As malaria deaths rise, there is no time to wait for new vaccines – the international community must invest more in prevention.
Malaria is both a disease of poverty and cause of poverty. If it were a western-prevalent disease, a cure is likely to have been discovered long ago. It is preventable and treatable, yet life-threatening to those without the multiple interventions needed to prevent or treat it. 91% of all malaria deaths occur in sub-Saharan Africa, causing the region to carry a disproportionately high share of the burden worldwide.
Concern has been recently sparked following reports of global malaria cases increasing for the first time in ten years. In 2016, cases were up by 5 million from the previous year to 216 million. Health experts say renewed action and boosting funding to fight malaria could prevent 350 million more cases within the next five years, saving 650,000 lives.
The Bill and Melinda Gates Foundation has revolutionised the amount of money going into tackling malaria since 1999, and last week pledged a further $1 billion investment until 2023 to fund research and development efforts to eradicate the disease. This will be in addition to $2 billion from the Global Fund, alongside other international contributions.
When so much money is being poured into the cause, why has there been a resurgence, and what can be done to prevent further malaria-related deaths? The answers are on the ground, where you can see how the problem is escalating.
While anti-malarial drug resistance is one of the greatest threats to malaria control, progress has been significantly impeded by a focus on research and development, as opposed to prevention. There is not enough time to wait for new vaccines which can be available en masse.
Where prevention is working
The Butterfly Tree charity is one of the few small organisations working in malaria prevention so effectively. It is volunteer-led, grass-roots organisation registered in Zambia, working predominantly where there is the highest prevalence of malaria, with 75% of deaths faced by children under the age of five.
"In our small way, we work directly with the experts on the ground and the shortfall of mosquito nets is everywhere. Until new treatments are developed and readily available, funding and experts on the ground is essential in preventing transmission”, says the organisation’s founder, Jane Kaye-Bailey.
For ten years now, the charity has run a prevention programme in the Mukuni Chiefdom, providing mosquito nets to help the Zambian government manage shortfalls. In response to the growing resistance to treatment drugs and insecticide resistance in mosquitoes, in 2015 the organisation introduced a joint intervention.
By controlling the mosquitoes both at the larval stage and killing them as opposed to merely repelling them with the new insecticide, this new dual approach has seen a record zero malaria deaths in the Mukuni Chiefdom in the past five years.
In December 2017, a World Health Organization (WHO) consultant visited where a local environmental officer was based and was astounded at their data which evidenced the lowest cases of malaria in the district.
Overcoming environmental challenges
After large-scale success in Mukuni Chiefdom, in 2017 the charity ventured 300km from their base into Moomba. Reportedly, no other charity had ever offered support there, despite 46% of the population being infected. After a distribution of mosquito nets in July, the insecticidal coating and larvicide granules was applied in December last year. In January and February 2018, only 51 cases of malaria were recorded, compared to 502 in 2016; a record-breaking 90% reduction.
A major challenge for international NGOs trying to combat malaria is the logistical difficulties of reporting cases. Infected areas can be inaccessible for up to three to four months of the year due to bad weather, while the inaccessibility of remote communities such as Moomba means they often go neglected. Kaye-Bailey drove for seven hours last summer through difficult terrain – roads with pot holes and roads that weren’t roads at all to reach the community.
Local actors play a crucial role in the success of programmes, helping to source projects and solutions. They are familiar with the area and communities, so there is less time needed for immersion and less discrepancies with communities feeling as though foreigners are treading on their toes and intruding.
“We are extremely lucky to have Sibeso Maseka, an Environmental Health Officer, on our team of volunteers.” Kaye-Bailey remarks.
“She continually trains and motivates community health workers to be aware of the importance of early testing and administering treatment to prevent complications.”
The work of The Butterfly Tree is just one example of how a widespread global disease can be tackled on small but significant scales by utilising local capacity. In order for work like this to continue however, funding must become better accessible to smaller charities making a difference, who often struggle to compete with giant international NGOs for grants. Ultimately, more money to develop new vaccines and fund innovations like Bill Gates’ proposal for satellite surveillance is imperative to win the fight against malaria, but prevention must take priority if we are to progress.
This article was originally published on The Diplomatic Courier.