This week Sam McManus gives us an assessment of the prospects for malaria eradication in an interesting feature article.
Outside the Balseskin Refugee Centre the rain falls hard on a potholed football pitch, the rusting goalposts framing a slate grey sky. In the centre’s health clinic where I sit the decor is as unrelentingly drab as the sky outside. The doctor I am with calls a patient from the waiting room and a sad eyed young Nigerian woman quietly enters. Her bright orange and green robes throw the greyness of the surroundings into relief. On her back is a tiny bundle. She carefully unwraps it revealing a mewling four-month-old girl, her thin limbs outstretched as if beseeching me.
The infant has had a fever for 24 hours the woman says. The doctor immediately runs through a checklist. When did they leave Nigeria? Has she or any members of her family suffered from malaria? The answers to these questions soon has him reaching for the phone to call an ambulance. Even here in Ireland, thousands of miles from the tropics, malaria extends its blighted reach.
The child we have seen is lucky to have fallen sick in easy reach of First World resources. Her chances of survival are excellent. The 850,000 people, mostly children, who died of the disease last year were not as fortunate.
Sam McConkey, now a professor of international health, worked on a malaria ward as a young doctor in Sierra Leone. “It’s a life changing experience to look after children who die despite your best efforts,” he tells me.
The experience made him dedicate himself to the search for a malaria vaccine. A viable vaccine is the long-looked for “magic bullet” that would send malaria the way of small pox.
“The most recent vaccine is 40%-50% effective,” McConkey says. “That’s not good enough, but I am optimistic about it. I like to compare it to the first motor car. It travelled eight miles an hour and was inviable as a mode of transport. But it heralded the car as we know it. Hopefully, we can have the vaccine equivalent of the Model T Ford before long’.
Few are pinning their hopes in the short term on a vaccine, but is progress being made on other fronts? The creation of the Global Fund and the setting up of the Roll Back Malaria campaign a decade ago raised hopes while the private jets of celebrities such as Bill Gates and Bono have been a regular feature at international malaria conferences.
Dr. Malcolm Molyneux who has lived in Malawi for nearly four decades while working on malaria has noticed a difference “In practical terms, things are a huge way on from where they were. Ninety percent of households have bed nets; rapid diagnostic tests and ACT’s, the malaria drug, are becoming more widely available”.
In countries such as Gambia and Zanzibar there has been a marked reduction in malaria deaths over the past five years as a result of these measures. Might these countries act as a model by which malaria can be controlled and then eradicated? Doctor Molyneux is quick to council caution.
“Eradication is not a reasonable (short term) aim. It is maybe forty years away. We need to gradually chip away at things until the goal of eradication appears in the distance”.
Of course, malaria has been eradicated before. The sleepy valleys of sicily and calabria once harboured the disease that in the 1950’s killed up to twenty thousand people a year. Malaria in Italy was eradicated after a concerted five year campaign. If in Europe why not in Africa? Sonia Shah, author of “The Fever: How Malaria Has Ruled Mankind for Five Hundred Thousand Years” explains: “we pretty much know that if we brought all the cities and rural areas in sub saharan Africa up to the level of Europe that would work, but of course, that is not going to happen in the short term’. For the present she echoes Malcolm Molyneux’s call for perseverance. “We need to be in this for the long haul. No expert really believes that there will be zero deaths (from malaria) in a handful of years.’
Despite new momentum in the fight against malaria, the reason that the effort to eradicate malaria is not moving at a faster pace, both Shah and Molyneux agree, remains a lack of political will and funding. The WHO estimates a short fall of $4 billion in malaria funding a year. When Western economies are creaking under double dip recessions and governments are spending trillions of dollars to shore up their banking systems, those combatting malaria must fight to keep the disease on the agenda while making do with limited resources.
For now, NGO’s and local volunteers work on the problem as best they can. As Shah says “we are not going down the right road, we are going down the only road we can go down”. In some places, such as Gambia and Zanzibar, lives are being saved. In others, like the Democratic Republic of Congo, the disease runs as rampant as it ever has.
Back in the doctors room in Balseskin the mother of the feverish infant holds her close to her breast as we wait for the ambulance to arrive. Outside there is no sign the rain is going to stop anytime soon.