While Working to Eradicate Malaria, Let's Eliminate Malaria Deaths

Last week, there was a glimmer of hope for everyone that suffers from malaria: the world's first-ever malaria vaccine received a green light from European authorities. While we aren't out of the woods yet, this is a positive step toward eliminating this deadly foe. While RTS,S, does provide hope for a tomorrow without malaria, we cannot be lulled into complacency -- this is not a panacea for malaria.

The sad truth about malaria is that it continues to be one of the most deadly conditions in the world. In 2013, 128 million people contracted malaria, of whom more than half a million died. 1.2 billion people remain at high risk of contracting the infection. Every minute a person dies from malaria, and by the time you are finished reading this piece, nearly three people will have succumbed to the parasite.

RTS,S, or Mosquirix, has a long history. Investigators have been developing this for more than 30 years, and the Bill and Melinda Gates Foundation has contributed a small fortune -- estimates are north of $200 million -- to fund the vaccine's development, according to recent media reports. Studies suggest that the Phase III regiment of RTS,S, reduced the number of malaria cases by almost 40 percent in toddlers and 27 percent in infants. It also prevented 6000 cases of malaria per 1000 vaccinated children over four years.

Efforts continue on many fronts to eradicate malaria, but as a clinician caring for people with malaria, my more immediate goal is to keep children alive. Malaria deaths have been cut nearly half (47 percent) since 2000 as a result of better drugs, improved prevention and more rapid diagnoses, but the war is far from over.

The malaria parasite is a formidable and wily foe. It has become deeply entrenched, and bobs and weaves through both its hosts -- man and mosquito -- with impunity. Within minutes of its injection into the skin by the bite of a female mosquito, it vanishes into the liver, becoming the proverbial needle in a haystack for seven to 14 days. Having in that time multiplied thousands-fold, it then emerges into the circulatory system and lives and reproduces within red blood cells. Among the vulnerable, largely young African children, a life-threatening illness can develop within days.

The elimination of malaria deaths (before we manage to eliminate the parasite) could be pursued by combining two existent strategies: prompt diagnosis and effective treatment. This would prevent most early infections from progressing to life-threatening disease.

Rapid diagnostic tests are now available. Malaria parasite antigens can be detected by health care workers using finger-prick samples of blood -- this can be done anywhere. No electricity is required and no microscopes are needed. The artemisinin-based combination drugs are highly effective and can clear parasites in the blood within 24 to 48 hours. These two strategies need to be more widely deployed: In 2013, in sub-Saharan Africa, only 61 percent of suspected malaria cases were tested to confirm or exclude the diagnosis, and only about 70 percent of patients with confirmed malaria were treated with drugs.

Expanding the reach of these two highly effective approaches will save lives. There is a model for how to do this: the AIDS epidemic. A life-long affliction, AIDS is far more difficult to diagnose and much more complicated to treat than malaria. Starting in 2003, efforts to identify HIV-infected individuals and to start them on treatment began, and as a result, HIV/AIDS has been transformed from a death sentence to a chronic disease. If we can alter the care of people living with AIDS in Africa, we can certainly establish the infrastructure required to rapidly diagnose and treat uncomplicated malaria.

It will take time, perhaps a long time, to eradicate this nefarious, tenacious foe. In the meantime, we should be encouraged by recent breakthroughs -- but we need to continue focusing attention and resources on saving lives through rapid diagnosis and prompt effective treatment. Together we can stop malaria.