PUBLIC HEALTH BACKGROUND
HISTORY:
In the 1950’s and
1960’s there were major eradication efforts undertaken worldwide to help stop
the spread of malaria. Funding
came mainly from the developed countries, so as malaria was eradicated throughout
North America and Europe, much of the involvement and funding stopped. There was also the added difficulty
that the majority of the problem with malaria was in undeveloped countries
whose problems went far beyond treatment and environmental regulation adjustment
to more structural geopolitical and public health problems. With eradication as the world programs’
unrealistic goal, interest and money soon dwindled and there was a serious
decline in public health output after 1969, paralleled by a huge increase in
the burden of malaria. Today focus
has shifted to a different approach: one of control and treatment rather than
eradication. But the need for a
worldwide push like that of a few decades ago is still prevalent and is
becoming more and more urgent.
A NEW CAMPAIGN?
Why should
the world rally to prevent this disease in a time of much more seemingly
imminent problems? While it’s true
that malaria has been a major problem for an exceedingly long time, the death
rates from malaria in Africa and Asia are astronomical and only getting higher
as time goes on. Complications
from fairly recent developments such as first line drug resistance, insecticide
resistance and public health infrastructure flaws are merely complicating the already
failing public health efforts. Our
expanding knowledge on the situation is also make efforts much clearer. Breakthroughs with the genome of A.
gambiae and P. falciparum promise progress in the areas of research and
development, but also heightened awareness of the spread of this disease has
altered the suggested approach.
With the possibility of expansion to the undeveloped areas that lack a
public health system, the control of malaria could rapidly improve. The push by the world community has also
already begun, making the process that much easier and that much more likely,
though funding continues to be a major challenge.
With
all these new developments, the fight against malaria has a promising
beginning. This new approach needs
to take these into account, and develop a system including 5 major
components. 1) a focus on the most
afflicted regions as this is where we failed last time. 2) A recognition of the specificity of
site, vector, and population activity as affecting the approach taken,
especially those variants that occur within political boundaries. 3) the pursuit of 2 tracks: both
prevention and treatment through current technology and an increase in research
and development. 4) Constant and
reliable funding for at least 2-3 decades as without this duration progress
will be limited and short-lived.
And finally 5)a blend of disease-specific controls (drug treatments
etc.) with more wide spread approaches, such as the development of a more
stable public health infrastructure in undeveloped regions.
Sources:
Morel, Toure, Dobrokjotov, Oduola, The Mosquito Genome—A
Breakthrough for Public Health. Science. 2002 Oct 4; 298 (5591): 122-4
Sachs, Jeffrey D. A New Global Effort to Control Malaria. Science. 2002 Oct 4; 298
(5591):122.
Tan DH, Upshur RE, Ford N., Global Plagues and the Global
Fund: Challenges in the Fight Against HIV, TB and Malaria. BMC Int. Health and Human Rights. 2003 Apr ; 3: 2.
For more information
contact lvogel@stanford.edu