World Malaria Day throws spotlight on world's third biggest killer
Malaria kills up to two million people per year, infecting 300 to 500 million more. The only infectious diseases that kill more people are tuberculosis and HIV/AIDS. The countries most at risk, and where these diseases have the greatest impact, are common to all three diseases - developing nations, especially sub-Saharan Africa. The Alliance of Liberal Democrats for Europe held a press conference at the European Parliament in Brussels on 25 April to publicise World Malaria Day, and to tie in with the new Roll Back Malaria campaign, announced on 24 April. The speakers included Professor Awa-Marie Coll-Seck, executive secretary of Roll Back Malaria, and the Minister for Health of the Democratic Republic of Congo; Emile Bongeli, who spoke of the fate of a child hit by malaria today - those most at risk are the under-fives. 'Malaria kills a child every 30 seconds,' said Sunil Mehra, executive director of the Malaria Consortium. 'Moreover, this child is killed within 24 hours, so this child has to be saved today. We are just beginning to see the fruit of investment in malaria - this is happening now. It would not be a good idea to cut the crop,' he said. 'Malaria is made out to be a complicated disease,' continued Mr Mehra, 'It needs sustained funding, with skills and expertise, and results will be seen in reducing the burden of malaria and debt. The malaria parasite is deadly, the mosquito is fairly active, but it is us people who are complicated.' In fact, malaria is almost entirely preventable. Malaria could be contracted in areas of southern Europe as recently as the early the 20th century. Prior to that, malaria has been known as far north as the UK, although localised to areas with micro-climates. The classic way to prevent malaria is to prevent the vector of the disease - the mosquito - reproducing. This can be done by disrupting its life-cycle, traditionally by pouring oil onto stagnant water, which is essential for the mosquito to reproduce. Unfortunately, this method is impractical in areas too large to cover properly, and with inadequate funds, such as in many African countries. An additional problem for those attempting to limit the spread of malaria is the efficacy of drugs. Widespread and unregulated use of anti-malarial drugs has caused many malarial strains to develop resistances, rendering these drugs useless. The Roll Back Malaria partnership announced on 24 April that it wants to concentrate efforts on Artemisinin-based Combination Treatments (ACT), which are the most effective for treating malaria available today. Artemisinin has an interesting history. Developed in China in the early 1970s from a traditional Chinese medicine (Artemisia annua, or sweet wormwood), it was unavailable for 20 years due to the secretive culture surrounding the Cold War, despite astounding rates of recovery in those given the drug. The plant from which the active ingredient derives was later identified to be a common weed, and widely available in the US, kick-starting trials of the drug and its derivatives. In treating malaria, it has been shown to be effective in move than 90 per cent of cases, even in the most lethal varieties of malaria and in those strains currently resistant to other forms of therapy. The ACT treatment combines Artemisinin, or derivative drugs, with other more familiar treatments. The 2006 Roll Back Malaria campaign, christened 'Get your ACT together', aims to introduce more ACT therapies, especially into Africa. 'As well as increased financial resources, countries need significant technical support in management and procurement to implement their plans,' said Professor Coll-Seck. While effective treatments are available, the Global Fund for AIDS, Tuberculosis and Malaria remains the single largest spender on anti-malarial drugs, particularly ACT. Ironically, despite the global desire to eliminate malaria, the single largest sponsor of ACT could in theory decide to cut funding. The Global Fund board meeting on 26-28 April will decide how funds will be allocated. Should donations to the Global Fund increase, so too will the number of ACT programmes. The EU and Member States have contributed USD 2.5 billion (2.01 billion euro) since the Global Fund's inception. 'The European Union is the most important contributor to the Global Fund,' said French MEP Thierry Cornillet (UDF), organiser of the Parliament press conference. 'The EU as a co-founder of this Fund has a strong interest in the fight against these illnesses that take people's strength away before killing them, and therefore constitute an important element for holding back the African economy,' he said. Aside from the ACT therapies, malaria is the subject of a large number of research projects, in the development of working vaccines and treatments. The rather elaborate way in which the malarial parasites are spread (described below) provides a very large number of potential targets for researchers. Under the EU Commission's framework programme, now into it sixth incarnation, some 190 individual projects have investigated some part of malaria, its spread or prevention. While ACT is effective for those who have already contracted malaria, the other bright hope is in vaccinations, preventing those at risk from contracting the disease in the first place. Pharmaceutical giant GlaxoSmithKline has the support of the world's richest man, under the guise of the Bill & Melinda Gates Foundation, in developing its malaria vaccine. Mr and Mrs Gates bequeathed the PATH Malaria Vaccine Initiative (MVI) 107.6 million US dollars (86.63 million euro) in October 2005. A GlaxoSmithKline spokesperson spoke to CORDIS news. 'We have run clinical trials since the late 1980s, but we are now moving into a proof of concept study in 1 to 4 year-old children in Mozambique [...]. The vaccine has a 35 per cent efficacy in non-fatal forms, moving up to 49 per cent for fatal forms. This is a significant effect, and we still see the effect after 18 months. The candidate vaccine will be submitted to see if the trials can be extended, and included in the EPI [UNICEF 'Expanded programme on immunisation'] vaccines, which have good coverage, and then we will see if we can bring down the age at which the vaccine can be given.' While malaria is spread by mosquito, the disease itself is another organism - protozoan parasites (known collectively as Plasmodium) that live in the blood. Researcher Ronald Ross discovered the plasmodium parasite in the stomach of the Anopheles mosquito in 1898, receiving the Nobel prize in 1902 for his groundbreaking work. His work solved the puzzle of malaria, which had until then been viewed as entirely mysterious, even taking its name from the French for 'bad air'. When the female Anopheles mosquito sucks the blood of a human, sporozoites, or tiny infectious agents, enter the bloodstream. The agents lodge in the host's liver, where they multiply rapidly and grow, turning into merozoites, which leave the liver and infect red blood cells. These merozoites can also multiply, infecting further red blood cells or can differentiate into male and female types, or gametocytes. Gametocytes are ingested by female mosquitoes when they bite humans. The gametocytes mate and reproduce in the mosquito's stomach, producing tiny sporozoites, which can again infect humans, so beginning the cycle again. The parasite needs both the human and mosquito hosts in order to complete its life-cycle. Of the identified species of Plasmodium, only four are known to infect humans, and thus spread malaria. Plasmodium falciparum is the most deadly variety, while Plasmodium vivax, Plasmodium ovale and Plasmodium malariae are often referred to as 'benign' as they are usually not fatal. Because of the rather elaborate methods needed to reproduce, each step in the malarial cycle is a potential target for prophylactics, vaccines or other treatments. While malaria has been eliminated from EU Member States for a long period of time, projections of global warming indicate that the Anopheles mosquito could easily return to more northerly climates, bringing the malarial parasites with it as temperatures increase.