During the 18 months that Ebola was grabbing headlines, malaria was
quietly killing by the million. This is the estimate the Malaria Atlas Project (MAP)
made of the number dying in Africa from that infection during our year of Ebola
(http://www.nature.com/nature/journal/v526/n7572/full/nature15535.html)
At the same time, MAP reports also
that the overall incidence of malaria fell by 40% in the period 2000 to 2015.
This was really good news, as 40% translated to a whopping 663 million clinical
infections avoided. Bed nets treated with insecticide (ITN) was the most
significant contributor to this decline in cases and deaths, MAP state. I
should say though, that my experience with the ITN has not been that
spectacular. I can testify to nightly engagements, armed with a weaponized
electronic racquet, battling mosquitoes that refuse to die after gaining entry
into my ITN. Obviously my second-line defence (chemo-prophylaxis) against the
pests is effective enough because I have not, in recent years, suffered a single
bout of the infection. But one and a half million deaths due to the infection among others in just one year is no joking matter.Any help in reducing this number, therefore, is more
than welcome, and Britain’s recently announced gift of £1 billion (http://www.bbc.co.uk/news/uk-34892921) to help further the fight is
hugely important. Kudos to the Brits.
Malaria has been mankind’s implacable enemy probably ever
since man gave up his hunting and gathering ways. The infection has been intractable
not only because of its intrinsic biological sorcery but also because of
environmental and economic factors as well. So any injection of new money is to
be celebrated. The UK donation is to be added to funds provided by the Bill
& Melinda Gates Foundation, creating a powerful synergy that should, once
and for all, eliminate the pestilence.
Still, in 2015, one cannot
help but look back over the last century or so with something like awe, during
which, one would have expected that the billions hitherto invested, should have
yielded more ample dividends: Infection rates should be near zero by now,
surely? Perhaps billions are not enough: A recent study has concluded that total
spend remains much lower than the need. We should be looking at trillions, then?
Besides, funding, when available, may not be always targeted at where it would
do most good. Judging by the more than 2500 notifications of papers in
peer-reviewed journals that land in my inbox every year, there must be among
them, many that could be hardly fit for purpose. Obviously, a few, over the
years have yielded worthwhile results. This year, the 2015 Nobel Prize in Physiology
or Medicine was awarded jointly to
three researchers. Half of the prize money went to the Chinese pharmaceutical chemist,
Youyou Tu for her work in demonstrating the effectiveness of a herbal-derived
remedy, artemisinin, as highly effective therapy for malaria. This award was
more than 108 years after the prize was given to Frenchman Alphonse Laveran for
demonstrating that malaria was caused by a blood parasite, and 113 years after
the prize went to Ronald Ross, a Brit, for showing that the parasite was transmitted
to humans by the bite of mosquitoes. Incidentally, in 1899, Ross was
commissioned to find out why British soldiers in Sierra Leone were dying of
malaria in such numbers. His discovery that the mosquitoes responsible for transmission
bred in stagnant pools of water on the lowland plains around Freetown, led to
the segregation of white British workers up on a range of hills at what became
known as Hill Station. This was how, in 1904, physical racial segregation was born in
Sierra Leone. Earlier, during his Nobel Lecture in 1902, Ross had declared
of malaria: “There it strikes down, not only the indigenous barbaric population, but, with still
greater certainty, the pioneers of civilization, the planter, the trader, the
missionary, the soldier. It is therefore the principal and gigantic ally of barbarism. No wild deserts, no savage races, no geographical
difficulties have proved so inimical to civilization as this disease.” My
emphases.
But that was then and Ross has long been forgiven and is now rightly celebrated for his scientific work..
The issue now in 2015 is to find ways of eradicating malaria entirely.
Tell
Fren Tru
There is so much that our learned minds could have been doing in the fields of Medicine, Science and Engineering over the many years since the 19th Century or even before that would have served our people well. They were hampered by the reckless if selfish political attitude of our own people who expect us to continue to depend and rely on the efforts of others. Meanwhile the mosquito remains relentless and cunning. Great piece, tho', my Fren!!
ReplyDeleteThanks, Coolie. You summarize our predicament well. There is no alternative to a rational approach to issues that impact lives and well-being. Sierra Leone can do so much more for itself but has, unfortunately, dropped the ball too often. Those who govern us must carry the blame, but I fear they are not yet ready to man up. Meanwhile, far too many capable Sierra Leonean technocrats are constrained to practice their craft elsewhere.
DeleteMany thanks for this very captivating piece. I like the picture of the Hill Station sign because the Hill Station community was established as a malaria control measure. Most of the iriginal Hill Station houses were built on pillars to avoid mosquito bites. The compounds were also designed so that the potentially infectious native servants’ lived in ‘boys quarters’ located as far away as possible from master’s main house. The daily commuter train from the Cotton Tree station was used mainly by the domestic service providers who lived many miles away from Hill Station.
ReplyDeleteWith regard to the Nobel Prize, it is also worth mentioning that the life cycle of the parasite that causes onchocerciasis (river blindness), was elucidated in Freetown in 1926 in the Liverpool School of Tropical Medicine Field laboratory (the present IPAM building ). Ivermectin is used mainly to treat river blindness.
It was also in Freetown that Sir Ronald Ross incriminated the most dangerous animal on the planet – the Anopheles gambiae mosquito as the carrier of the malaria parasite. Ross picked Freetown to demonstrate that Anopheles mosquitoes carried the malaria parasite because of our country’s reputation as the ‘White Man’s grave’. The Italians had, before Ross, demonstrated in the lab that only Anopheles and not Culex mosquitoes were vectors of malaria. Ross’ pioneering work in India was based on bird malaria carried by Culex mosquitoes. As far as the Italians were concerned, it did not count.
Moses Bockarie
Professor of Tropical Health Sciences
Liverpool School of Tropical Medicine
Thanks for the insight, Prof. It was a nice piece of social engineering the Brits undertook when they conceived and executed Hill Station. However, it is a testament to the resilience of the parasite-vector nexus, that even today, the world still has to endure over a million deaths from malaria’s depredations every year. If it is not one thing, it is the other-- resistance of the mosquito or parasite resistance to parasiticidal agents and, frequently, simultaneous manifestation of both. Anyway, one can never deny that Ross, and subsequently, LSTM did great work in unravelling the ecology of the disease. And I am old enough to have played my own part, albeit meagre and reluctant, as subject, when health technicians used to come to our school to prick our fingers and squeeze out blood for malaria (and other blood) parasite evaluation. I can also remember the Sanitary Men, supervised by their “Inspectors”, going around Freetown spraying their larvicidal oils onto stagnant pools as a means of vector control. I wonder how much of this takes place nowadays.
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