Learning to Outwit Malaria: Dr Robert D Newman Tells the WHO Bulletin Why Malaria Programmes Don't Make Headlines, Why Rapid Diagnostic Tests Are the Hottest New Technology and Why Eradication Is the Only Acceptable End-Goal in Beating This Ancient Scourge

Bulletin of the World Health Organization, January 2011 | Go to article overview

Learning to Outwit Malaria: Dr Robert D Newman Tells the WHO Bulletin Why Malaria Programmes Don't Make Headlines, Why Rapid Diagnostic Tests Are the Hottest New Technology and Why Eradication Is the Only Acceptable End-Goal in Beating This Ancient Scourge


Q: The WHO malaria eradication campaign of the 1950s and 1960s failed, so why did the Gates Foundation resurrect that goal 30 years later and why did WHO endorse it?

A: I wouldn't want to speak for the Gates Foundation, but I do believe that eradicating malaria is the only morally acceptable end-goal, one that will take 40 years or more to achieve. Today, it's possible to reduce malaria in the places where it's worst and to eliminate it from the fringes where it is already low. But it's not possible to take the centre of Africa and reduce malaria to zero with today's tools.

Q: There is a long history of efforts to control malaria, from the League of Nations' Malaria Commission of the 1920s to the abandoned eradication campaign of the 1950s and 1960s. What is different today?

A: First, the tool kit is broader. People know that it's not going to happen with a single wonder drug or insecticide, but a complicated mix of insecticide-treated nets, indoor residual spraying, better diagnostic testing, better antimalarials and new tools on the horizon. Also, we have realized that no one organization can do this alone. It needs to be a global partnership, as with Roll Back Malaria. The WHO Global Malaria Programme plays a key role in that partnership by setting evidence-based policies, independently tracking progress, designing approaches for capacity building and health systems strengthening, and identifying threats to success and new opportunities for action. But you also need bilateral programmes, nongovernmental organizations and academic institutions. At the centre of everything you have national malaria control programmes, which are much more sophisticated than 20 years ago. So you have a different landscape today.

Q: What is the difference between elimination and eradication?

A: In the past, the term "eradication" was applied at the country level, so you'll hear about countries having "eradicated" malaria. Today, we use the term eradication to refer to the permanent reduction to zero of the worldwide incidence of malaria, and "elimination" as interrupting local mosquito-borne malaria transmission in a defined geographical area, usually a country.

Q: In March 2010 WHO changed itspolicy and now recommends diagnostic testing for malaria in all suspected cases before initiating treatment. Given the limited availability of quality microscopy, especially in Africa, how will countries achieve this?

A: Over the past few years a constellation of changes has compelled our technical expert group to recommend we move to universal access to diagnostic testing for malaria. Microscopy remains a reliable diagnostic tool but is seldom available. In the past 10 years, we have seen an increase in the availability of rapid diagnostic tests for malaria. Their cost has come down and their accuracy is reported through a product testing programme. In recent years, malaria transmission has dropped, so that in many places we are also saving money, as a typical rapid diagnostic test costs about US$ 0.50 while the average course of an artemisinin-based combination therapy (ACT) costs just under US$ 1. About a decade ago in Africa fewer than 5% of suspected cases in the public sector were given a diagnostic test, whereas in 2009 diagnostic testing was performed on 35% of such cases.

Q: Have any countries introduced such tests yet?

A: Many countries are using rapid diagnostic tests. For example, Senegal began to roll them out in 2007 to its health facilities, scaled up to every health facility within 18 months and saved a quarter of a million courses of ACTs every year. Until now, health-care workers have had to guess, treating all fever cases with anti-malarials. Now fevers are no longer being treated presumptively, and Senegal knows from every single district exactly how many malaria cases it has every month. I don't see how we can defeat malaria unless we know where we've been successful or not, and where we're seeing resurgences. …

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Learning to Outwit Malaria: Dr Robert D Newman Tells the WHO Bulletin Why Malaria Programmes Don't Make Headlines, Why Rapid Diagnostic Tests Are the Hottest New Technology and Why Eradication Is the Only Acceptable End-Goal in Beating This Ancient Scourge
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