A mother and her toddler suffering from malaria in Ghana (PHOTO: Mary F. Adams, Reuters)
Since the year 2000, the number of malaria deaths has been cut in half worldwide. Many factors went into this dramatic decline, and their collective impact has been tremendous success. Some of these were advances in treatments and diagnostics, but many were far more practical. For example, in some cases it was not a matter of an appropriate medication existing; it was a matter of getting the medications to the people who needed them. Numerous programs have streamlined that process and advocated for generic drug manufacuring and fair pricing.
If there is a "most important" strategy to the successes seen in the past decade and a half, it is inarguably vector control. Malaria is spread by the bite of an infected mosquito; therefore, prevention of malaria is literally as simple as prevention of mosquito bites. Numerous aid groups have campaigned tirelessly to provide mosquito nets, and specifically insecticide-treated mosquito nets (ITNs), to communities lacking them. ITNs have been a key invention in the fight against malaria. One of the benefits of ITNs is that they not only physically protect a sleeping person from coming into contact with a biting mosquito, they repel mosquitoes from approaching the net and even entering houses. Another important discovery has come from the world of electrical engineering. It turns out that mosquitoes are far less attracted to LED lighting than fluorescent, and strategic changes in light source can therefore be a very effective means of contol.
Anopheles spp. mosquito (photo: Centers for Disease Control and Prevention)
All of this goes to show you that progress in infectious disease is often a rich complex of interdisciplinary effort. Microbiologists may identify a drug or vaccine target, biochemists will then generate a compound that interferes with it, pharmacologists then charatcterize the compound and how it might work in a patient, production engineers then perfect the process of synthesizing it, analysts must then find a way to distribute it within the means of those who need it, advocates must then work with local physicians and nurses to ensure that patients receive it, and those clinicians must then in turn ensure that their patients take it. On the vector side of things, entomologists identify mosquito biology and behaviors, engineers, biochemists, or both come up with a way of manipulating the biology or behavior to minimize contact between humans and mosquitoes, and then the same serious of professionls must manufacture, distribute, advocate, educate, and ensure use of the intervention. When you think about the coordination of effort, the rate being halved in 15 years is quite remarkable. Those who have worked tirelessly toward this goal should be loudly applauded!
There are still approximately half a million malaria deaths (the majority being in children) per year in the world. How will malaria be beaten back further? I'm not sure. But I have every confidence that some very, very competent and passionate people do.