A Realistic Strategy for Fighting Malaria in Africa

In 1955 the World Health Organization (WHO) launched its global campaign to eradicate malaria, essentially on the basis of two novelties. The first was the application of two chemicals: DDT to kill mosquitoes and chloroquine to overcome the malarial parasites in people. The second was the construction, by George Macdonald, of an ingenious mathematical formula to correlate the epidemiological factors that underlie the transmission of malaria. The use of the chemicals had led to some preliminary success in managing malaria in a small number of areas with relatively limited intensities of malarial transmission. The formula was designed to provide a measure of the levels of change in several malariarelated factors that would facilitate the total interruption of malarial transmission. Malaria eradication became the ‘holy grail’ to which we all aspired. Following a visit across the African continent from west to east, your reviewer — who was, like Jobin, deeply involved in this effort — once said to a journalist (in retrospect, unwisely): ‘I set off (in 1953) to Liberia with a bucket of DDT in one hand and a bottle of chloroquine in the other to eradicate malaria. I returned to the continent nearly two decades later and almost nothing had changed’. I was equally unwise to conclude, in a report that I wrote in 1960 for the WHO, that, with the means then at our disposal, to eradicate malaria from Africa was impossible. As a result of making this statement, I became virtually persona non grata in Geneva for a very long time. In this book, which the author calls a ‘polemic’, Jobin comes to a similar conclusion half a century later. His argument, emerging from his lifetime involvement in the management of malaria as both a practitioner and administrator, is based essentially on the increasing evidence of the vital role that human fallibility plays in the limited success that has met all major attempts to achieve malaria eradication. What Jobin does not specifically point out is that, for all its ingenuity and mathematical logic, the Macdonald formula omitted one crucial factor: the mentality of Homo sapiens. Since the 1950s a wealth of technological progress has been made at all levels in our knowledge of malaria, with the development of new forms of therapy and new insecticides to kill the vectors and the investigation of the molecular biology of the parasites and the molecular nature of immunity to malarial infection. During the past decade there has been an awakening of the developed world to the cost of malaria, in terms of human suffering and its impact on social and economic development. This has given rise to an unprecedented, exponential increase in the level of financial support for research into ways of reducing the burden of malaria, and some (as-yet limited) successes have been achieved. Unfortunately, as Jobin points out, the challenge of reducing malarial transmission, particularly on the African continent, remains little changed. No longer do we talk of ‘eradicating malaria’. That goal was officially abandoned as long ago as 1969. Today we set our sights, somewhat more modestly, on ‘malaria elimination’ or, even more realistically, on ‘malaria limitation’. Jobin offers his view on what he calls ‘a realistic strategy for fighting malaria in Africa’. Annals of Tropical Medicine & Parasitology, Vol. 104, No. 8, 685–686 (2010)