World Malaria Day

Today is World Malaria Day.  Every year hundreds of millions of people are infected with Malaria and approximately 430,000 people die from this disease.  Over  90% of these deaths occur in sub-Saharan Africa and despite malaria mortality rates falling, a child in Africa still dies every minute from malaria.

Malaria is a parasitic infection transmitted from person to person by the bite of infected female Anopheles mosquitoes. The term malaria originates from Mediaeval Italian: mala aria meaning bad air as people didn’t know the origin of the disease and there was a common belief that many diseases were caused by bad air in earlier times. Scientific studies on malaria made their first significant advance in 1880, when Charles Louis Alphonse Laveran, a French army doctor in Algeria observed parasites inside the red blood cells of infected people for the first time. The first effective treatment for malaria came from the bark of cinchona tree, which contains quinine and the Jesuits introduced the treatment to Europe around 1640. It was not until 1820 that the active ingredient, quinine, was extracted from the bark, isolated and named by the French chemists Pierre Joseph Pelletier and Joseph Bienaimé Caventou.

Quinine was the predominant malarial medication until the 1920s when other medications began to appear. In the 1940s, chloroquine replaced quinine as the treatment of both uncomplicated and severe malaria until resistance emerged, first in Southeast Asia and South America in the 1950s and then globally in the 1980s.

The most effective treatment for malaria is artemisinin-based combination therapy (ACTs). ACTs have low toxicity, few side effects and act rapidly against the parasite. Today, the majority of African countries have officially changed their protocol to treat first-line malaria with ACTs. But in many places, ACTs are scarcely available and there is growing evidence of emerging parasite resistance to artemisinin – the core compound of ACTs.

There is progress though and we can see that the malaria map is rapidly shrinking. In 1900, endemic malaria was present in almost every country. Nowadays, the disease has been eliminated in 111 countries and 34 countries are advancing towards elimination. No-one can know when malaria will be eradicated but many scientists estimate 2050 or 2060 and that the last battles against this awful disease will likely be waged in wet, tropical, and poor areas.

An important driver of the eradication scenario is scientific research. Thanks to the Bill & Melinda Gates Foundation, the Wellcome Trust and others, research in malaria is stronger than it has been at any point in the past 50 years. New drugs are in development and vaccines. Currently, the most effective malaria vaccine is R21/Matrix-M, with a 77% efficacy rate shown in initial trials and it is the first vaccine that meets the World Health Organisation’s (WHO) goal of a malaria vaccine with at least 75% efficacy.

Until relatively recently, speaking of elimination and eradication in connection with malaria was regarded as overambitious. However, speeches by Bill and Melinda Gates in 2007, calling for nothing less than global malaria eradication, radically changed discussions and research. Since then, there has been a huge upsurge of commitment to elimination and eventual eradication. Progress is really encouraging now and the responses produced by science are effective and continually improving. With adequate and sustained commitment, the task can be achieved and you can support research that will lead to eradication at