Malaria: Portuguese scientist sees advances, but alerts for the need to keep the efforts

According to the expert, to eliminate the disease, it must be broadly observed, from health systems enhancements, access equality and sanitary and socioeconomic conditions

According to a recent report from the World Health Organization (WHO), malaria worldwide mortality rates have dropped by 60% since 2000. This means that 6.2 million lives were spared in the last 15 years – from these, 6 million children, mainly living in Sub-Saharan Africa. Despite this great achievement, for Dr. Henrique Silveira (), investigator at Portugals Institute of Hygiene and Tropical Medicine (IHMT), all efforts built until today controlling the disease must be maintained at risk of losing all achievements.

We need combined and discussed efforts by the various components which range from international financiers to local communities, including a powerful political commitment in places where malaria is still a severe public health issue, explained Dr. Henrique in an exclusive interview to the Brazilian Society of Tropical Medicine.

Find the full interview below:

BSTM: Despite the great advances fighting malaria for the past 15 years, in a recent interview, you said there is much progress to be made until controlling the disease. Which are the main actions to reach this goal, especially in poor countries?

Dr. Henrique: Even though the incidence and mortality have significantly decreased for the past 15 years (37% and 60% respectively) and we currently find ourselves in elimination and pre-elimination phases in several places around the world, we must maintain our efforts, in order not to lose all our achievements. We need combined and agreed efforts from the various actors, which range from international financiers to local communities, including a powerful political commitment in places where malaria is still a severe public health issue. This way, it is fundamental to be ahead of the upcoming difficulties that rise, as drug and insecticide resistances, the lack of a highly effective vaccine, current quality information of what is happening in the field and specific information about the new pre-elimination / elimination reality.

Emerging or reemerging threats as resistance to anti-malaria drugs and insecticides are problems that demand multi-sector partnerships, multidisciplinary approaches and regional and international cooperation (malaria does not have any kind of frontiers). However, for malaria to be eliminated, it needs to be seen from a broader point of view, of health systems enhancements, access equality and sanitary and socioeconomic conditions.

BSTM: Should the international agents, especially WHO, be more present in the most affected countries by the disease?

Dr. Henrique: There is a possibility to improve, but during the past few years there have been more discussions between the various actors from which, WHO has been an important participant.

How could poor countries invest in a more efficient combat against malaria?

Dr. Henrique: First, they should define strategies to perfect their health systems and universal access to them, as well as socio-sanitary conditions, with massive investments in specialized human resources. This way, they would not rely on eventual strategy diversions among the different actors.

BSTM: When can we expect malaria to be eradicated or controlled?

Dr. Henrique: This is a question I cannot answer, but the strategy played by WHO and Roll Back Malaria Partnership foresee a death reduction of 90% and elimination in 35 countries until 2030.

BSTM: How long until an effective vaccine against malaria reaches the market? Is this solution still inefficient?

Dr. Henrique: After the European Medicines Agency approved the RTS,S/AS01 vaccine this year, we come a little closer to our goal, but we still need approval from other drug agencies such as the FDA. This way, its use recommendations must be sent by WHO and the authorities from the countries that will use it. Nevertheless, it is important to stress its efficiency is low, preventing malaria only in 56% of the children from 5 to 17 months and 31% in children from 6 – 12 weeks.

BSTM: Is there a lack of effectiveness combating the transmitting mosquito?

Dr. Henrique: Fighting the mosquito vector is a fundamental factor for malaria control, and the success programs have this component very well structured and developed. Due to the need of logistics and specific experts, some times it is deficient in some programs/places.

The investment in studies on the mosquito and the parasites life cycle in the mosquito is fundamental. Researches with strong entomological components that help us understand the interaction between the parasite and the mosquito, the insecticide resistance mechanisms, new insecticides, new techniques to block the transmission and control the mosquitoes populations are crucial to reach the goal of eliminating malaria in a close future.…