This year, we commemorate World Malaria Day by celebrating recent advances in controlling malaria. At the same time, we acknowledge the urgency in meeting critical milestones if we are to eliminate and eventually eradicate the disease worldwide.
Although significant strides have been made toward malaria control and the elimination of the disease from many regions, global eradication is a long-term goal that will require a sustained commitment. As we accomplish our goals, disease patterns may change and new problems will inevitably arise. It is important that we adapt to the changing circumstances that result from our successes and commit to a long-term effort.
Today we enter the second year of the Global Malaria Action Plan, [http://www.rollbackmalaria.org/gmap/] developed by the Roll Back Malaria (RBM) Partnership, a global framework for coordinated action against malaria, [http://www.rollbackmalaria.org/], which set ambitious goals to control, eliminate and eradicate malaria. We continue to support the RBM campaign, Count Malaria Out, which strives to achieve the 2010 target of delivering effective and affordable protection and treatment to all people at risk of malaria and cutting the disease burden in half compared with 2000 levels. This target marks a critical milestone in achieving the Millennium Development Goal [http://www.un.org/millenniumgoals/] set by the United Nations to halt the spread of malaria by 2015.
In 2000, an estimated 350 million to 500 million cases of malaria occurred worldwide and more than 1 million people died from the disease. Despite progress in controlling malaria, the number of deaths remains unacceptably high, and many challenges remain. According to the World Health Organization, there were about 243 million cases of clinical malaria and 863,000 deaths in 2008. Most of the deaths occurred among children less than 5 years of age living in sub-Saharan Africa. Reducing the number malaria deaths to 500,000 by the end of this year and to near zero by 2015 will require a concerted effort engaging all stakeholders.
Controlling malaria is especially challenging because of the biological complexity of the disease. Different forms of human malaria are caused by five species of the parasite Plasmodium, which are spread by as many as 40 species of the Anopheles mosquito. Effectively addressing malaria requires a fundamental understanding of the complex interactions that occur as the parasite replicates in both the human host and mosquito vector. Malaria elimination and eradication are made even more daunting by the impact of malaria on different populations and age groups, which varies greatly in different epidemiological settings and from region to region.
The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is joining with the RBM partnership, malaria-endemic nations and other domestic and international partners to address the threats to future progress against malaria that may evolve as we achieve some measure of success.
For example, resistance to the best anti-malarial drugs likely will emerge; indeed artemisinin resistance is occurring already in Southeast Asia, and there is great concern that it could spread more widely if not aggressively contained.
Similarly, mosquitoes already have demonstrated the ability to develop resistance over time to the insecticides used to control their spread. A pipeline of new drugs and insecticides is required to keep up with the inevitable resistance to these interventions. In addition, different species and strains of malaria parasite infect different populations throughout the world.
Widespread infection of humans in Malaysia with P. knowlesi, a malaria species previously known to infect non-human primates, led to its identification as the fifth malaria species capable of infecting humans.
Finally, global eradication of malaria and even regional elimination may not be possible without the development of a safe, affordable and highly effective malaria vaccine.
Because of these formidable challenges, existing interventions require continuous improvement, and new treatment and control strategies are essential. Such innovation to keep the malaria toolbox up-to-date will require a substantial investment in basic and clinical research. NIAID continues to support a robust research portfolio throughout the world, aimed at understanding malaria pathogenesis, immunology and epidemiology, and at developing new tools and strategies to diagnose, prevent and treat malaria.
This summer, NIAID expects to present the first awards for its newly created International Centers for Excellence in Malaria Research program [http://grants.nih.gov/grants/guide/rfa-files/RFA-AI-09-017.html]. This initiative aims to expand our international basic and clinical research capacity in malaria-endemic areas. Meanwhile, NIAID continues to enhance public-private partnerships to translate basic research findings into new or improved interventions. Recognizing the increasing contribution of parasites other than P. falciparum to malaria, we also are stepping up our focus on P. vivax and other plasmodium species in an effort to develop tools and strategies for interrupting all forms of malaria transmission.
As we work with our partners to meet the targets for the Millennium Development Goal of halting the spread of malaria by 2015, we recognize the essential and complementary roles that all the partners play in realizing this objective. Only through a multidisciplinary, multi-pronged, collaborative effort and a firm resolve to sustain our collective efforts over the long term can malaria control, elimination and eradication be achieved in all regions of the world.
B.F. (Lee) Hall, M.D., Ph.D., is chief of the Parasitology and International Programs Branch in the NIAID Division of Microbiology and Infectious Diseases. Anthony S. Fauci, M.D., is director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.
NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.
The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
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