People And Their Problems

New Delhi, 10 May 2007

Despite Vigorous Efforts…

SLOW PROGRESS IN COMBATING MALARIA

By Radhakrishna Rao

For more than two decades now vigorous and widespread efforts have been on to devise an effective and comprehensive vaccine to combat the emaciating disease of malaria which has become a major public health problem in India and many third world countries. It has been estimated that as many as one million people get killed every year by malaria and the continent of Africa accounts for around 90% of the deaths due to malaria.

Ecological devastation and poverty accentuated by wars have contributed in a big way to the spread of malaria in Africa. The disaster is already a big killer of children in the impoverished sub-Saharan Africa. It has also been estimated that one in three in the world is vulnerable to malarial infection.

“Sadly we say that though research is going to find remedies to combat malaria, we are unable to develop a vaccine to date. The only treatment we have is in the form of drug. We hope to develop a vaccine in the next decade”, says Dr.S.Padmanabhan, a well-known researcher from the Bangalore-based Indian Institute of Science (IISC). Significantly, though a number of vaccines meant to provide protection against malaria are under various stages of development, testing and trial, none of them has been cleared for a regular and routine use.

Meanwhile, a malarial vaccine developed by the drug giant Glaxosmithkline Biologicals has shown good results during the clinical trials carried out in Mozambique. Monitoring of the children who were given three dose regime of the vaccine showed that that they were protected for 18 months. But then as pointed out by a spokesman of the company “several years of clinical investigation will be needed before this vaccine is ready for licensing”.

On the other hand, Dr.Melinda Morse, Director of Path MVI created with the objective of overcoming the barriers in the malarial vaccine development has this to say, “The ability of this vaccine to protect children from severe malaria for at least 18 months makes it a very promising, potential public check tool for the developing world”.

In an yet another development of significance, a team of French scientists at Pasteur Institute under the leadership of Prof.Pierre Drulhe has reported about  the trials of a malarial vaccine that  drugs and bednets to mimics the natural immunity some people develop against the disease. But the biggest problem associated with a malarial vaccine is that the antigen a vaccine could target may vary depending on what stage the parasite is at in its life cycle. Clearly and apparently, this implies that a single vaccine might not work against all strains all strains of the disease causing germ.

In a related development, studies carried out by the Biochemistry department of IISc have revealed that the inhibitor Geldanomycin could be used to combat malaria. According to IISc researcher Utpal Taty, the discovery is the outcome of the study on the growth malarial parasite plasmodium falciparum on patients suffering from malaria.

Incidentally, of the four malarial parasites, Plasmodium facliparum is by far the most dangerous, especially to undernourished, weak or young. In fact, the strategy to control malarial also depends on safe water, efficient public health facilities, education, supply of latest genre drugs and bednets to the people vulnerable to malarial infection. Not surprisingly, malaria is considered a disease of poverty and cause of poverty. In recent years, there has been a steady resurgence in malarial incidence in India and the States like Karnataka, Orissa and hilly north-eastern region have been reporting an increasing number of malarial cases.

On the other hand, urban centres like Mumbai and Goa too have been reporting a spurt in malarial cases mainly due to the migration of people from various parts of the country. In 1998, WHO Director General Dr.Gro Harlem Brundtland had announced a strategy to substantially reduce the cases of malaria by 2010.

Indeed, in the Indian context, the proliferation of slums and shanty towns in the urban centres of the country has contributed in a big way to the explosive spread of the disease. In fact, the conventional method of monitoring the potential breeding ground of the disease causing mosquito strains across the Indian urban sprawl has become a cumbersome exercise in terms of money and time.

As such, the New Delhi-based Malarial Research Cetnre (MRC) has been making use of the data made available by a string of earth observation and weather monitoring satellites to map the potential malariogenic areas in the country. In the long run, the repeated observation from space over a period of time can provide comparable data which will add to the malarial eradication measures.

But the grim ground reality is that in recent years, the malarial control programme in India and in other parts of the world has run into difficulties owing to the disease causing parasites fast developing resistance to the once potent anti-malarial drugs and the mosquito strains spreading the disease developing resistance to a range of hitherto potent pesticides.

According to Arata Kochi, WHO’s Head of malaria, “our biggest concern right now is to treat patients with safe and effective medication to avoid the problem of drug resistance”. Kochi also drives home the point that “if we lose ACTS (artemisinen combination therapy) we will no longer have a cure for malaria and it will probably be at least ten years before a new one can be discovered”.

The drug resistance is now a major problem in the fight against malaria, say the WHO sources. For instance, sulfa doxine pyrimthanine, which was one hundred per cent effective about two decades back, has now lost much of its efficacy and punch. As pointed out by Kochi, “so far no treatment failures due to artemisine drug resistance have been documented, but we are watching the situation very carefully”.

Meanwhile, researchers working on devising new and novel strategies to combat malaria are veering round the view that climatic fluctuations could be used to predict the spread of malaria. Researchers are confident that the system which is based on computer models of climate change can predict outbreaks upto five months in advance.---INFA

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