Can Malaria Be Stopped?

In her recent OpEd for The New York Times, Pulitzer Center grantee Amy Maxmen discusses seasonal malaria chemoprevention (SMC) as a means of fighting malaria in Africa–an approach supported by the World Health Organization (WHO) as well as local African mothers participating in SMC campaigns.

In 2010 there were an estimated 219 million cases of malaria that occurred worldwide; 660,000 people died of the disease, with 91 percent of those deaths occurring in the African Region. Although the disease is both preventable and treatable, it continues to claim millions of lives each year.

But with SMC there is hope. SMC is a treatment plan in which healthy children receive a cocktail of older malaria drugs, including SP (sulphadoxine and pyrimethamine) and amodiaquine, in order to halt the disease, much like "tourists visiting malaria-ridden countries." The idea is that by administering these drugs during the rainy season—from July to November—when the disease typically strikes, fewer children will be left vulnerable. Maxmen has reported on this issue for Nature and Scientific American.

According to the WHO, employing this prevention method in Mali, Togo, Chad, Niger, Nigeria, and Senegal where the disease is strictly seasonal could prevent hundreds of thousands of malaria deaths per children among children. This represents monumental improvement given that in Africa malaria claims approximately one child's life per minute.

So what's the problem?

Aside from the fact that this prevention method is only being advised for regions where the disease is seasonal, there is a major risk associated with chemoprevention: drug resistance. "For every drug you give, you will increase the risk of drug resistance," says Alassane Dicko, a malaria researcher at the University of Bamako in Mali.

For some, including Dicko, chemoprevention is worth the risk. Large clinical trials recently demonstrated that SMC averts close to 75 percent of severe malaria cases, compared to the 30 percent of malaria cases temporarily reduced by the leading vaccine. This mechanism could mean that thousands of children typically bedridden due to malarial fevers will be able to continue their studies and their mothers will be able to continue working, saving families hundreds of dollars each year.

But chemoprevention is only an option in places where malaria is strictly seasonal, such as West Africa. Reducing the prevalence of the disease elsewhere will depend on addressing a number of other problems including inadequate medical care, substandard sanitation, counterfeit drugs, and insufficient funding.

In Ghana, the absence of public trash bins and open defecation lead to stagnant gutters which become breeding grounds for mosquitoes. Pulitzer Center student fellow Diksha Bali's project on waste management in Ghana featured interviews with local government and private waste management officials who discussed this serious and under-reported issue. While some are focused primarily on the short-term effects of this unpleasant situation, the long-term effects—which include spread of pestilence and vermin—are serious and extensive.

In countries like Tanzania and Uganda, the problems are not related to the spread of the disease but rather, its treatment.

As Pulitzer Center grantee Kathleen E. McLaughlin reports in her project, China's Aid in Africa: Good Intentions Mix with Bad Drugs, in countries like Uganda up to one third of all the available malaria cures are either fake, substandard, or counterfeit.

According to McLaughlin, who traveled to Tanzania and Uganda to investigate this problem, the fakes are so good they can even fool medical professionals. Some of the "fake pills bear the same inscriptions as real drugs, but contain little or no real medication. Only lab tests can spot the bad drugs, and testing equipment is scarce and expensive," says McLaughlin. And the intensity of the disease in this region leaves little room for error: the difference between a real drug and a fake can mean the difference between life and death.