Biology 103
2003 First Paper
On Serendip

The United Nations has declared 2000-2010 the "decade to roll back malaria." The social, economic and human effects of this disease are dramatic: 40% of the world's population is currently at risk for malaria, and it kills an African child every 30 seconds(7). The presence of malaria, as that of most other endemic tropical diseases, is directly related to the precarious living conditions of people in developing countries, but is also a cause that hinders growth and development, "In Africa today, malaria is understood to be both a disease of poverty and a cause of poverty." (6). This essay aims to show the connections between disease and society in specific regards to malaria, as well as the need for a more comprehensive analysis of cultural, environmental and socio-economic factors in scientific study to attain better understanding of the implications of malaria and find better preventive measures and possible cures.

The Disease: Malaria is a life threatening, parasitic disease, where the female Anopheles mosquito (who takes blood to feed her eggs) transmits the parasite from human to human. Transmission can also occur through infected needles among drug users and occasionally, in blood transfusions. It is a protozoal infection (protozoa are single-celled organisms). There are four types of species of Plasmodium protozoa that cause human malaria: Plasmodium falciparum, P.vivax, P. ovale and P.malariae. Malaria caused by P. falciparum is the most serious (3). The initial stage of the disease is characterized by nausea, muscular pains, headaches, fatigue, slight fevers and diarrhoea, and later gives way to more serious intermittent fevers. Because of the vagueness of these symptoms, misdiagnosis is common. More acute forms of malaria cause organ failure, convulsions, spleen enlargement, anaemia, impaired consciousness, persistent coma and death.

The History: The name malaria (bad air) comes from the early belief that tropical swamps caused the disease. It is one of the most ancient infectious diseases recorded; as early as the 5th century BC, Hippocrates (often referred to as the "father of medicine") recorded observations of malarial fevers. Investigation in the disease gained importance in the late 19th century not only because of its relatively high prevalence in countries such as Italy, but by the growing presence of mainly English, French and Spanish soldiers and colonizers in Southern Asia, Africa and the Americas, all areas of high risk. In the 1880's, Alphonse Laveran, a French army-surgeon, was the first to distinguish the malarial parasite and recognize it as the cause. Later in the same decade, the British Dr. Ronald Ross showed that the Culex mosquito transmits malaria in birds, finding for which he earned the 1902 Nobel Prize in Physiology. Ross' discovery allowed his Italian contemporaries Giuseppe Bastianelli, Amico Bignami and Giovanni Battista Grassi to find that malaria in humans is also transmitted by mosquitoes, though of a different species: the Anopheles. Sanitation as a basic preventive measure resulting from these observations became a key factor in significantly diminishing death from malaria, which allowed the completion historical endeavors, such as the Panama Canal, a major agent of economic development.

Social, Economic and Human Impact: Along with tuberculosis and HIV/AIDS, malaria is one of the most important public health challenges that hamper development in the world's poorest regions. Malaria exists in 100 countries around the world, the vast majority of which lie in the least developed, tropical areas of Central and South America, Asia, and most prevalently, Africa, where at least 90% of
the annual 1 million deaths due to the disease occur(4). The majority of those who die are children under five years of age and pregnant women. Acute cases of malaria amount to 300 million per year. Roll Back Malaria, a global partnership between the World Bank, UNICEF, and UNDP to "halve the world's malaria burden by 2010", states in its website, "Malaria, is one of the major public health challenges eroding development in the poorest countries in the world. Malaria costs Africa more than US$ 12 billion annually. It has slowed economic growth in African countries by 1.3% per year, the compounded effects of which are a gross domestic product level now up to 32% lower than it would have been had malaria been eradicated from Africa in 1960." Consequently, the development of many nations and of the entire Sub-Saharan region, along with the quality of life of millions of people would greatly increase with the control, prevention and cure of malaria, "for developing economies this has meant that the gap in prosperity between countries with malaria and countries without malaria has become wider every single year." (5). In countries burdened by malaria, foreign and local investment decrease, workers are unable to attend their jobs, and the tourist industry remains underdeveloped. Also, more importantly and harder to explain in economic terms, malaria causes great human suffering. Children cannot regularly attend school, and often cannot reach their potential due to the neurological damage caused by malaria. This is when scientific research becomes an issue of social justice.

Possibilities... Although scientists are hopeful, there is no proof of an effective vaccine currently on the market, and it may be years until one is proven viable and can be administered. Drugs are expensive (particularly because those who are most affected are poor), and resistance to them presents heavy economic load, for, "The average cost of discovering and getting a new drug to the market is estimated to be at least $500 million." (2). Mosquitoes are also developing resistance against insecticides. Therefore, while there needs to be an active search for new drugs, and especially a vaccine, wider scale and inexpensive measures must be taken. The Roll Back Malaria global partnership encourages countries to promote the usage of mosquito nets treated with insecticide (ITNs), especially in homes where there are young children and pregnant women. Stronger health care systems that extend their coverage to rural areas need to ensure that pregnant women can receive prompt Intermittent Preventive Treatment. In addition, the availability of updated drugs and treatment (artemisinin combination therapies, for example) once there is infection among the population may ensure survival of individuals and well-being among societies. This is, in large part, the responsibility of the public sector, while globally, debt relief and aid for countries burdened by malaria is in discussion. The private sector, pharmaceutical industries included, may use their networking systems for educational purposes and for distribution of medicine. The donation of capital now will result in increased productivity later, and reduce human suffering, which in a globalized world, is the responsibility of all.

References

1)Salud y desarrollo. Aspectos socioeconomicos de la malaria en Colombia, From the Virtual Library Luis Angel Arango, a review of a book Publisher on the socieconomic impacts of malaria in Colombia

2)Introducing MMV, the Medicines for Malaria Venture, Projects for low cost prevention

3)Encyclopaedia Britannica Online , Definition, discovery, history

4)Malaria Disease Info, UNDP-World Bank-WHO special programme for research and development, basic info sheet

5)RBM Information Sheet , A more comprehensive info sheet, focused on Africa

6)Roll Back Malaria , A global partnership

7)World Health Organization , self explanatory


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