Malaria is a coiled spring

Malaria Mosquito
Flickr, ACJ1

The world has made great strides against malaria, bringing down the estimated global death toll from more than a million — mostly children — to about 650,000 per year today.

That’s been done through a concerted and diversified strategy supported by the international community, through the Global Fund to Fight AIDS, TB and Malaria, Roll Back Malaria, the President’s Malaria Initiative … the list goes on, and on. Countless organizations, public as well as private, have helped distribute hundreds of millions of insecticide-treated bednets, anti-malaria medications, conducted spraying campaigns and worked on a number of fronts to achieve these major gains.

But the situation remains precarious, says one of the world’s leading malaria experts, and malaria today is perhaps  best thought of as a coiled spring held down under pressure.

WHO's malaria chief Dr. Robert Newman describes the massive, mostly hidden, burden of disease
WHO’s malaria chief Dr. Robert Newman describes the massive, mostly hidden, burden of disease

“In one year, if we don’t keep up, we could easily undo this past decade of progress,” said Robert Newman, director of the global malaria program at the World Health Organization. Newman was in Seattle recently and gave a talk at the University of Washington describing the current state of affairs in the battle against malaria. “I’m concerned that we may not be keeping up.”

Today is World Malaria Day and there’s lots of stories out there celebrating the progress we’ve made so far – with stories about how some countries are close to completely eliminating malaria, how we are now using cell phones to assist in the fight or how a malaria vaccine could be just around the corner. But there are also the stories about rising resistance to malaria drugs, about how we aren’t really that close to finding a vaccine and about malaria spreading into new corners of the world.

What worries Newman most is money, not enough of it, as well as the tendency to largely focus on malaria mortality while neglecting the much larger ‘army in waiting’ represented by asymptomatic carriers of the infection – or those not diagnosed with the infection.

“We are doing a better job of preventing people from dying,” Newman said. But we’re not doing a very good job, he said, of tracking down and reducing the spread of the parasite within the at-risk population in general.

One of the issues few in the global health community like to talk about in public, Newman said, is that the international community’s approach to fighting malaria — though successful in the short term — isn’t addressing the long-term risk of reducing natural immunity. Most adults are asymptomatic with malaria infection, having developed immunity over time due to exposure. If we continue to reduce exposure in children, many are prevented from dying – but are then also at risk later because they have developed no natural immunity.

“Getting people to pay attention to this problem, to the fact that fighting malaria isn’t all about bed nets, isn’t easy,” Newman said. His organization, WHO, only recently updated its approach to surveillance and tracking of malaria — after 50 years.

“Malaria control over the past decade has been like compressing a spring,” Newman said. “If we let the pressure off, the disease will be spring back … and even be worse.”

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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org, follow him on Twitter @tompaulson and/or send a comment below.