The massive use of resources to tackle the pandemic generated by SARS-CoV-2 can worsen other health problems. Ongoing strategies to reduce mortality caused by diseases as deadly or more deadly than COVID-19 may be left behind. Malaria is one of the examples. So much so that in November 2020 the World Health Organization requested that measures to fight the disease be strengthened.
The Global Malaria Strategy 2016-2030 was approved by the World Health Assembly in 2015. Its bold goal is a world without malaria. It is intended that by 2030 the burden of mortality from this disease will be reduced by 90%.
More than 200 million new cases are diagnosed annually. The World Malaria Report 2019 indicates that 93% of cases and deaths occur in sub-Saharan Africa. More than half were diagnosed in Nigeria, the Democratic Republic of the Congo, Uganda, the Ivory Coast, Mozambique, and Niger. More than two-thirds of the deaths, some 400,000 in 2018, were in children under the age of five. Since 2000, cases and deaths have fallen significantly, but in recent years the decline has stalled. Malaria is advancing in some countries, especially in Latin America.
One hundred years ago, malaria was endemic in a very wide swath that included Europe and North America. Only a few imported cases appear in these areas today. In Spain the disease, known since ancient times, was declared eradicated in 1963.
Malaria (from medieval Italian “bad air”) or malaria (from paludis , genitive from the Latin term palus : swamp or swamp) is a disease produced by parasites of the genus Plasmodium. For centuries, the cause of the typical fevers of the disease was attributed to certain conditions that created a “malarious environment”.
Alphonse Laveran identified the causative agent of malaria in 1880. Between 1891 and 1892 the different species of the parasite were described. The role of the different species of the Anopheles mosquito as a transmission vehicle was clarified by Ross and Masson between 1897 and 1899. Around 1902 it was possible to propose intervention strategies. The antimalarial campaigns included actions against mosquito larvae, mosquito nets, isolation of houses and the preventive use of quinine.
Chloroquines arrived, but malaria did not go away
The subsequent use of other preventive measures, such as the insecticide DDT, generated some optimism in the fight against the disease. One more step was the appearance of chloroquine, a synthetic drug that made it possible to overcome the shortage of quinine. It was an optimism extended to all infectious diseases. In the 1960s editions of Burnet and Davis’s Natural History of Infectious Diseases manual it was stated: “In many respects it can be said that the first half of the twentieth century marks the end. of one of the most important social revolutions in history: the virtual elimination of infectious diseases as a significant factor in social life ”.
Malaria, however, did not disappear from the planet. Attempts to globalize antimalarial measures developed by the League of Nations Hygiene Society and, later, the World Health Organization, were not as successful as expected. Vertical type strategies were used. This was the case with the use of DDT and chloroquine in World War II. The disease had become a problem for the allied armies. It was said to be more dangerous than enemy bullets.
Comprehensive actions were less used. Its objective was structural changes and improvements in the living conditions of the populations. In addition, public health systems should be strengthened. Decades later, malaria continues to be a serious problem worldwide.
The search for an effective and safe vaccine is very recent. The RTS, S / AS01 (RTS, S) vaccine is the first and, to date, the only effective one. It makes it possible to significantly reduce the incidence of the disease and the potential lethality for African children.
Covid-19 and its impact on malaria
On World Malaria Day (April 25), 2019, the first universal childhood malaria vaccination campaign began. According to Pedro Alonso, director of the malaria program of the World Health Organization: “this vaccine will not be the definitive solution, but it has the potential to save thousands of lives and, therefore, will contribute to the economic and social development of some of the most disadvantaged areas of the planet ”.
In the current situation, against the background of the pandemic, some authors have made very worrying estimates. In 2020, in the worst-case scenario, deaths from malaria in sub-Saharan Africa would be about 769,000. It would mean returning to the mortality rates of the beginning of the century. The cause would be the suspension of the distribution campaigns of insecticide-treated nets and the reduction of access to effective antimalarials.
The hopes generated by the vaccine against covid-19 should not obscure other infectious diseases whose eradication is, today, impossible. Failure against malaria can be a good vaccine for the virus of exaggerated optimism.
Rosa Ballester Añón, Emeritus Professor of History of Science, Miguel Hernández University and Enrique Perdiguero-Gil, Professor of History of Science, Miguel Hernández University
This article was originally published on The Conversation. Read the original.
