Health Special

New Delhi, 29 August 2008

War Against Malaria

DRUG RESISTANCE CAUSES WORRY

By Radhakrishna Rao

For long, malarial fever caused by the virulent micro-organism plasmodium falciparum has been a major contributing factor for the fatalities arising out of this ancient, emaciating disease. Every year, around 800,000 people in India fall prey to malaria.

However, today two cases of suspected malarial deaths in Goa have rattled the medical fraternity in the country. Primarily, because they have been caused by the parasite plasmodium vivax, responsible for spreading the non-fatal form of malaria. This has given enough reason for the biomedical researchers to be worried. They want this development to be probed to find out the exact causative factor for the two deaths ascribed to malaria.

In this context, according to the Indian Council Medical Research (ICMR) emeritus scientist CR Pillai, “It could be that the organ failure and cerebral malaria may have been caused by different undetected reasons, probably a weak immune system which may sometimes cause the vivax to behave more virulently.”

An estimate by the Malaria Vaccine Initiative, an international non-profit organisation, pointed out that India spends nearly half its health budget on its malaria control program. In fact, in recent years, there has been a steady resurgence in malarial incidence in States like Karnataka, Orissa and the North-East region .In particular, the under-nourished, weak and the young have been falling prey to malaria at an increasing frequency.

Described as a major health challenge, malaria is known to kill upto two million people a year around the world. Presently, over 50 million people are in dire need of an appropriate treatment for the disease. Thanks to the efforts of the former US President Bill Clinton Foundation’s HIV/AIDS Initiative, four Indian  and  two Chinese pharma outfits  have agreed to lower the prices of artemisnin combination therapies(ACT) for treating malaria. 

These prices will be available to 69 countries in Asia, Africa, Latin America and the Caribbean. Said experts, “The rise in demand saw prices of artemisnin fluctuate by around 700%. If increased input costs had been passed on to the consumers, the ACTs prices would have more than doubled and the patients would have suffered significantly reduced access to ACT.”

In a related development the World Health Organisation (WHO) has stated that more than one million lives could be saved if insecticide treated bed-nets are used in the malaria endemic zones. Significantly, the Union Health Ministry has taken up a project aimed at introducing insecticide bed-nets on a large scale in the malaria prone regions of the country. According to the WHO’s Regional Advisor on malaria,  “Around 548-million Indians live in the malaria endemic areas and the number of long-lasting nets required to cover the population at risk is around 30 million.”

Significantly, the WHO has been forced to acknowledge that “battles have been won against malaria but the war against the ancient scourge is in danger of being lost” .It notes that the remarkable progress notched up in the war against malaria in the 1950s and 1960s ended up in miserable stagnation in the 1970s. The emergence of pesticide-resistant mosquito strains and drug-resistant malarial parasites have conspired to make malaria a difficult to tackle epidemic. Public health administrators are highly critical of the relative lack of resources devoted to fight malaria as compared to other diseases.

In an important development to help fight malaria with greater vigour, medical researchers have devised a technique that is much faster and more cost effective than the current diagnostics techniques. An international team  led by researchers at the Exeter and Coventry Universities  have perfected a technique that uses a magnetic optic system to detect haemozoin, a  waste product of the malarial parasite in the human blood circulation system. Parallelly, the team has developed a devise which gives a positive or negative reading for malaria in less than a minute.

In another significant development, French researchers at the Pasteur Institute have reported trials of a malarial vaccine that mimics the natural immunity some people develop against the disease. However, the vaccine would need to undergo a series of further rigorous trials before it is accepted for routine administration.

Conversely, the biggest problem associated with a malarial vaccine is that the antigen the vaccine could target might vary depending on what stage of its life-cycle the parasite is at. In other words, a single vaccine might not work against all the strains of the disease-causing germ.

In recent years, the proliferation of slums and shanty towns in the urban centres of the country has been contributing in a big way to the explosive spread of this emaciating disease leading to a loss of “productive man hours”. Sadly, the conventional method of monitoring the potential breeding ground of the disease-spreading mosquito strains across the urban sprawl has become a cumbersome and complex task in terms of money, time and human resources.

Against this backdrop, the New Delhi-based Malaria Research Centre (MRC) has been making use of the high resolution data being made available by a string of earth observation and weather-watch satellite constellation to map the potential malariogenic zones in the country. In the long run, the repeated observation from space over a period of time could provide comparable data which would add to the malaria eradication strategy.

But the grim ground reality is that in recent years, the much-touted malaria control programme in India and other Third World countries has run into rough weather owning to the parasites causing the disease developing resistance to potent anti-malarial drugs and to a range of potent pesticides. According to a WHO spokesman, “our biggest concern is to treat patients with safe and effective medication to avoid problems of drug resistance.”

Clearly, drug resistance is now a major problem in the war against malaria. For instance, sulfa doxine pyrimathanine, which was 100% effective some two decades back, has now lost much of its punch. Thus, to curb the incidence of malaria, we need efficient public health facilities, growing public awareness, supply of the latest genre drugs and insecticide-coated bed-nets to people vulnerable to infection. ---- INFA

(Copyright, India News and Feature Alliance)