The Cure for Malaria is Development: A Controversial Notion?
I think not. I’ve just returned from a meeting of malaria researchers in Basel, Switzerland. The meetings were excellent. It is rare to have such a wide showing of malaria experts in one place, talking about nothing but malaria.
The meeting was notable for what was included, namely excellent presentations on vaccine development, subsidies to increase access to medications, malaria elimination programs in less than talked about parts of the globe (Bhutan, Turkmenistan, PNG), and the paucity of research on Plasmodium vivax.
The meeting was also notable for what it did not include, namely global economic determinants of malaria.
To me, malaria is 100% a disease of poverty. Where poverty is low, malaria is low. This is true globally, as well as within still malarious countries. The graph to the right shows the relationship of country level GDP with the estimated number of malaria cases per 100,000 in 2006. Though accurate data on the true number of cases is difficult to obtain for developing countries for a host of reasons, the trend should be clear. More money equals less malaria.
Is this because on better funding for malaria programs? After all, wealthier countries are able to put more resources into prevention, mosquito control, and treatment. Sure, I think this is partially the case. It has to be said, however, that malaria was eliminated from the United States without modern medicines and insecticide treated bednets, cornerstones of current malaria control strategies. Though DDT was instrumental in helping to control malaria transmitting mosquitoes in the US, the truth is, the bugs are still here.
Malaria deaths around the world are down. It is also the case that worldwide development is up. The economies of developing countries are improving, record numbers of people are moving out of entrenched poverty and, while within country inequality is increasing, global inequality is decreasing. Personally, I think the relationship between development and malaria is no accident at all.
What strikes me, is that this topic was hardly mentioned last week. I brought it up a couple of times, but, unfortunately, scientists are hesitant to move out of their comfort zone, and wish to give it little thought. Talk of politics or economics produces blank looks in scientists trained in microbiology or entomology. I’m sure its the same on the other end. Certainly, the current research is important, helpful, relevant and should be continued. However, I don’t think that we, as scientists, should stick our heads in the sand and willfully ignore the bigger picture.
Malaria will be eliminated not through fancy pharmaceuticals and ever improved bednets, but through the increase in access to employment, market economies and remunerative opportunities. Malaria will be eliminated through the elimination of entrenched poverty, the expansion of free education, reductions in gender inequities and improved nutrition. In my opinion, these were the true factors which led to the elimination of malaria from the US, Europe, Japan. Granted, there are climatic differences between those countries and sub-Saharan Africa, but P. vivax, a cold weather malaria, was also fully eliminated.
People I spoke with sort of waved their hands and acted as if there is nothing we can do about these global and economic problems. I disagree, of course. Policy makers look to scientists for answers (though they make ignore what they don’t like). Endless bednet trials that only marginally expand on previous research do not do much to ameliorate the structural factors which keep people in poverty. Research which explores those big picture factors, however, could have vast benefits.