Malaria can be totally eradicated by 2050

Every two minutes, a child under 5 dies of malaria.

It's one of the most deadly diseases in the world, and we've been trying to eradicate it for decades. We have made a lot of progress: more than half of the world's countries are now malaria free. Net distribution is estimated to have saved 6.8 million lives. And the number of children under 5 who died as a result of the disease has increased from 440,000 in 2010 to 285,000 in 2016.

But that leaves 285,000 children too many. Scientists are now saying that there is no reason why we can not eradicate malaria. And there is no reason why we can not do it in a generation, if we play our cards well.

"For too long, eradicating malaria has been a distant dream, but we now have evidence that malaria can and must be eradicated by 2050," said Richard Feachem, co-chair of the World Health Organization. Lancet Commission on Malaria Eradication, which has just released the results of a major new study funded by the Bill and Melinda Gates Foundation.

"But to achieve this common vision, we simply can not continue with a status quo approach," Feachem added. "The world is at a turning point, and we must instead set ourselves ambitious goals and engage in the bold action necessary to achieve them."

The study proposes a roadmap for overcoming malaria, a disease transmitted to humans through the bite of infected mosquitoes, which can cause problems ranging from fever and chills to severe respiratory problems or death. He recommends focusing on three areas: what he calls the "eradication" "software" (think of general skills, such as management training), the "material" of eradication (think of molecular technology for diagnosis) and the financial investment needed to make it happen. .

And it is crucial to ensure that this happens, because malaria is not just a health problem, it is also a problem of equality, of social justice. This disease is preventable and curable – in fact, Malawi and Ghana have recently tested a new vaccine – but low-income people and rural people still die because they often do not have access to treatments that could save them life. The disease is particularly prevalent in poor countries, particularly in sub-Saharan Africa, as well as in the Indian subcontinent and in South-East Asia.

At a time in history when we are armed with sound scientific bases and sufficient resources to deploy it, letting malaria remain a death sentence is undoubtedly ethically indefensible. Moreover, as the study notes, liberating a country from malaria means liberating it so that it can use its resources for other purposes, thereby enhancing its development and economic prosperity.

How to "bend the curve of malaria"

If you had to draw a graph showing the incidence of malaria over time, you would find that the curve is generally decreasing. However, the study authors note that progress stagnates sometimes and that between 2015 and 2017, 55 countries actually reported an increase in the number of cases. Our goal should be to "bend the curve" so that it reaches its goal more quickly and consistently.

So, how do we do that?

Launched in 2017 by the Global Health Group of the University of California at San Francisco, the Lancet Commission has developed a machine learning model to capture the complex associations between malaria and a variety of factors. current socio-economic (such as urbanization) and environmental (such as climate change). Using projected global trends, they mapped these factors in 2050 to see how they might affect the future global malaria landscape.

For example, with the increase in temperature and rainfall worldwide, the prevalence of malaria to increase in some parts of the world? What will the future look like if, at this moment, we do not intervene at all, a little or a lot?

The simulation shows us what 2050 will look like if we continue to intervene at the same level as we intervene in 2017:

Lancet Commission

It's not so terrible; Malaria is still quite common. But let's look at what happens when we improve our antimalaria intervention, by deploying more insecticide-treated mosquito nets than in 2017. The simulation shows that we can practically have very little malaria in Africa. Here 2050.

Lancet Commission

If we add new interventions that can reasonably be expected to be available in the next few years, the authors say that we can eradicate malaria altogether. Here's how they think we should get there.

1. "Software" improved eradication: One of the biggest problems hindering progress in the fight against malaria is, quite simply, the lack of management training for the managers and staff of national malaria programs. Making this training more widely available would increase the quality of operations and ensure the judicious use of financial resources.

We must also provide managers and staff with access to more accurate, detailed and up-to-date malaria data, including data on the evolution of antimalarial drug resistance, to enable them to make more effective decisions. And we need to educate and encourage local communities to be active in malaria prevention.

2. New "equipment" for eradication: We must create and deploy innovative tools to overcome biological barriers to eradication. This includes investing in new rapid diagnostic methods, new long-lasting insecticides and new drugs. The last two are particularly crucial in this period of increasing resistance to drugs. Malaria parasites still develop resistance to commonly used drugs, as well as to insecticides like those used to treat mosquito nets.

The study also asks us to explore novel approaches such as gene transfer, which would involve modifying the DNA of a few mosquitoes, then releasing them to propagate throughout an entire population. We could change mosquito species so that all their offspring are males (thus reducing their populations) or add a gene that makes them resistant to the malaria parasite (thus preventing transmission to humans). If you want to better understand how a gene player works, watch this video from Vox:

3. The financial investment: We need to mobilize new donors around the world while demanding more national funding. The authors note that we should be ready to increase our global spending on malaria by $ 2 billion a year. We are currently spending just over $ 4 million, but annual spending of about $ 6 billion is likely to be required for eradication. If this sounds prohibitive, be aware that the United States spends more than $ 6 billion a year on toilet paper.

The commission envisions that a quarter of the $ 2 billion comes from an increase in development aid provided by external donors, the rest coming from governments of malaria endemic countries.

Finally, the authors note that success in all these areas will depend on strong leadership and accountability mechanisms. They recommend creating an independent supervisory board for the eradication of malaria.

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