The will to win in Viet Nam

World Health • SlstYear, No. 3, May- June 1998 27 The will to win in Viet Nam Le Dinh Cong & Allan Schapiro Malaria control in Viet Nam suffered severe setbacks in the 1980s as a result of the general economic decline. Health services deteriorated, DDT was no longer donated by the Soviet Union, resistance to antimalarials 1 developed relentlessly, and people seeking new economic opportunities in forested and hilly areas carried the infection back to parts of the country which had previously been malaria-free. Morbidity and mortality peaked in 1991, and in that year alone 144 epidemics were recorded. From the early 1990s, economic recovery made it possible to increase financial support for malaria control. Collaboration between industry and researchers led to the local produc- tion of artemisinin and related drugs for the treatment of severe and multidrug-resistant malaria. The artemisinin drugs, used for centuries in traditional Chinese and Viet- namese medicine, had been redis- covered by Chinese scientists in the 1970s. In Viet Nam, the introduc- tion of these rapidly acting anti- malarials in the general health services has helped to reduce the number of severe cases and deaths from malaria. The other important development was the introduction of insecticide- impregnated bednets. Trials in Viet Nam indicate that the effectiveness of this method for preventing malaria is comparable to that of spraying the indoor walls of homes with insecticides. The advantages are both economic and ecological, since less insecticide is needed per person protected. The method is also more popular, as it provides protection against bedbugs and other nuisances as well as malaria, and is adaptable to different lifestyles. For example, people who sleep away from home can take their nets with them. The impregnation of nets is now provided as a free public service to Malaria in Viet Nam 1990-1997 2.50,000 5,000 200,000 1.50,000 j 100,000 .50,000 0 1990 1991 1992 1993 -o- Confirmed malaria coses -+- Malaria deaths 1994 1995 1996 1997 4,500 4,000 3,500 3,000 2,500 :I 2,000 l,500 l,000 500 0 Malaria cases and deaths have declined rapidly since the revitalization of the national control programme from 1991. Graphic WHO/National Malaria Control Programme, Viel Nam people living in malaria-endemic areas. Nearly 10 million persons are protected by this method in Viet Nam, but not aJI problems are solved. Some ethnic groups have still not acquired the habit of using mosquito nets. A nationwide evalu- ation of malaria control in 1995 showed that malaria had gone down in most of the areas where impreg- nated nets had been introduced but not in all of them. Where the nets had been less effective, the popula- tion usually did not know that the purpose of using them was to pre- vent malaria. Obviously the distrib- ution of nets and insecticide needs to be accompanied by sufficient educa- tion, to ensure their correct use. Government funding for malaria control continued to rise rapidly between 1991 and 1995. Since 1995, foreign partners have greatly increased their contributions to the successful Vietnamese control programme, allowing the Govern- ment to give more attention to other health problems such as dengue fever. While the Vietnamese achievements in malaria control are encouraging, it should be noted that the gradual reduction in malaria incidence during the 1990s resem- bles the reduction which occurred between 1975 and 1984, when the programme relied mainly on house- spraying. Government commitment has been important and so has interna- tional cooperation. In particular, the programme has benefited from the rapid technological advances in other countries, followed by trials in Viet Nam and then large-scale appli- cation. This is carried out by a large workforce of trained malaria control staff in a centrally managed struc- ture, collaborating closely with general health services at the periph- ery. Over the years, apart from the setbacks caused by two major wars, there has been much trial and error, yielding both positive and negative lessons. Technology, training and money have been indispensable, but perhaps the main driving force has been the will to win. Today, malaria control for all groups at risk is an unquestioned imperative. • Or Le Dinh Cong is Chairman of the Steering Committee of Viel Nam's National Malaria Control Programme and Or Allan Schapiro is the WHO Medical Officer responsible for malaria control in Cambodia, Lao People 's Democratic Republic and Viel Nam. Or Schapira 's address is c/ o The WHO Representative, P.O. Box 52, Hanoi, Viel Nam 10000.