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Six Experts, Six Answers


Six Experts, Six Answers

What are history’s lessons for malaria eradication?

Randall M. PackardThere are a lot of lessons from the effort to eradicate malaria in the 1950s and ’60s that have not been learned:

A number of pilot projects in Africa were highly successful, but in every case malaria came back in epidemic form. You can’t turn your back on that reality. Once you go down that road [of eradication], you’d better sustain it. And it is extraordinarily difficult to sustain in areas where you do not have broad-based socioeconomic development.

Another lesson is: Everything takes longer than you think it’s going to take. Everything costs more than you think it’s going to cost. In general, in the places where they did eradicate malaria, they thought it was going to cost 50 cents per person but it turned out to be $2 per person. When Taiwan began its eradication campaign in the early ’50s, they went from 889,000 cases to 600 in 4 to 5 years, but it took another 5 or 6 years to go from 600 cases to zero—and Taiwan’s an island. That sort of endgame is costly from a per-case perspective. It’s much more extensive than we tend to think about.

One of the other lessons is there is never enough attention paid to the challenge of getting people to use the technology in an appropriate manner. The need to achieve buy-in in the population is a really important issue. All these social science efforts have been severely underfunded. The notion that you get 80 percent coverage with bed nets doesn’t mean people are using the nets and using them properly.

The absence of adequate health services was one of the major obstacles to success of eradication in many places. Without health services, it is impossible to identify new cases and prevent the renewal of transmission. Getting people treated efficiently and effectively in a timely manner is difficult in many places in sub-Saharan Africa. We’re putting a lot of energy into drugs or nets, but we’re putting little into basic health services.

Randall M. Packard, PhD, is director of the Institute of the History of Medicine at Johns Hopkins University and the author of The Making of a Tropical Disease: A Short History of Malaria.

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  • Dr. C. Nagaraj

    Bangalore, India 02/08/2011 10:47:20 PM

    I wish to inform you that already resistance of Pf has occurred and I have detected resistant Pf from Karnataka, Maharastra and Orissa in India - resistant to ACT (Artisunate +SP) by therapeutic efficacy method (in vivo). I can send my findings to you if are interested. I have lot of interesting findings which I wish to discuss - gametocyte increase after ACT, side effects of ACT, etc.

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