Published in The Hindu on October 28, 2011
When the World Health Organisation published its revised guidelines for malaria treatment in March 2010, just four years after it came out with its maiden version, an editorial in the British Medical Journal (BMJ) was quick to highlight its significance. It was a “testament of how quickly malaria control” had developed and a “marked reduction in the global burden of malaria” had been achieved. A WHO report now confirms this assessment. There has been a 20 per cent drop in the number of malarial deaths during the last decade — from about one million deaths in 2000 to about 800,000 in 2009. The number of infections fell from 233 million to 225 million. About a third of the 108 countries where the disease is endemic may be able to eradicate it in a decade if all targets continue to be met. In India, the annual number of confirmed cases has remained “stable” at 1.5 million since 2007. But according to a 2008 WHO report, the number of cases reported by countries was “only 37 per cent of the estimated global incidence.” And the gap between reported numbers and true incidence “was greatest in [the] South-East Asia region,” where 10 of the 11 countries were malaria endemic. This gap certainly exists in India. The data collection is poor and is mainly confined to the nine States that are highly endemic — Arunachal Pradesh, Assam, Meghalaya, Tripura, Orissa, Chhattisgarh, Madhya Pradesh, Jharkhand, and West Bengal.
The battle against mosquitoes can be won when an efficacious vaccine becomes available. Interim results of a Phase-III trial undertaken in seven African countries on more than 15,000 children of two age groups — 6 to 12 weeks and 5 to 17 months — show some promise. Fifty-five per cent protection was seen in children belonging to the older age group. However, efficacy declined with time, and adverse events like meningitis and seizures were observed in the vaccinated children. Although complete results will be available only by 2014, WHO has taken the “unusual step of recommending” the vaccine for use in some African countries by 2015 if the final results turn out to be favourable, as The New England Journal of Medicine notes in an editorial. In the absence of a vaccine, insecticide-treated mosquito nets and indoor spraying will continue to be the two potent preventive weapons. Though the preventive tools were able to cut malaria cases and deaths by half in 11 African countries, the malaria control programme could be declared successful only when the disease ceases to be a mass killer in Africa and South-East Asia.