The Other Mosquito-Borne Illness

Understandably, many people are alarmed over the rapid spread of the Zika virus in Latin America and the Caribbean as women face an infection that may lead to the severe, sometimes fatal, birth defect microcephaly. So far, as many as 50 babies may have died from the condition since the start of the outbreak less than a year ago. Yet, when it comes to mosquito-borne illness, Zika is the tip of the iceberg.

The same Aedes aegypti mosquito responsible for spreading Zika, also carries chikungunya, dengue, and, yellow fever—with the latter leading to some 30,000 deaths annually, mostly in Africa. But even these numbers pale in comparison to malaria. According to the World Health Organization, in 2015, there were an astounding 214 million malaria infections, and of these, 438,000 people died. But perhaps just as astonishing is the rapid pace of progress against the disease.

Over the past decade, malaria control effects have cut the number of deaths from the disease by close to 60 percent, resulting in 4.3 million lives saved. Many credit this progress to one man: Rear Admiral Timothy Ziemer, who has led the President’s Malaria Initiative (PMI) since it was launched in 2005 and recently visited the Mailman School to talk about efforts to control malaria and the possibility of eradicating it—a monumental task given the scale of the problem.

“The most dangerous animal in the world is the female Anopheles mosquito,” said Ziemer, referring to the chief carrier of the malaria parasite. “More people have died of malaria than all the famines and all the world wars put together.”

Today, PMI focuses on 19 of the hardest hit countries in Sub-Saharan Africa as well as the Greater Mekong Subregion with a strategy that puts a premium on prevention: mosquito nets, indoor residual spraying, rapid testing and treatment of positive cases, preventive treatment for pregnant women, and general health systems strengthening.

And, as students of health systems improvement will tell you, efforts like these do much more than reduce cases of malaria. In the last 10 years, malaria control has accounted for as much as one-fifth of all the progress in reducing preventable child and maternal mortality in PMI countries. In Senegal, Rwanda, and Zambia, mortality for children under age 5 was cut by at least half. There is an economic upside too: many countries have seen significant declines in lost workdays. (Mailman School graduates played a part in this progress as members of the PMI staff.  “We’re always in recruiting mode,” noted Ziemer.)

In its 2015-2020 strategy, PMI affirms its goal of worldwide malaria eradication.  Such a goal was seen as folly only a decade ago. “There has been a significant shift in mindset,” Ziemer acknowledged. To help get there, new treatments and technologies are in development, and not least of all, there is a real possibility of a vaccine.

At the same time, malaria control efforts need to contend with growing resistance to drugs and insecticides. But the biggest challenge, according to Ziemer, is the potential for a change in political priorities that could happen with the election of a new president. He is eager to show the White House and Congress how far we’ve come and what is possible in the coming years with continued political will.

The cost of eliminating malaria is estimated to be $110 billion. It sounds expensive, but the return on investment is a whopping $2.3 trillion in the affected countries. Ziemer calls this “a best buy in public health.”

“We can’t let up,” he said. “All of us who understand malaria know that the minute we take our eye off the ball, malaria is going to come back… Let’s celebrate success, but let’s keep our sleeves rolled up and our heads down.”