There is an arsenal of cost-effective tools available to combat malaria but getting people to adhere to treatment regimens can be challenging, said Jessica Cohen, assistant professor of global health, at a symposium focused on “The Last Mile to Malaria Eradication,” held December 4, 2014 in Kresge G3. It was sponsored by the Department of Immunology and Infectious Diseases and the Harvard Institute for Global Health and included a poster session and reception in the FXB Atrium.
This was the second such event sponsored by the cross-Harvard initiative Defeating Malaria: From the Genes to the Globe. This effort brings together experts from different disciplines within the University to address complex issues related to eradicating malaria. Dyann Wirth, who heads the Harvard Malaria Initiative and is also Richard Pearson Strong Professor and chair, Department of Immunology and Infectious Diseases, called the Defeating Malaria initiative “a transformational way to focus on major public health problems.”
Cohen discussed the challenges of increasing use of bed nets, which provide protection for people while they sleep against malaria-carrying mosquitos. Some people don’t use them properly; others don’t use them at all and subject themselves to hungry mosquitos looking for a blood meal.
She also noted the challenge of getting patients to finish all of their malaria medication. Often they stop taking it because they think that when they start feeling better that they are cured, or if they continue to feel sick during treatment, they blame the medicine and stop taking it. Others may decide to save pills for later for themselves or other family members.
When people don’t finish their medication, they can have lingering parasites. This can lead to reccurrence of the malaria infection and can accelerate the emergence of resistance (i.e. the parasite becoming resistant to the medication). “This is dangerous because we don’t have any other very effective malaria medications available if the current one fails,” she said.
In a test group in Africa, Cohen and her colleagues found when they experimented with adding simple stickers to bottles of medication that read “Malaria is not gone until all tablets are finished,” that compliance to the regimen increased about 7%. They also are experimenting to see if more attractive and simplified medication packaging will help.
According to the World Health Organization’s World Malaria Report for 2014 released on December 9, 2014, 3.2 billion people in 97 countries and territories are at risk of being infected with malaria. In 2013, there were an estimated 198 million malaria cases worldwide and an estimated 584,000 deaths. Ninety percent of the deaths occurred in Africa. The disease killed an estimated 453,000 children under five years of age.
“We’ve made tremendous progress over the last 50 years thanks to the global investment that has led to a remarkable scale up of key interventions, but we’re not anywhere close to the last mile in many countries,” said speaker Günther Fink, associate professor of international health economics. Over the last 150 years, about half the world’s countries have eliminated malaria, he said. “Fifty percent of the world lives malaria-free, but this means 50% of the world still has malaria. We need new tools and we need to move fast.”
While global incidence of malaria is down, in parts of Africa it’s up, said Barry Bloom, Harvard University Distinguished Service Professor and Joan L. and Julius H. Jacobson Professor of Public Health. Fifty-nine countries are expected to meet the United Nations’ malaria reduction targets by 2015 and more than 50 will exceed the targets. “Only 18 countries are responsible for 80% of the cases,” he said. Most deaths from malaria occur in the Democratic Republic of the Congo and Nigeria.
Matthias Marti, associate professor of immunology and infectious diseases, co-hosted the symposium and Michael Reich, Taro Takemi Professor of International Health Policy, was a moderator. Other speakers included Caroline Buckee, assistant professor of epidemiology; Marcia Castro, associate professor of demography; Flaminia Catteruccia, associate professor of immunology and infectious diseases; Manoj Duraisingh, professor of immunology and infectious diseases, and Sarah Volkman, principal research scientist.
– Marge Dwyer
photos: Craig LaPlante