United against malaria: editorial

World Health • 51 st Year, No. 3, Moy- June 1998 3 Editorial United against malaria At first it seemed simple. If DDT and other insecticides were sprayed in sufficient quantity where the malaria vectors lived and bred, the disease could be eradicated within a few years. It took 15 or 20 years - from the 1950s up to the late 1960s - for governments and the international community to learn that global eradication was not possi- ble, at least for the foreseeable fu- ture. The mosquito and the parasite it carried had proved far more diffi- cult to control than anyone had imagined. WHO's Global Malaria Eradication Campaign achieved some notable successes but it also proved that, without a much more flexible and variable strategy com- bined with poverty reduction, self- reliance and sound environmental management, the war against this disease could not be won. The eradication effort was gradu- ally replaced by strategies emphasiz- ing protection against infection and reduction of its severity. These have proved difficult to implement, how- ever, with the scarce resources made available for them nationally and internationally, and at present up to two million people die of this disease every year. In 1992 WHO, other United Nations bodies and the malaria- endemic countries adopted the Global Malaria Control Strategy. Nearly all the countries concerned are now carrying out national plans of action within the framework of the strategy, which favours a combina- tion of approaches adapted to national and local needs and resources. WHO has recently con- tributed an additional US$20 million to malaria control activities in Africa, where 90% of the deaths occur. Dr Hiroshi Nakajima, Director-General of WHO. Photo WHO/H. Anenden Global malaria control still re- quires a much greater effort, how- ever, both in scientific research and development and in the mobilization of human and financial resources. More effective technologies are needed to control vector populations, prevent and cure malaria and reduce drug resistance, but the full potential of existing approaches is still far from being realized. Individuals and communities, when adequately informed and equipped, can them- selves provide a large amount of the protection they need through such measures as eliminating breeding sites near the home and using im- pregnated mosquito nets . Health care workers at primary and referral level can, with the right kind of training and sufficient supplies, greatly reduce the severity and dura- tion of malaria infection through appropriate case management. At the same time, as I have stressed on many occasions, the incidence of a disease such as malaria is an indicator of poverty, unacceptable living standards and social injustice. To be effective, prevention and control activities must include the reduction of these underlying causes of disease. This requires a major multisectoral effort both nationally and internationally. While fulfilling its own responsibili- ties in the field of research and public health, WHO has been campaigning for many years to gain the political support needed for such an effort. This work is being vigorously pur- sued and expanded by WHO's next Director-General, Dr Gro Harlem Brundtland, who takes office in July. The "Roll Back Maleria" initiative emphasizes health services develop- ment and multisectoral collaboration, and is being spearheaded by Africa. The Organization of African Unity, at its meeting of Heads of State last year in Harare, Zimbabwe, pledged its full commitment to a plan of action for malaria control in Africa. Asia has also taken up the challenge. Following these initia- tives, the Group of Eight at their Summit this year in Birmingham, UK, issued a joint communique in which they supported a commitment to halving the numbers dying of malaria by the year 2010 and halving them again by 2015. I am greatly encouraged by the preparations now under way to expand and intensify the fight against malaria on all fronts. With its rich store of experience to draw on, and with the cooperation of all its part- ners in health and development, WHO can demonstrate that malaria control is achievable in all parts of the world. • Hiroshi Nakaiima, M.D., Ph.D.