The commission highlights three important tools—rapid diagnostic tests, artemisinin-based combination therapy, and long lasting insecticide-treated nets—which have proved highly effective.
By Arjun Mukherjee
Malaria causes around 435,000 deaths each year, and children are the worst hit. The Lancet Commission on Malaria Eradication recently published its report, which states that eradication of malaria is possible by 2050. In 2017, there were a total of 219 million malaria cases in 86 countries, a decline from 262 million cases, and 839,000 malaria deaths in 2001. India ranks 4th globally with regards to the number of malaria cases. Out of the 219 million cases reported in 2017, 9.6 million were in India. The commission warns that, while over 100 countries have managed to eradicate malaria, a chance of resurgence and re-establishment still exists. It notes that, in India, the malaria vector, Anopheles stephensi, having a suitable environment for breeding in the cities means incidence of the disease in urban areas is quite significant.
The Lancet commission notes that, while the world cannot achieve the target of eliminating malaria by 2030, eradication by 2050 is possible. The commission highlights three important tools—rapid diagnostic tests, artemisinin-based combination therapy, and long lasting insecticide-treated nets—which have proved highly effective. Apart from those, new tools which are being deployed—IT, molecular methods for diagnosis and surveillance, and a new drug for Plasmodium vivax malaria—will act as catalysts for eradication. To eradicate malaria, India follows the recommendations of WHO’s Global Technical Strategy for Malaria. However, due to improper waste management, lack of municipal water supply infrastructure, etc, Anopheles breeding is facilitated, and unregulated private health sector hampers efforts, thanks to misreporting and under-reporting.
Malaria’s link to a high out of pocket (OOP) burden for patients affects elimination strategies. This OOP according to the commission is “undesirable, forcing families to forego necessary care and causing medical impoverishment”. To beat malaria, India must invest a lot more in making malaria prevention and treatment tools more affordable and accessible for its citizens. But, investment can only be part of the solution, a diversified policy outlook is needed, too. Dr Shailja Singh, Associate Professor at Special Centre for Molecular Medicine, JNU, says, “Generalised policies will not work in case of India because the nation in itself is so diverse, and so are the Plasmodium parasites that affect its people.” She says, to achieve complete eradication, firstly, a large scale surveillance to capture the diverse nature of malaria in India is needed. Secondly, a mass campaign—like in the case of polio—can also help in eradication processes. The campaign would need to focus on both preventive and curative aspects of the fight against malaria.
The commission notes, eradicating will not only reduce morbidity and mortality, but will also be a financial win for nations. It notes, as per the modeling work taken up by the WHO advisory group to effectively implement malaria controlling tools to reach a coverage of 90% by 2030, in the 29 most burdened nations, this will result in an estimated gain in GDP of $238 billion, which would be a lot higher than the cost of eradicating it—$35 billion. One must make note of the strong correlation between malaria and poverty. For instance, the highest number of malaria case are in Nigeria—25% of the global total—which has the highest number of people living in poverty (94.3 million). So, in order to tackle malaria and to eradicate it by 2050, a unidirectional implementation strategy might not suffice. The eradication strategy has to address all structural problems—especially poverty and diversity—in order to make the world malaria-free by 2050.