Crossing borders: Sub-Saharan Africa is focus of efforts to defeat a killer
03/24/2013 12:00 AM
04/19/2013 8:21 PM
This is Ann. She drinks blood! Her full name is Anopheles Mosquito and she's dying to meet you!
Dr. Seuss' breezy 1943 account of malaria for U.S. soldiers captured the reality of this cross-border menace during World War II.
She can make you feel like a combination of a forest fire, a January blizzard and an old dish mop. You can't get malaria unless Ann plugs you, but if she does, she can make you just as dead as a shell can, or lay you out flat for a long, long stretch.
Seventy years later, malaria remains – 219 million cases a year and 660,000 deaths from this preventable, treatable disease. The distribution, however, is concentrated – 80 percent of cases and 90 percent of deaths are in sub-Saharan Africa.
The face of malaria today is not children's author Theodor Seuss Geisel's "party gal Ann" but an African child. Malaria is the No. 1 killer of children under age 5.
In 2005, with first lady Laura Bush affirming "our moral obligation to defeat malaria," President George W. Bush launched a five-year, 15-country anti-malaria campaign in Africa – a major legacy project that has expanded.
The long path
It is worth recalling that California took more than a century to eliminate malaria, which arrived in 1832 with infected fur trappers. In 1873, the new state Board of Health worried that California would have malaria "for centuries to come, if not for all time." The Central Valley, the board noted, was "specially proclivious" to malaria – with the largest death toll in Sacramento, Amador, El Dorado and Placer counties.
By 1910, Dr. L.R. Willson of the state Board of Health laid out a four-part plan for malaria control: draining and filling areas of stagnant water; floating oil on water surfaces to kill mosquito larvae; screening houses and using bed nets; and using quinine to treat and prevent transmission.
The University of California launched a campaign in the Sierra foothills – where malaria affected school and work attendance, caused suffering and hindered California's potential – to teach that malaria was carried by mosquitoes (not "swamp gases") and to demonstrate methods for control. Professor William Herms advocated legislation for a "larger, wider effort" to eliminate malaria.
It took several years to win pas- sage of a Mosquito Abatement Act, creating local mosquito control districts. The tipping point of the campaign was the 1939 discovery of DDT, the "miracle insecticide." Malaria was eliminated in the United States by 1951.
Unfortunately, due to heavy agricultural use, mosquitoes were developing resistance to DDT, which also was wreaking havoc on ecosystems. A Global Malaria Eradication Program, which started in 1955, ran up against this and increasing malaria parasite resistance to chloroquine, the main treatment. The World Health Organization ended the eradication effort in 1969.
Malaria came back, as I saw when I was a Peace Corps volunteer living in the Lowveld of Swaziland in southern Africa in the early 1980s. While water-borne diseases such as a cholera epidemic were more immediately pressing, malaria was a fact of life.
By the end of the 20th century, the malaria map was half of what it was in 1900, now concentrated in the tropics.
New global eradication strategy
Bill and Melinda Gates upped the ante in 2007, renewing the call for worldwide eradication. Their foundation put up significant funds, with the University of California landing millions. The international community now is embarked on an "everything" strategy to keep ahead of the ever-evolving mosquito and parasite.
Bed nets, indoor spraying and water management remain tools of choice against the mosquito – and scientists from five UC campuses, including UC Davis, are developing new insecticides and working on a genetically engineered malaria-resistant mosquito.
Low-cost drug treatments are key to battling the parasite. Researchers at UC Berkeley are working with San Francisco-based OneWorld Health, a nonprofit drug company, to reduce costs.
UC San Francisco is helping to shrink the malaria map, starting with the four southernmost African countries, which hope to eliminate malaria by 2015 – with Swaziland on target to be first. Most important are tireless on-the-ground efforts by local people, such as Simon Kunene and a corps of dedicated workers, who spread better understanding of malaria and tools people can use on their own to control it.
The aim is to keep pushing the border of the disease northward, eliminating malaria in the next four countries by 2025 – continuing until malaria is eradicated.
The holy grail, as with smallpox in earlier years, is a vaccine. While vaccines have been developed for bacteria and viruses, a vaccine for a parasite remains elusive.
Professor Randall Packard of Johns Hopkins University, author of "The Making of a Tropical Disease: A Short History of Malaria," believes the lesson from the past is that biomedical approaches alone won't defeat malaria. Continued malaria control and economic growth efforts that would allow people to afford better houses, adequate diets, bed nets and medicines remain important.
As President Bush said in 2007, defeating malaria doesn't require a miracle but a "smart and sustained campaign," each of us around the world contributing in his or her own way.
What you can do
Find out about bed nets for children at Nothing But Nets: www.nothingbutnets.net/.
The President's Malaria Initiative also lists organizations that provide malaria assistance: pmi.gov/about/donors.html.
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