if it doesn’t kill them, it makes them stronger (III) / why would you do things that way? (II)

well, this is bad and annoying.

bad: malaria resistance to ACTs is being increasingly reported in Thailand.

annoying: the article’s narrator & interviewee go on to say that immediate steps need to be taken.

then, instead of listing some possible steps, they highlight that maybe a malaria vaccine is on the horizon.

1. what should we do now? use rapid-diagnostic testing? encourage proper use (dose-completion) of ACTs? encourage prevention with bednets?

2. what do we think is that actual probability of having a viable malaria vaccine in three years? if so, how likely is its protective immunity likely to last for an inoculated person?

3. why are we so, so, so jazzed about a malaria vaccine when malaria elimination & eradication in the past has been very much about environmental management? is sanitation not sexy enough? do we not think that governments in malarious countries can and should be providing drainage, sewage, and other services that reduce malaria breeding habitats?

from The Making of a Tropical Disease (Packard)

In the end, the book males a simple point. Malaria policy needs to be informed by history. The history of malaria tells us that malaria cannot be understood or eliminated independently of changes in the societal forces that drive it. This is not to argue that past and current malaria control efforts have had no effect on reducing the burden of malaria. Nor do I believe that malaria cannot be controlled before social and economic impediments to health are completely removed. Rather I argue that the array of biological weapons mobilized in the war against malaria needs to be joined with efforts to understand and improve the social and economic conditions that drive the epidemiology of the disease (xviii).

from The Fever (Shah)

The uncomfortable truth is that ending malaria over the long-term will require difficult social and economic adjustments in African communities, just as it has elsewhere. Infrastructure will have to improve. Settlement patterns and housing styles will have to change. Education and healthcare systems will have to be built. Antimalaria activists know this. But it is not possible for them alone to transform Africa’s economies and cultures. The best they can do is offer partial, short-term solutions. That is, in the meantime, they can blanket the continent with treated nets and better drugs… After all, the perfect need not be the enemy of the good. The question is how the short-term solutions impact the long-term ones. Usually, something good today doesn’t reduce the probability of something better tomorrow. But in malaria, it can (237).

The conflict over short-term solutions and long-term sustainability has yet to be adequately resolved. The US antimalarial program, government malariologist Thomas Ritchie says, ‘is pouring obscene amounts of money’ into quick fixes against African malaria, but is spending little on supporting local antimalaria leadership or building antimalarial infrastructure. Plenty of African clinicians, scientists, and community leaders are dedicated to taming malaria, Ritchie says, but when the world’s richest country decides to help, ‘they give these people nothing, not a cent!’ (238).

The conflict plays out in heated debates at international malaria meetings. At one, an official from the Nigerian MoH became engrossed in a long argument with a representative from Sanofi-Aventis, which was at the time the sole purveyor of WHO-recommended ACT drugs. Finally she turned to me. ‘Write it in your paper,’ she commanded. ‘We need to build African capacity to make treated nets and ACTs. That is the only way we can solve malaria. They don’t want to do technology transfer,’ she said, motioning to the drug company rep. ‘They just want us to buy, buy, buy’ (238).

Although it publicly recognizes the need to build infrastructure in endemic countries, RBM has also stated that tackling the disease cannot be the responsibility of local governments. ‘If malaria control is left to governments to plan and execute,’ RBM wrote, ‘malaria will not be controlled.’ This is, of course, exactly backward. It is the only way malaria will be controlled. Malaria-endemic societies have proven this over and over again, from when the Italians distributed quinine to their populace – and built the schools and clinics and roads they needed in order to do it – to when Malawi banned the sale of chloroquine and rid the country of chloroquine-resistant parasites… ‘You can do a lot of good with bed nets, with spraying,’ says malariologist Tom McCutchan, ‘but in the end, you have got to give power to the people who are at risk’ (239).

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