From Dr Onome Akpogheneta…

Malaria eradication “should be our aspiration, but not our priority” advised Professor Kevin Marsh, Director of the Kenya Medical Research Institute (KEMRI)–Wellcome Programme and Oxford University Professor of Tropical Medicine, during his discussion with Professor A C Grayling for the BBC World Service’s Exchanges at the Frontier series.

The movement towards malaria eradication and elimination has grown in confidence and capacity over the last few years. Heartened by reports of reduced incidences of malaria in East and West Africa in particular, many leaders in malaria research are creating momentum in the drive towards malaria elimination. Marsh commented on the “enormous interest and excitement” in the possibility of eradicating or eliminating malaria. While this growing confidence is to be applauded, the enthusiasm could have adverse consequences for those at risk of the disease if goals are set but not met.

The global malaria eradication campaign of the 1950s to 1970s led to disappointment and frustrated hopes; the knock-on effect was inadequate funding for research and targeted malaria reductions. If they do not achieve success on a significant scale, malaria elimination drives could take malaria research and intervention strategies in a similar direction.

Noting that “no country has ever eliminated malaria that hadn’t reached a substantial level of social and economic development”, Marsh emphasizes the importance of economic development in determining malaria elimination. He also advises that “corruption in some countries is not the issue it’s made out to be,” suggesting that this potential hurdle may not be such a difficulty to overcome.

The number of malaria cases has continued to show marked reductions over the last 15 years or so, but Marsh says that the “big drop preceded the widespread implementation of bed nets”. The widespread use of bed nets has a proven effect in reducing malaria cases, but “coverage still isn’t high enough”. However, he does admit that sustained investment in “doing what works” will likely not result in eliminating this politically and socially complex disease. Marsh emphasizes that “we know what works to the extent that it works but it won’t be enough”.

With any occurrence of fever being treated as “malaria” in many malaria endemic countries (analogous to the treatment of common colds as influenza according to Marsh), counterfeit malaria drugs are becoming increasingly common. This international counterfeit market creates “a definite anxiety” for Marsh.

Marsh admits that he “used to be much more pessimistic” about the possibility of a viable malaria vaccine. But a likely malaria vaccine is currently undergoing trials, and a vaccine with increased efficacy is becoming more and more feasible. However, Marsh warns that without sustained investment in long-term basic malaria research as well as in capacity for organization and delivery of interventions, we will be led to “regret” this lack of investment “20 years down the line”.

The Exchanges at the Frontier discussion with Kevin Marsh will be broadcast on the BBC World Service from 2nd November.

Dr Onome Akpogheneta is a freelance consultant writer and researcher based in the UK.