KIGALI, Rwanda — If you’re tapped in to the internet, Twitter, Hollywood, or just generally following what’s happening in the world, there’s little chance you won’t hear of the extraordinary developments in the global fight against malaria.
Former U.S. Secretary of State Colin Powell, Bill Gates and Queen Rania of Jordan together with Ashton Kutcher and other celebrities have launched a Twitter campaign to end malaria deaths. Also, the television juggernaut “American Idol” dedicated a portion of its "Idol Gives Back" fundraiser to the fight against the disease. This isn’t about glitz and glamour; it’s about a parasite that for millennia has devastated humanity.
Even HBO’s new series “The Pacific” depicts the enormous toll malaria took on our troops during World War II. That wasn’t so long ago, so why the sudden ramp-up in the battle against the disease today? It’s not simply because malaria is a top childhood killer and because by distributing tens of millions more mosquito nets we’ll save millions of lives and drive GDP in some of the poorest countries up by about $80 billion. It’s because we can do it and there are simply no more excuses.
At the beginning of this new millennium, global leaders decided that — finally — it was time to tackle killers for which we had the technologies to make real progress. The highest-profile of these is, of course, AIDS. In spite of the costs, global commitments flowed in, allowing unprecedented program build out to prevent AIDS and millions to receive life-saving drugs — at costs up to $600 per person, per year a decade ago.
Malaria always made it into the buzz words of what we’d tackle, too: AIDS, tuberculosis and malaria became the new battle cry for public health activists. But somehow, funding needs for malaria and the effort to vanquish the disease never received the attention or publicity that it warranted.
The challenge, in part, is that historically, we have made big pushes against malaria only to see it come back with a vengeance. Malaria came to be viewed, particularly in Sub-Saharan Africa, as somehow unconquerable. The parasite quickly developed resistance to new treatments, and soon after, epidemics would once more rage. But, with better technology, we started to gain traction against this beast of a disease. In just the past few years, 25 countries have cut their malarial deaths by 50 percent. I’m lucky to live in one of the places where extraordinary success has been realized.
Here in Rwanda in 2006, health centers were loaded with adults and children, feverish and deathly ill with malaria. Over 450,000 cases of malaria were registered that year in children under the age of 5 — that’s in a population of just over 10 million. Put simply, nearly everyone was sick with malaria (my wife and I were hit with it twice that year). But in came millions of nets — insecticide-treated nets that actually kill mosquitoes (think of it as a bug zapper without the electricity) — and rates dropped precipitously. By 2008, there were only about 25,000 kids who tested positive for malaria nationally.
Over the last five years, we have experienced a similarly stunning decline in the number of deaths from malaria. The leading drug for treating malaria infection — artemisinin combination therapy — is now available at every single health facility in Rwanda. If someone gets sick with malaria, there’s no reason to suffer. Fighting malaria gathers momentum quickly: higher treatment rates combined with bed net utilization quickly lower the rate of malaria in the population. Total eradication remains tricky — that would require ecological changes as well — but we do know that there’s no reason for anyone to die or suffer from malaria today.
There’s a maintenance side to all of this, of course. When malaria cases drop, people tend not to be as religious about using their nets, which can in turn lead to resurgence. That’s why it’s so critical not to simply talk about the amazing results and progress we’ve achieved to date on World Malaria Day, but rather to keep talking about it.
Tweet it, Facebook it, blog about it, get the word out until the last death due to this horrible disease is only a memory. On that day, it will be time to start the process all over again, because this is a pernicious and crafty parasite. We must always remain vigilant in the fight and supportive of those working on public health’s front lines, lest Mother Nature catch us resting on our laurels.
Josh Ruxin is Assistant Clinical Professor of Public Health at the Mailman School of Public Health at Columbia University and Director of the Access Project in Rwanda.