For millennia the battle of man versus mosquito has raged. During most of the war, man was fighting an unknown enemy, not realizing that it was the lowly mosquito that bore the lethal gift of malaria. The mosquito has played a significant role in world history: murdering Alexander the Great, and contributing to the fall of the Roman Empire. But it wasn’t until 1898 when Sir Ronald Ross, a British officer in the Indian Medical Service, demonstrated that malaria originated from mosquitoes that the mosquito received any of its well-deserved infamy. Indeed, before Ross’s discovery the suffering was attributed simply to mal aria, or “bad air.”
In October of this year, Bill Gates took up the challenge to eradicate the mosquito and its weapon malaria. Gates declared “that the parasite has been killing children and sapping the strength of whole populations for tens of thousands of years.” Gates is not the first to attempt to eradicate malaria Sir Ronald Ross lead an effort to eliminate stagnate water in the British Empire. In the 1950’s, the World Health Organization launched the Global Malaria Eradication Campaign with the goal of extraditing the disease worldwide only Africa was excluded. Primarily using chemical weapons (DDT) malaria was eradicated in the United States, Japan, Italy and Greece. Despite these successes, the program ended in 1969 after political and financial support waned.
Today malaria kills 780,000 people a year: 85 percent are children and a significant majority are in sub-Saharan Africa. At present, the primary method for defeating the mosquito is a global campaign to procure and distribute millions of insecticide-treated mosquito bed nets (ITNs) to at risk populations. The campaign has been most effective when recipients of ITNs have been educated on the correlation between the mosquito and malaria, and instructed on the proper methods to hang and maintain their nets. Without proper information recipients often end up not sleeping under the nets; reduce the nets efficacy through inappropriate washing practices; or fail to replace the nets when they become damaged. Communities that have seen the highest levels of reduction in malaria cases are those that have used the existing health systems to design and implement locally appropriate distribution and communication strategies. If these measures aren’t taken, then it is likely that the bed net initiative will likely fail and be abandoned, much as the WHO’s chemical eradication program was.
Whether bed nets continue as the primary malaria prevention tool or if a vaccine is developed, recent history has taught us that to have any chance at success we must follow certain practices. Malaria interventions must be implemented through existing community health systems, and political and financial support must not wane prematurely. Malaria has been a scourge to man for as long as time, and the drastic reduction of its impact will not come through poorly implemented, short-term programs.