first potential malaria vaccine proved only 30 percent effective in African babies in a crucial trial, calling into question whether it can be a useful weapon in the fight against the deadly disease.
The surprisingly poor result for the vaccine, which GlaxoSmithKline has been developing for three decades, leaves several years of work ahead before a protective malaria shot could be ready for countries that desperately need one.
Malaria, a mosquito-borne parasitic disease, kills hundreds of thousands a year, mainly babies in Africa, and scientists say an effective vaccine is key to hopes to eradicate it.
Philanthropist Bill Gates, who helped fund the GSK vaccine's development, said further research was now needed to see whether and how it might be used.
"The efficacy came back lower than we had hoped, but developing a vaccine against a parasite is a very hard thing to do," he said in a statement.
Results from the final-stage trial with 6,537 babies aged six to 12 weeks showed the vaccine provided "modest protection", reducing episodes of the disease by 30 percent compared to immunization with a control vaccine, researchers said on Friday.
That efficacy rate a year after vaccination is less than half the 65 percent in an earlier trial in babies which analyzed protection rates after six months. It is also a lot less than the 50 percent rate seen in five to 17 month-olds.
Vaccinating babies, rather than toddlers, is the preferred option, since the new vaccine could then be added to other routine infant immunizations. A separate program for older children would involve a lot of extra costs.
Eleanor Riley, a professor of immunology at the London School of Hygiene and Tropical Medicine said the results showed that GSK's vaccine, called RTS,S or Mosquirix, is potentially useful, but "not the complete solution".
"The slightly lower than expected efficacy will ... affect the cost-benefit analysis that health providers and funders will have to undertake before deciding whether the vaccine represents the best use of limited financial resources," she said.
NOT GIVING UP
Despite the setback, Britain's top drugmaker said it would push ahead with developing RTS,S and GSK Chief Executive Andrew Witty said it could be an important tool in fighting malaria.
"We've been at this for 30 years, and we're certainly not going to give up now," he told reporters on a conference call.
GSK does not expect to make any profit from the vaccine, which would only be sold in poor countries.
Witty reiterated a promise that if RTS,S is ultimately approved for market, it would be priced at cost of manufacture plus a 5 percent margin, and the margin would be reinvested by GSK in malaria research.
Given the target market, it is governments and international groups that will fund the vaccine's roll-out, and they now need more positive data before deciding whether it is worth buying.
"We will have to have more information to give us a clearer idea as to how useful this vaccine will be," said Seth Berkley, CEO of the GAVI Alliance, which funds bulk-buy vaccination programs for poorer nations.
In particular, Berkley told Reuters he wanted to see longer-term data, including the effect of booster shots, and an analysis of how the vaccine performed in different settings.
Details of the malaria trial, which is Africa's largest ever clinical trial involving almost 15,500 children in seven countries, were presented at a medical meeting in Cape Town and published online by the New England Journal of Medicine.
Witty said he would have liked to have seen efficacy rates of around 50 percent in infants, but stressed that more data would become available before the trial ends in 2014 which may throw more light on why rates of success are so variable.
"It may open up a more customized approach to how this potential vaccine gets used," he said.
Malaria is caused by a parasite carried in the saliva of mosquitoes. It is endemic in more than 100 countries worldwide and infected around 216 million people in 2010, killing around 655,000 of them, according to the World Health Organisation.
Control measures such as insecticide-treated bed nets, indoor spraying and anti-malaria drugs have helped cut cases and deaths significantly in recent years, but scientists say it will take an effective vaccine and many more years work to wipe out malaria.
Scientists around the world are working on other potential malaria vaccines but RTS,S is by far the furthest ahead in development.
(Editing by Mark Potter and Jon Hemming)
African populations are extremely affected by Malaria
Malaria is caused by blood parasites transmitted from person to person through the bites of infected mosquitoes. In the absence of prompt and effective treatment, malaria often causes death.
The African Region accounts for 85% of malaria cases and 90% of malaria deaths worldwide. Malaria causes avoidable and often catastrophic spending for households and is an obstacle to the development of affected African communities and nation
Mothers and Children
85% of malaria deaths occur in children under five years of age. Every 30 seconds a child dies from malaria. Malaria episodes in pregnant women cause anemia, and other complications in the mother and newborn child.
People Living With HIV/AIDS
People Living With HIV/AIDS have a higher risk of recurrent malaria episodes and severe malaria.
Fighting malaria contributes to the attainment of several Millenium Development Goals (MDGs)
Reducing malaria burden contributes in particular to the attainment of the Millennium Development Goal 4 target of reducing under-five mortality by two-thirds by 2015 but also to MDGs related to poverty reduction, education, and maternal health.
African Leaders committed to the reduction of malaria burden
African heads of states and governments have committed to leading the reduction of malaria burden at the 2000 and 2006 Abuja Summits through ensuring universal access of exposed populations to essential malaria prevention and treatment interventions.
Malaria Burden can be reduced in Africa
As a result of the scale-up of use of insecticide-treated nets, Indoor residual spraying, intermittent preventive treatment during pregnancy and Artemisinin-based combination therapy, 10 countries in the WHO African region have reduced malaria cases by at least 50% between 2000 and 2008.
Health Systems Strengthening and Malaria Control have reciprocal beneficial effects.
Access to services and prevention and treatment interventions, procurement and supply of quality medicines and commodities, diagnostic capacity; routine surveillance, monitoring and evaluation concur to systems strengthening and progress towards national and international targets.
Engagement of all stakeholders is critical to intensify the fight against malaria
The support of all development partners to malaria control and other disease control programmes, maternal and child healt as well as education must be integrated in the broader context of a sustainable environment and development.
WHO advocates for the scale-up of proven cost/effective malaria control interventions.
WHO in collaboration with international, continental and regional partners advocates and provides normative guidance and technical assistance for the scale-up of essential interventions in order to reverse the incidence of malaria by 2015.
Primary health care and community empowerment and involvement are critical for the success of malaria control and progress towards its elimination
All African communities must own and take part in the fight against malaria, provide human and financial resources and develop alliances to conquer the scourge of malaria.
World Malaria Day will be commemorated on 25th of April 2012, under the theme "Sustain Gains, Save Lives: Invest in Malaria".
The 2011 WHO World Malaria Report indicates that the African Region accounts for 81% of the malaria cases that occurred worldwide. Over 90% of the deaths attributable to the disease occur in the Region and 86% of these deaths are among children below five years of age. Pregnant women, people living with HIV and AIDS and victims of disasters are also particularly vulnerable to malaria.
Charles Dickens' depiction of Magwitch grabbing Pip has stuck in my mind and, I suspect, in the mind of generations of scared school boys who watched or read "Great Expectations." The Kent churchyard, with its "lozenge shaped" tomb stones, in "marsh country down by the river," is now firmly on the literary tourist trail during the Dickens 200th anniversary. But few visitors will know that the "marsh ague" that filled these graves was none other than malaria.
The inscriptions tell a story familiar to millions of Africans: "Mary died in infancy, William 8 months, William 7 months, Francis, 17 months, James, 4 months, Elizabeth, 3 months, William, 8 months." Seven children under five dead in 12 years, all between 1767-1779. The family must have so much wanted a William to live but it was not to be. Malaria was then, as it is now, a child killer.
In contrast their illustrious contemporary, George Washington, survived his first bout of malaria in Virginia -- it was at the age of 17 -- but suffered periodic attacks until 1798. The fifth President of the United States, James Monroe, also caught malaria in "marsh country down by the river," by the Mississipi in 1795. Escaping death by malaria seemed almost to be a qualification for America's early Presidents.
The notion that malaria in the "West" was only a scourge of the 18th century is far from the truth. Abraham Lincoln survived attacks during childhood. War was a great ally of the disease and American Presidents remained notable victims until after J.F. Kennedy, who caught the disease during the Second World War. He followed in the footsteps of Andrew Jackson in the Seminole campaigns in the Florida swamps. The discovery of quinine began to change the picture in the 1840s, though it was only by the 1890s that the poorest could get access to the drug in significant numbers. That did not stop many hundreds of American troops in southern Italy dying from malaria during the Second World War. The malaria parasite remained a minor scourge for America into living memory.
So it always came as a surprise to me when, on both sides of the Atlantic, my Faith Foundation reported back about our interfaith campaign against malaria deaths that people sometimes said "but we don't get malaria here." True enough but memories are short. Teddy Roosevelt caught malaria in 1914, James Garfield, 20th President, caught malaria in Ohio in 1848 when he was 16 years old. The Pontine marshes around Rome were lethal until Mussolini drained them -- mainly for political effect. And Dickens' stomping ground around Rochester, Kent makes the point with great poignancy.
Tony Blair, ex-President Olusegun Obasanjo, and Nigerian religious leaders demonstrate use of bednets against malaria in Kuje, Nigeria with a volunteer and her child. Photo: Tony Blair Faith Foundation
The real point is that malaria was eradicated in the USA and UK because people realized that it was utterly preventable and set about preventing it with adequate resources to hand. And there are no reasons it cannot be eradicated in Africa and other endemic malarial areas too. Or rather there are several reasons all of which can be overcome with sufficient political will and application. It remains an entirely preventable disease.
World Malaria Day this year comes at a critical juncture for the massive global effort at malaria eradication. It has made extraordinary gains under the impact of some extraordinary people. I am thinking of Ray Chambers, the UN special malaria envoy, and, of course, Bill Gates. But there are countless lesser known champions against malaria deaths like Sheikh Conteh in Sierra Leone, Bishop Dinis Sengulane in Mozambique, Bishop Sunday Onuoha in Nigeria who are leading faith communities in national campaigns against the disease.
Faith leaders through the authority they hold, and the outreach and networks of their communities, can be powerful influences for the good in public health. Giving health messages and training others, just five malaria dos and don'ts to protect families, can, and does, save lives. I have seen this collaboration with Ministries of Health in Sierra Leone and Nigeria. It takes so little to protect the under-fives, an impregnated bed net, the knowledge of how to use it properly and cleaning up stagnant water. Two visits to the health clinic can save the lives of pregnant women who are particularly vulnerable.
Yet intensive national campaigns that reduce deaths significantly and open up the possibility of eradication cost money. International donors, the Global Fund and the US Presidents' Fund, make them possible. Under the impact of economic crisis they are faltering. Pledges are not being fulfilled. There is foot dragging. This could set the clock back and break the momentum across the world.
So World Malaria Day on 25 April highlights a critical year for achieving the most achievable of the Millennium Development Goals, halting and reversing the spread of malaria. We owe it to the Marys, Williams, Francis, James and Elizabeths of Africa not to reduce funding to the Global Fund, not to falter in this great endeavor.
Tony Blair is the former Prime Minister of Britain