April 12, 2016 |

The next great elimination story: malaria

Villains, heroes, and plot twists. Can we write a happy ending for one of the world’s most enduring and deadly diseases?
Steve Davis and Cathy Cahill look on as a man demonstrates a mobile app.
Health workers in Ethiopia demonstrate how they use a mobile phone app to track down malaria. Looking on are Steve Davis, PATH’s president and CEO (third from left), and Kathy Cahill, vice president, International Development (far right). Photo: PATH/Mark Murray.

It’s a brutally hot day in the Amhara region of Ethiopia, but that doesn’t stop the community health workers I’m visiting. I follow them as they walk from house to house, showing me how they use mobile phones to hunt down a deadly disease.

In this village, I am witnessing one of the most inspiring stories of our time. It has villains and heroes, historical themes and plot twists, and even the foreshadowing of a happy ending.

Taking on an age-old villain

The villain: mosquitoes, or to be fair, female mosquitoes and the diseases they carry, including dengue, yellow fever, West Nile virus, and Zika.

Perhaps the most deadly and complicated of all the mosquito-borne diseases is malaria. This villain has plagued humanity for thousands of years. It was described in ancient Chinese texts in 2700 BC, and the ancient Greeks blamed it for the fall of city-states.

Half the world’s population is currently at risk of malaria, and nearly half a million people die from it each year. Malaria deaths are just one part of the story: the disease perpetuates the cycle of poverty, keeping more African children out of school than any other disease and costing the continent an estimated USD$12 billion annually in lost productivity.

Thanks to the US Centers for Disease Control and Prevention, the United States eliminated the disease in 1951. But after a global effort eliminated malaria north of the equator, efforts stalled.

For the last 15 years, PATH has been working to write a new ending to this story with profound historical impact: the elimination of malaria everywhere.

6.2 million people and counting

Here’s an exciting plot twist: since 2000, malaria deaths have fallen nearly 60 percent thanks to improved tools, increased investment, and committed partnerships. PATH-pioneered approaches have contributed to 6.2 million lives saved in that time.

Heroes of all kinds have stepped forward. Governments, international organizations, and foundations have committed resources and set bold goals. The private sector is stepping up with financial support, expertise, and operational muscle. And thousands of health care workers and community members are involved in elimination campaigns.

Chart showing 58% reduction in malaria deaths and 37% reduction in new cases, 2000-2015.
PATH-pioneered approaches have contributed to 6.2 million lives saved since 2000.

But the last miles of elimination are the hardest. It’s going to take a whole toolkit of technologies and strategies to reach far-flung villages and stop the cycle of transmission from mosquitoes to humans to mosquitoes and back again.

PATH’s malaria portfolio spans the toolkit—from diagnostics to surveillance platforms that track infected individuals, from drugs to the world’s most ambitious (and advanced) pipeline of malaria vaccine projects.

With decades of experience and PATH staff fighting malaria in 22 countries, we understand the on-the-ground realities and the tools needed to accelerate efforts.

Innovation in control and elimination strategies

First, we’re combining and optimizing the best existing methods for malaria prevention and control and ensuring they reach the people who need them most.

Next, to develop the science behind how to eliminate malaria in Africa, we’re piloting breakthrough strategies in collaboration with communities. This includes a trial of a mass treatment campaign in southern Zambia. By treating everyone in the trial villages, whether or not they have symptoms, we hope to interrupt the cycle of transmission. The results of this trial are due out very soon.

Four people wearing backpacks and carrying additional malaria treatment supplies.
Zambian community health workers walk from house to house to treat people for malaria, including those who don’t have symptoms but can still carry—and pass on—the disease. Photo: PATH/Laura Newman.

Our goal is to develop a package of interventions that can be adapted and adopted across many different geographies.

Another key strategy is improving the use of data to track transmission patterns, optimize the deployment of resources, and ultimately track down the last malaria parasites. That’s what I was witnessing in Ethiopia. Health workers used a cell phone app with GPS to locate a malaria case. Then they went door-to-door to determine if the disease had been transmitted to neighbors.

This ability to manage, gather, and interpret data has become one of the most important themes for hope in the malaria elimination story.

Innovation in tools

PATH is also developing the next generation of tools needed to detect, prevent, and treat malaria, as well as to control mosquitoes. We’re working to help ensure a stable supply of artemisinin for treatments so that no one who contracts the disease dies from it. We’re developing methods to detect malaria infections more quickly and effectively, especially the low levels of infection that can elude current diagnostics.

PATH also has one of the largest portfolios of malaria vaccine candidates and approaches in the world. PATH worked with GSK and other partners to develop the first malaria vaccine candidate approved for pilot use by the World Health Organization. We’re also working on vaccines that would block transmission of the malaria parasite.

Innovation in partnerships and financing

The recent declines in malaria correlate with increased funding over the past decade. However, forecasts for global health and development aid show a flattening or even declining trend. National governments have set bold goals to eliminate the disease and are increasing their domestic financing, but significant funding will be needed to eliminate the disease.

PATH is working with national governments and partners to evaluate the most effective allocation of resources and cultivate new resources. And we’re harnessing the power of the private sector by creating unique collaborations that build on our respective expertise. For example, Tableau Software is bringing its expertise in data visualization and analytics to the effort.

We’re also engaging individuals, foundations, and corporations like Expedia through an initiative within PATH’s Reach Campaign that specifically targets malaria elimination. These donors are supporting PATH’s Center for Malaria Control and Elimination, which is aligning our expertise so we can accelerate progress against the disease.

Graph showing potential reduction of malaria infections from 600 million in 2015 to practically zero in 2040.
Models suggest that, with a combination of best practices, new innovations, and ongoing financial commitments, we can end malaria in our lifetime.

A happy ending?

The thought of ridding our planet of a disease that has plagued humanity and undermined our collective potential for thousands of years is audacious—and urgent. The malaria parasite and the mosquitoes that transmit it are developing resistance to currently available drugs and insecticides. Without dedicated and sustained efforts, we could very well see resistance spread and a resurgence in illnesses and deaths.

The end of this story will depend on the choices that we make as nations, as institutions, and as global citizens. There is a role for us all.

Posted in: , , , , , , , , ,