Fighting a killer, one bed net at a time

We talk to Dr Gregory Noland, malaria control programme epidemiologist at The Carter Center, on the threat to recent gains against malaria

Friday 25th April marked World Malaria Day, when healthcare and non-profit organisations from across the world came together to highlight the threat of a deadly disease to which half of the world’s population is at risk. Dr Gregory Noland, malaria control programme epidemiologist at The Carter Center, a US-based nonprofit organisation that is leading efforts against six diseases including malaria, explains the threat to recent gains against the disease.

What progress has been made so far against malaria?  

The UN’s World Health Organisation estimates that 3.3 million lives have been saved since 2000 as a result of the scale-up of malaria prevention measures. One of the key pillars of the global malaria strategy is distribution of insecticide-treated nets. The Carter Center has helped to distribute more than 15 million nets in Ethiopia and Nigeria, contributing to the overall increase in net coverage in malaria-endemic areas from 3 per cent in 2000 to 53 per cent by 2011.

How many people still need help?

There are still around 200 million cases of malaria, and 627,000 deaths from the disease, each year. Malaria is a disease of poverty that has a particular impact on communities with limited resources. Cost of treatment, care and prevention for malaria can consume substantial amounts of household income along with indirect costs such as lost wages, school absenteeism and time spent caring for sick individuals. Approximately 80 per cent of cases, and 90 per cent of malaria deaths, occur in Africa where malaria remains one of the top three killers of children. For a disease that is entirely preventable and treatable, these figures are inexcusable.

What are the challenges to reaching those vulnerable to malaria? 

The funding gap for malaria is $3bn a year. Based on recent successes, many countries are now embarking upon malaria elimination strategies. Yet history has shown that failure to completely eliminate the disease due to programmatic or donor fatigue can lead to a rapid and costly resurgence of malaria. Barriers for malaria are similar to other diseases afflicting the world’s poorest. Chief among those is improving access to medical care in areas with limited physical infrastructure. Many of the places The Carter Center works, for example, exist ‘at the end of the road and 50 miles further’, sometimes where no radio signals exist and where there are significant logistical challenges to delivering treatment and prevention measures.

What are some of The Carter Center’s initiatives in fighting malaria?

The Carter Center's malaria control programme focuses on interventions at the grassroots level, including bed net distribution, case detection and treatment, operational research and communication, such as teaching people how to properly hang a net. For example, in the northern Amhara region of Ethiopia, The Carter Center has provided nearly 6 million insecticide-treated bed nets since 2006 and more than 275,600 people have been treated for malaria since 2008. The programme also works in Haiti and the Dominican Republic to eliminate malaria and lymphatic filariasis from the countries' shared island, Hispaniola.

How can we accelerate progress against the disease?

eports of parasite resistance to a small number of effective drugs threaten the recent gains against the disease, so there is an urgency to develop additional drug therapies as well as to tackle malaria now. Of course, an effective vaccine would accelerate the fight. But it is important to highlight that at least 25 countries have eliminated malaria during the past 60 years using existing technologies. The Carter Center believes in supporting full scale-up of prevention and control measures now in those countries we support.