Malaria-related deaths have increased by 100% in some places

Richard Allan

The world has fooled itself into believing that the fight against malaria can be won using the same old approach. The truth is we have to shake things up to save lives.

The world must face an inconvenient truth in the fight against malaria, says Richard Allan. And it must face it now.

The inescapable fact is that the number of people contracting the disease — and dying from it — is rising. “Central African Republic, Chad, Congo… the incidence of people infected by malaria in places such as these has escalated dramatically and death rates have increased by 100%,” he says. “That’s extraordinary data.” And incredibly worrying.

“The situation is dire”

There have been malaria prevention success stories, of course. Two years ago, heartening statistics from the World Health Organization’s World Malaria Report showed impressive malaria reductions in 55 countries. But there was a catch, notes Allan. These countries only accounted for four per cent of the total estimated malaria cases. “There were 97 countries where we had achieved little, and two years on, 80% of the worlds malaria cases are contained in a group countries across the central belt of Africa, most, affected severely by humanitarian crises. The annual toll of malaria deaths in these has consistently risen in all of these since 2010” he says the situation is increasingly dire.

Allan is founder and CEO of The MENTOR Initiative — an organisation offering technical and operational support in order to deliver disease control to countries suffering from tropical diseases — and knows how people are suffering on the ground. He believes the organisations tasked with malaria prevention must fundamentally reassess their approach. For example, he says, there’s a tendency to assume that if people in affected countries own mosquito nets then that will be enough to save their lives.

Sadly — and invariably — it isn’t.

Nets are sometimes not culturally accepted

“Nets protect you amazingly well if two things happen,” says Allan. “If the insecticide on them is effective; and if people sleep under them. We make the assumption that if we just keep giving out nets in vast volumes, those two things will be true.” Yet, too often nets are distributed without effective insecticides; and checks are not being made to see if people are using them properly — or at all.

Some houses or tents are unable to hang nets — perhaps they aren’t high enough or have no point of attachment.

And anyway, nets are not the solution in every case, especially in countries where communities are displaced and living in temporary settings, says Allan. “For example, some houses or tents are unable to hang nets — perhaps they aren’t high enough or have no point of attachment — plus there are settings where nets just aren’t culturally accepted or used.” He stresses that other tools in the malaria prevention toolbox, such as larvicides, insecticide-treated tents, curtains and blankets, wall linings, indoor residual spraying with effective insecticides, and spatial repellants, should also be employed where necessary. “Integrating all these solutions — and then selecting the right ones for the right context — will yield far better results,” he says.

High-risk areas have less money to battle malaria

Allan also believes there has been too much focus on countries where malaria is easier to control and where the fundamental burden of disease is lower. But what about those places where malaria is endemic and where infrastructure is poor or non-existent? Or where fragmented communities are at war with each other?

“The amount of money spent on malaria funding varies immensely,” he says. “Look at São Tomé — a country where many people would like to go on holiday — and where 16 dollars per person is being spent on malaria control. Then look at those countries where there has been a 100% increase in death rates from malaria since 2010, such as the Central African Republic, where the amount spent on control is about 40 cents per person.”

There is something fundamentally wrong with this mentality, says Allan. “The problem is, when you take the lower hanging apples off the tree, you are left with the truth,” he says. “And the truth is that the fruit on the harder-to-reach parts of the tree take up much more space — but we didn’t buy a ladder to reach it because we didn’t want to spend the money on it.”

The world currently has it backwards, says Allan: it should be spending 16 dollars per person on countries with the highest burdens of malaria, and 40 cents per person on those countries where control has been achieved in order to maintain the gains that have been made.