Eradicating malaria

Lost in the deluge of news about Covid-19 vaccines have been the momentous strides made recently in fighting other major health challenges. Among these is malaria. In April, it was announced that a vaccine developed at the University of Oxford's Jenner Institute had achieved 77% efficacy in trials. While we may still be several years from an effective guard against a disease that afflicts more than 200 million people each year, there is a sense that we're significantly closer to that goal than ever before.

Yet the vaccine's very potential to eradicate malaria could, perversely, undercut the support necessary to achieve reality. Malaria is an example of where the needs of the Global South, or developing world, clash against the interests of the Global North, or developed world.

First, a caveat. It must be noted that the vaccine trial in Burkina Faso was small, involving 450 children over one year in an area where malaria is not present year-around. Longer-term monitoring, and larger trials, are the next stage in confirming these early results. But the findings thus far offer a tantalizing glimpse of real possibilities.

Malaria is a parasite transmitted by the anopheles mosquito feeding on human blood, which can lead to fevers, severe anemia and severe damage to organs. With some types of malaria, the disease attacks brain function. Around 95% of cases and deaths are in Africa. Children under age five account for around two-thirds of the 400,000 yearly deaths around the world.

However, malaria historically is not a disease confined to the Global South. The disease's very name Italian, literally "bad air" - highlights the extent of its historical presence in Europe. It was endemic in the UK and the Netherlands into the 20th century, and Italy was not declared malaria-free until 1970.

The first efforts to eradicate malaria began in the 1950s under the World Health Organization's Global Malaria Eradication Program (one that - shamefully decided to leave sub-Saharan Africa out of the "global" campaign), making use of the anti-malarial drug chloroquine and spraying large areas with the insecticide DDT.

Attention on malaria revived in the late 1990s with the creation of the Roll Back Malaria campaign, and the focus on the disease as one of the "big three" global health challenges in the UN's Millennium Development Goals (MDGs), and as the main focus of organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Bill & Melinda Gates Foundation.

Through the distribution of insecticide-treated bednets, the development of new drugs to treat malaria and renewed efforts to control mosquito populations, malaria deaths have halved over the past two decades. And the new Oxford vaccine offers the possibility of cutting deaths significantly, perhaps to the low tens of thousands, within a few years of a successful vaccine being rolled out.

But caution is still required. First, what is clear from the history of malaria control, and the global response to health challenges over the past half-century, is that successful health programs require sustained and focused attention and support.

Progress against malaria made in places like Sri Lanka and elsewhere by the 1970s was subsequently undone as global funding for control efforts fell. And as strange as it may seem, success sometimes can pave the way to failure.

The renewed focus two decades ago on malaria, alongside the human immunodeficiency virus (HIV) and tuberculosis, in the MDGs and in international organizations were not just a reflection of the terrible toll these diseases have taken in the Global South, and especially Africa, but a recognition that they posed threats to the health security of the Global North, too.