Significant progress in malaria control has stalled.  Here's how to get it back on the right track - Professor Heather M Ferguson

Significant progress in malaria control has stalled. Here’s how to get it back on the right track – Professor Heather M Ferguson

Mass distribution of insecticide-treated bed nets has helped significantly reduce the spread of malaria, but progress has faltered in recent years (Photo: Paula Bronstein/Getty Images)

Parasites have become resistant to drug treatment, and mosquito control has been limited.

However, several breakthroughs in the early 2000s began to turn the tide. In 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria received unprecedented funding. New highly effective drug treatments became available, and mass distribution of one of the most effective mosquito control methods began: insecticide-treated mosquito nets.

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Combined with improved health systems, this malaria halved the prevalence of malaria in Africa between 2000 and 2015.

However, progress has now faltered, and we have seen little change in prevalence since 2015. Infections and deaths are even on the rise in some African countries.

Several factors have contributed to this reversal, including until recently only one class of insecticide approved for treated nets. Severe resistance to this class is becoming widespread in mosquitoes across Africa, and worrying signs of resistance to current drugs have been reported. Mosquitoes also turn to bite outdoors and in the early evening when people are not protected by nets.

Despite these challenges, hope comes from several directions. This includes the recent approval of the first malaria vaccine by the World Health Organization. Despite only partial protection, trials in four African countries have shown that this vaccine can reduce malaria deaths by 70 percent when combined with malaria prevention. This vaccine works by stimulating an immune response to the stages of the parasite that mosquitoes inject into the bloodstream during a bite.

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In my role as co-chair of the World Health Organization’s Vector Control Advisory Group, I have noted tremendous recent progress in new approaches to mosquito control. These include the development of high-tech approaches such as new chemicals to insecticides that overwhelm mosquito resistance, drugs that humans or livestock can take to make their blood deadly to mosquitoes, spatial repellents that drive mosquitoes away from homes, and genetic modifications that reduce mosquito populations.

Some are already used in countries where malaria is endemic, such as insecticide-treated bednets that contain piperonyl butoxide, a chemical that prevents mosquitoes from developing typical resistance responses.

To maximize impact, innovations must also be combined with new thinking about ‘old ways’. For example, targeting juvenile malaria mosquitoes in their aquatic habitats helped eliminate malaria from Europe but was often considered too difficult in Africa.

However, new research led by colleagues from the Ifakara Health Institute in Tanzania and elsewhere is developing better ways to identify these habitats and treat them with mosquito repellants. Home screening is also simple and very effective against malaria.

These new and renewed interventions are cause for optimism, but they are insufficient without increased investment in research, people and control programs in endemic countries.

Funding for malaria control has not risen since 2012, and experts in the Global South are still struggling to get funding. By supporting research leaders in endemic countries, the fight against malaria will not fail.

Heather M Ferguson is Professor at the University of Glasgow’s Institute for Biodiversity, Animal Health and Comparative Medicine, and a Fellow of the Royal Society of Edinburgh. This article expresses her own opinions. RSE is Scotland’s national academy, bringing great minds together to contribute to the social, cultural and economic well-being of Scotland. Find out more at rse.org.uk and Tweet embed



2022-05-09 15:49:37

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