[afro-nets] RFI: Malaria Management (11)

[Dr Bruno Moonen <somalia.mtc@merlin-eastafrica.org>]

RFI: Malaria Management (11)
----------------------------

Re: Clarification of the idea of cost?

Hi Peter,

very interesting. It's the eternal discussion between prevention
and treatment. I fully agree with you that preventing the mos-
quito to bite would solve (theoretically) the problem. I also
agree that cost-effectiveness (accountability) of proposed in-
terventions is very important. Some small food for thought on
this...

In the 50's WHO thought they would be able to eradicate malaria
using a strategy that combined prevention (vector control meas-
ures) and treatment (cheap at the time). It worked in few coun-
tries (Greece was one of the last countries to declare malaria
eradicated in Europe in the mid 70s) and failed in sub-Saharan
Africa and Asia. It seemed that the mosquito was a tougher
cookie than initially thought and later resistance to chloro-
quine developed. Even the use of DDT on a massive scale didn't
kill all the mosquitoes and as long as few survive, transmission
can go on. It would be interesting to contact some entomologists
to find out why aerial spraying worked in certain areas but not
in others (to do with vegetation, resistance developing in mos-
quitoes and stuff but I'm not a specialist so...)

I saw the proposal for Liberia and can't say if this is indeed
the magic bullet that will reduce malaria in Monrovia or, if ap-
plied in wider areas, elsewhere. If Liberia can afford this, why
not... I don't think (although I'm not sure) that it will cause
harm. Again, hopefully the mosquitoes will not become resistant
to the drug that will be spayed (it's not only the parasite that
can develop resistance!).

But why did I ask you to clarify your position on cost? I was
afraid, but wrong I hope, that for sub-Saharan Africa the argu-
ment of cost would once again be used to not treat people with
effective drugs. I agree that prevention is equally important
but we cannot not treat people with malaria today with drugs
that are proven to be effective. Moreover, ACT (the artesunate
part) also kills the gametocyte, a crucial "sexual" form of the
malaria parasite that is necessary to complete the cycle. I
could thus use your argument that if there would be universal
coverage of ACT (immediate prompt treatment of all case or even
mass treatment) the parasite would die out. But I'm afraid that
neither mine nor your strategy will be 100% successful unless
efforts are combined.

At the end of the day I think that Sachs might be right. Eco-
nomic development might solve a lot (not only malaria). The maps
he produces in his book are striking. All malaria countries are
also poor. As with TB in Europe, medical science might not solve
malaria but overall economic progress might (neither antibiotics
nor the vaccine against TB made a real change in the declining
incidence of TB in England but higher overall income did). In
the mean time... let's treat people with effective drugs, let's
implement correct vector control measure (including spraying),
let's try to be cost-effective and accountable but let's not use
cost as an argument to continue treating people with drugs that
are useless.

Regards,

Dr Bruno Moonen
GFATM Malaria Technical Coordinator
Tel. (Merlin): +254-20-3875530
Tel. (SACB): +254-20-3754145 Extn 108
Mobile: +254-724-401629
mailto:somalia.mtc@merlin-eastafrica.org