Malaria spread feared as WHO releases action plan to tackle global spread of insecticide-resistant mosquitoes (REPORT)

(Video World Malaria Day, 2012/WHO)

By Amy Maxmen

The war to bring malaria to heel has made slow but steady progress during the past decade, with the overall mortality rate dropping by more than 25% since 2000. A key factor in this progress has been improved control of mosquitoes, which transmit the Plasmodium parasite — a potent killer that claimed an estimated 655,000 lives in 2010 alone. But health officials fear that the spread of insecticide-resistant mosquitoes could bring about a resurgence of the disease. To help combat this threat, on May 15, the World Health Organization (WHO), based in Geneva, Switzerland, issued a strategic plan to curb the spread of resistance.

“We don’t want to wait for failures to happen,” says David Brandling-Bennett, the senior adviser for infectious diseases at the Bill & Melinda Gates Foundation in Seattle, Washington, who advised on the document.

Such failures could reverse the recent drop in malaria mortality credited to insecticide spraying in the home and coating of bed nets, which save about 220,000 children’s lives each year, according to the WHO. Insecticide resistance could also result in as many as 26 million further cases a year, the organization predicts, costing an extra US $30 million to $60 million annually for tests and medicines.

The WHO report says that insecticide-resistant mosquitoes already inhabit 64 malaria-ridden countries (see map).

The problem is particularly acute in sub-Saharan African countries such as Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Ethiopia and Uganda, where mosquitoes are frequently resistant to compounds known as pyrethroids and even to the organochloride DDT, venerable tools of mosquito control. Because they are extremely safe for children, effective against mosquitoes and affordable, pyrethroids are the only insecticides used to treat bed nets, as well as the first choice for household spraying.

Health authorities in Somalia, Sudan and Turkey have also reported sporadic resistance to the two other classes of insecticides recommended by the WHO for safe and effective household spraying: carbamates and organophosphates. Resistance has probably evolved several times independently, and is now spreading as extensive use of pyrethroids and other insecticides favors resistant mosquitoes. “In 2004, there were pockets of resistance in Africa, and now there are pockets of susceptibility,” says Janet Hemingway, chief executive of the Innovative Vector Control Consortium (IVCC), a product-development partnership based in the United Kingdom.

(MAP: Global malaria map, 2012/WHO) Among other things, the WHO recommends rotating the classes of pesticides used to spray houses, and developing safe and effective non-pyrethroid insecticides that can be used to treat bed nets. To implement all of the WHO’s suggestions would cost $200 million - on top of the $6 billion that the WHO requested last year to fund existing malaria-control programs. Rob Newman, director of the Global Malaria Program at the WHO, hopes that the report will draw more funds to the table as donors grasp the situation. “If we can stop pyrethroid resistance from spreading, it will be cheaper in the long run,” Newman says.

“In 2004, there were pockets of resistance in Africa, and now there are pockets of susceptibility.”

But the two largest players in malaria aid - the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President’s Malaria Initiative (PMI) - have not yet pledged additional money to fight resistance. Their spending on mosquito control is already high - in 2009, 39% of the Global Fund’s malaria expenditures went towards insecticide-treated bed nets and household spraying, as did 59% of the PMI’s in 2010.  

For now, pyrethroids are the only class of insecticides approved by the WHO for bed nets, and where spraying is concerned they are less costly than the alternatives. Vestergaard Frandsen, a company based in Lausanne, Switzerland, says that it has in the pipeline a bed net coated with a non-pyrethroid insecticide - one that does not belong to any of the four WHO-approved classes - and that the company expects to bring this to market within the next five years. It is also one of several companies partnering with the IVCC to create innovative mosquito-control products.

(PHOTO: Malaria `home test'/NoProphalactics)In the meantime, health officials may be able to keep malaria at bay by swapping insecticides. The report notes that in Colombia, for instance, mosquitoes regained susceptibility to pyrethroids after five years of treatment with an organophosphate. But some African countries lack the surveillance needed to spur such an approach. To address that deficiency, the report urges that a global database be set up to track the spread of resistance, and that entomologists be trained and hired at surveillance stations. That could prove the most challenging goal of all.

“Nobody wants to fund capacity building,” says Newman. “Donors would rather say they purchased $10,000 in bed nets than pay a salary.”

African ministers of health realize the need to manage resistance but can’t do much without outside funds, explains Maureen Coetzee, a medical entomologist at the University of the Witwatersrand in Johannesburg, South Africa. “In some countries, malaria control means one person sitting in one room, and he’s lucky if he’s got a chair,” she says.

- This report originally appeared by Amy Maxmen at Nature.

Global Fund Cancels Fundraising; Seeks New Leadership (NEWS BRIEF)

(HN, November 23, 2011) The high profile Global Fund to Fight AIDS, Tuberculosis and Malaria has, in a surprise move, cancelled its multi-million dollar fundraising efforts and has instigated a search for a new chief.

The Geneva-based Fund aims to save 10 million lives and prevent 140-180 million new infections from AIDS, tuberculosis and malaria from 2012 to 2016. It has$4 billion in its trustee account and expects to sign grants for existing approved programs worth $10 billion for the period 2011 to 2013.

In a statement today issued in Ghana, the Fund said that in its last pledge round, in October 2010, it managed to raise only $11.7 billion, well short of the $13 billion “austerity budget” it said it needed as a minimum to continue programs already started. It had hoped to raise $20 billion.

Questionable disbursement practices by many countries, including Djibouti, Mali, Mauritania and Zambia, lost their grants or had new safeguards put in place after officials were accused of stealing. The Fund’s own inspector general exposed the fraud and earlier this month was trying to recover about $20 million that had been allegedly stolen.

The funding has its complications. Recipient country, Zimbabwe, for example, has blamed the United Nations Development Programme (UNDP) for delays in disbursements of Fund grants.

"The five-year strategy and transformation plan adopted at the meeting together commit the Global Fund to shift to a new funding model that focuses on investing strategically in countries, populations and interventions with high potential for impact and strong value for money,” said Fund board chair Simon Bland. “It will provide its funding in a more proactive, flexible and predictable way. It will better manage risk and it will work more actively with countries and partners to facilitate grant implementation success. In doing so, I believe the Global Fund will shift from an institution that has successfully provided emergency funding to allow countries to cope with the runaway pandemics, to become a sustainable, efficient funder of the global efforts to control them and eventually win the battle against AIDS, TB and malaria."

The fund’s board, while meeting in Accra, created a new general manager position to take some day-to-day authority from the executive director - French national and physician, scientist and diplomat, Michel Kazatchkine. His fundraising capabilities have reportedly come into question.

- HUMNEWS staff, agencies, Global Fund

On Their Annual Day African Children Remain Extremely Vulnerable (NEWS BRIEF)

A young boy in Burundi. CREDIT: HUMNEWS(HN, June 16, 2011) As the Day of the African Child is commemorated across the continent today, millions of young people face deadly threats, ranging from pneumonia and malaria to HIV and AIDS and domestic violence.

There are thousands of children under 18 languishing in jails from Nigeria to Burundi - either housed with adults or incarcerated without trial or proper legal representation.

The best laid plans of donors and governments have, in some instances, have failed to reach targets.

For example, despite the distribution of millions of bed nets, for example, in many African countries - including Nigeria and Burundi - malaria will be far from eradication by the UN goal of 2015.

In countries such as Lesotho, almost one in four people are living with HIV and an estimated 17 percent are aged 15-24.

In Africa, sexual violence is a daily reality for girls. A recent Swaziland study documents that about one third of adolescent girls under the age of 18 have stated that they have been victims of sexual violence by boyfriends, husbands and/or male relatives. Most of the violence takes place in the home, or close by in neighborhoods or at school.

There are bright spots on this day that deserve acknowledgement. The incredible efforts of such institutions as the Bill and Melinda Gates Foundation has translated into the near eradication of polio in the four remaining endemic countries: Nigeria, India, Pakistan and Afghanistan.

And across the continent, more children are receiving free primary education than ever before.

In Burundi, a visionary project operated by CARE and funded by the Nike Foundation has provided micro credit, small business grants to adolescent girls who have fallen into poverty due to early pregnancy and other reasons.

- HUMNEWS correspondent in East Africa

World Malaria Day: Race to 2015 Elimination Faces Challenges (REPORT)

A Nigerian mother with her infant: the vast majority of malaria deaths in Sub-Saharan Africa are among children under 5. CREDIT: M Bociurkiw/HUMNEWS(HN, April 25, 2011) - The race to eliminate malaria - a preventable disease that claims the lives of almost one-million children every year - by the United Nations target of 2015 faces several challenges - despite tens of millions of dollars earmarked each year towards prevention efforts.

In a conference call hosted by the United Nations Foundation on the eve of World Malaria Day (today), experts agreed that despite well-meaning efforts of several fronts, recalcitrant governments and unpredictable world events could frustrate efforts to reduce malaria deaths to zero by 2015.

On average, malaria claims the life of an African child every 45 seconds. The vast majority of the deaths are among children under five years old.

The main item in the arsenal to fight the disease is insecticide-treat bed nets - which last as long as five years and costs about $10 (including associated costs such as training of health workers). If used properly, the nets protect sleeping children and also kill malaria-bearing mosquitoes.

Malaria eradication proponents claim that more than 75% of people in Sub-Saharan Africa are now covered by bed nets. "We are really making a difference," said sports columnist Rick Reilly.

But the on challenges the road to 2015 are many.

The recent civil war in Ivory Coast, for example, has delayed the distribution of millions of bed nets, said Ray Chambers, a philanthropist and humanitarian who was appointed by UN Secretary General Ban Ki-moon in 2008 as his Special Envoy to mobilize global support for action on the disease. Chambers said the nets are stuck in warehouses in Ivory Coast and if they are stolen or destroyed it could prove difficult to raise replacement funding.

"The greatest risk is that they may disappear between now and the time they get the opportunity to distribute them," said Chambers in reference to the nets in Ivory Coast. In addition, the migration of at least 75,000 people to Liberia also makes protection of people difficult.

Experts also identified Nigeria - Africa's most populous nation with 150 million people - and the Democratic Republic of Congo - as serious trouble spots in the battle against malaria. In Nigeria, nets are not distributed as efficiently as they should and crucial social mobilization efforts need to be scaled up.

Awa Marie Coll-Seck, Executive Director of the Roll Back Malaria Partnership, said it is expected that the mobilization of community health workers and community-based organizations will improve the usage rates of bed nets. "In a lot of countries they never used to have nets..it needs explanation and a lot of work. They have a lot of nets coming but they have to catch up on the work to change the behaviour of the people."

Of the 67 million nets earmarked for Nigeria, about 27 million have been paid for but have yet to be distributed "because of different delays within the government process," said Chambers.

Chambers said the DRC has its own set of problems that prevent proper distribution, but that universal distribution is expected as soon as later this year.

He added, however, that an incredible set of partnerships has evolved to fight malaria. Aside from the UN Foundation, the collaboration includes Nothing But Nets, Roll Back Malaria, UNICEF, Rotary International, the World Health Organization (WHO) and Population Services International. "It's because of this incredible partnership that has ever been assembled in a fight against any type of major disease," said Chambers. "We have made the greatest and most rapid progress against any major disease in our lifetime."