By Mark Dybul
Mosquito-borne parasites know no borders, as the Zika virus in Latin America has reminded us this year. While the impact of Zika is still being assessed, we know that malaria kills hundreds of thousands of people a year, most of them young children. Malaria is a preventable and treatable disease, and we are determined to end it.
We have to looks past borders, just like infectious diseases do.
Our most effective weapon against malaria – building on preventive measures and rapid treatment – is strong partnerships that can constantly adapt to changing situations on the ground.
The Greater Mekong region in South East Asia is a lesson in how partnerships and new thinking can come together to confront global health risk. After years of careful investments, the malaria situation in the Greater Mekong region has improved dramatically, with sharp declines in cases and deaths. However, the region still faces huge challenges, with high transmission taking place along borders and in remote forests.
Most urgent, the emergence and spread of resistance to the drug artemisinin – the most commonly used drug against malaria – threatens to undo hard-fought gains, not only in the region but worldwide. Artemisinin-resistant malaria could be globally devastating if it arises independently in other geographies or crosses more borders, especially to India, the gateway to Africa. To deal with this public health emergency, a partnership of external funders, multilateral agencies, technical partners, scientific researchers, local communities and governments came into being. It’s an audacious and ongoing goal, ripe with challenges and opportunities, and one that calls on us to work with a clear mission and perseverance as we fight an elusive enemy.
The Global Fund partnership is backing a smart regional initiative with a US$100 million grant to tackle artemisinin resistance in Myanmar, Thailand, Viet Nam, Laos and Cambodia, with a special focus on mobile populations such as farming communities and seasonal agricultural workers. The Regional Artemisinin-resistance Initiative (RAI) has galvanized strong political commitment from East Asian leaders to achieve the goal of a malaria-free Asia Pacific by 2030. Countries are now saying that to end this devastating disease, control is not enough, and that to stamp out malaria we need to work together, with deeper cross border collaboration and regional data sharing.
To speed up the response to artemisinin resistance, the World Health Organization has developed a regional strategy for malaria elimination, providing a framework for all stakeholders. The investments have stimulated the use of innovative approaches to eliminate malaria, such as piloting mass drug administration in “hot spots” in hard-to-reach border populations along Thailand and Myanmar.
A significant number of people in low transmission areas harbor malaria parasites without apparent illness, detectable only by highly sophisticated laboratory tests, meaning that conventional malaria activities cannot identify these people. Data from the mass drug administration pilot shows that the plan has been a success. Other tools to roll back the disease include the use of malaria posts – simple structures that provide access to reliable diagnosis and effective treatment for any fever cases from the community - and the training of village health workers. Disease elimination is not possible without strong community engagement and a high level of community participation. Eliminating malaria is not just about using the right drugs or the right insecticide-treated nets. It is also about trust and knowing the people we serve.
Similarly, no battle can be fought without enhanced surveillance and data analysis. Intelligence in real-time is crucial to adapt and respond effectively to a rapidly changing front-line, including the use of an on-line database system for continuous monitoring and for the sharing of information among all partners and stakeholders.
We still face big challenges. Malaria is well entrenched in communities, and the mosquito parasite and humans have evolved side by side. Resistance is an evolutionary phenomenon. Over time, as we attack malaria with a new drug the parasite fights back and develops resistance. In Cambodia, the spread of resistance to artemisinin and also to the partner drug used in the combination therapy threatens to drive both drugs to uselessness. In such cases, the flexibility of the RAI structure allows us to follow national programs and change the partner drug.
Our ability to succeed will ultimately depend on the resilience of our partnerships. RAI is a terrific example of working together, in an interconnected world, to end this malaria.