By Rebecca Kwei, Ghana

Had the scene been rural Accra some 50  years  ago,  children  would  have loved to gather by the fireside late in the  night  to  listen  to  the  “malaria story.”

This  malaria  story  may  not  have  all the  ingredients  of  a  good  African folklore  with  its  traditional  beliefs and  superstition,  but  there  are lessons to be learnt from the malaria story  just  like  any  other  African folklore.

Rebecca Kwei, one of Africa’s young generation had the rare opportunity of listening to Prof Don de Savigny of the  Swiss  Tropical  Institute,  as  he shared the malaria story at the lobby of the plush new hotel in Accra, the Holiday Inn.

Here goes the story Once  upon  a  time,  in  the  1950s, there  was  a  global  effort  (Global Malaria  Eradication  Programme (GMEP)  from  1955  to  1969)  to eradicate  malaria  after  it  was realised  that  spraying  houses  with DDT was a cheap and effective way of  dealing  with  the  menace.  It  was  promoted  by  the  World  Health Organisation (WHO).

The effort succeeded in eliminating malaria  from  most  developed countries  and  some  sub-tropical developing countries such as in Latin America,  parts  of  Asia  and  Europe,
including  parts  of  former  Soviet Union using DDT.

According  to  Professor  de  Savigny, this  global  effort  was  fantastic  as world  leaders  showed  political  and financial  commitment  by  pumping billions  of  dollars  into  the   project.    Every  country  issued  colourful malaria eradication postage stamps as  advocacy  for  the  worldwide campaign  to  eradicate  malaria under the theme “The World United Against  Malaria”.  An  initial  printing o f   1 0 0   m i l l i o n   s t a m p s   w a s  
authorized by the government of the United  States  of  America  to  raise funds  for  the  worldwide  drive against  malaria.  Between  1958  - 1960, the US alone contributed over 140 million dollars to the worldwide malaria eradication programme.

As the malaria eradication intensified,  Africa  seemed  to  have been left out.

Professor  de  Savigny  said  Africa, however, never fully participated in  or benefit from the full effort of this "global"  campaign.  The  GMEP  was d es ig n ed   t o   ex t en d   g lo b a lly . However,  experience  in  tropical Africa before the GMEP started was  not  successful  in  areas  with  stable malaria  where  transmission  could  not be interrupted. Therefore, most of  tropical  Africa  was  deliberately excluded  from  the  GMEP  on  a provisional basis until more effective and  economical  methods  could  be found  to  eradicate  malaria  in  such settings.

During the eradication era only the areas currently known as Botswana,  Cameroon, Eritrea, Ethiopia, Gabon, Ghana,  Madagascar,  Mauritius, Mozambique,  Namibia,  Somalia, South  Africa,  Swaziland,  Zambia, Zanzibar  and  Zimbabwe  had  focal programmatic  use  of  IRS  with  the goal to control in limited territory. For the rest of tropical Africa, vector control  was  considered  unfeasible due to intensity of transmission and partly because no solution could be found to the strategy for Africa.

After  10  years  (early  70s)  when  it was realised that it was not possible to eradicate malaria from Africa with the  available  tools  the  effort  was abandoned. It was no longer a goal. As  Prof  de  Savigny  puts  it,  ‘malaria f e l l   o f f ’   t h e   p o l i t i c a l   a n d   development  agenda  of  the  World Health  Organisation  (WHO)  to  the e x t e n t   s u c h   t h a t   a t   t h e   Organization’s annual World Health Assembly  meetings,  the  word
‘malaria’  practically  disappeared from discussions for many years. “It  was  as  if  nobody  wanted  to  talk about  or  be  associated  with malaria,” he says.

Malaria control then became one of the  routine  Ministry  of  Health programmes, as part of the Primary Health  Care  movement “Health  for All”,  w h ic h   in vo lved   a   m o re
i n t e g r a t e d   a n d   i n t e r - s e c t o r a l   approach.

Prof  de  Savigny  notes  that  the approach was not bad in itself. Wha was  worrying  was  that  malaria eradication  efforts  lost  the  globa touch  as  if  to  say  ‘let  the  Primary Health Care people deal with it’. The result  was  that  malaria  was  no longer paid any specific attention as a   d i s e a s e   o f   c o n c e r n .   T h e development  of  tools  for  malaria eradication  was  abandoned.  There was also no new thinking for malaria control.  Surprisingly,  even  though malaria  was  still  the  number  one killer  of  children  in  Africa,  the disease was not being mentioned in the  annual  State  of  the  World’s  children reports of UNICEF.

Malaria was finally put back on the international  health  agenda  in  the late 80s and 90s to refocus attention on the disease. The renewal of interest in  the  disease  gave  birth  to  the development of a new technology - the Insecticide Treated Nets (ITNs) in 1996.

"Suddenly,  there  was  new  hope because ITNswere easy to manage and  that  really  lit  the  fire  to  put malaria  agenda  back  on  track"

Professor de Savigny notes. In 1998 Roll Back Malaria Partnership, which is a coordinated global approach to fighting  malaria,  was  launched  to  galvanize partners to put malaria on the world's health agenda. Prof. de Savigny  says  since  then,  a  lot  of progress  has  been  made  regarding efforts  to  support  both  malaria  research  and  malaria  control.  Now there is renewed interest to try again to eliminate malaria.

The learned professor notes that the recent  announcements  of  over  a billion dollars in the latest round of funding from the global fund to fight  AIDS, TB and Malaria specifically for malaria  control  in  Africa  will  drive efforts  aimed  at  ending  malaria deaths  by  2015.  This  is  a  strong indication that the world is revisiting  t h e   i d e a   o f   e l i m i n a t i n g   a n d   eradicating  malaria.  The  funds would  be  used  by  countries  to support rapid implementation of the new  Global  Malaria  Action  Plan (GMAP). The projection is that, more than 4.2 million lives could be saved between 2008 and 2015, if the plan is  well  implemented  and  the foundation  laid  for  a  longer  term effort to eradicate the disease. Described by some as the road map for  malaria  control  and  elmination, GMAP's  plan  of  action  include  the p r o v i d i n g   o f   a n   a r r a y   o f   interventions  including  insecticide- treated  nets,  indoor  insecticide spraying  and  effective  malaria drugs.

End of story?
Could  this  be  the  end  of  malaria story?  Or  may  be  the  story  is  not about to end. It is just the opening of another  chapter.  And  is  Africa actively  involved  in  the  renewed efforts  to  put  malaria  behind  us? What  happened  to  the  Abuja Declaration? The financial resources are  coming  into  play.  Will  they  be used effectively? So many questions but are there any answers yet?