Key part of Burwell decision: “Congress passed the Affordable Care Act to improve health insurance markets”

June 25, 2015

U.S. Supreme Court hearing oral arguments in King v. Burwell.  The decision issued on June 25, 2015. Image from Newsworks (who is the artist?)

U.S. Supreme Court hearing oral arguments in King v. Burwell. The decision issued on June 25, 2015. Image from Newsworks. [Continued search for credit information on this image turned up this caption; artist is Dana Verkouteren of Associated Press] “This courtroom artist rendering shows Michael Carvin, lead attorney for the petitioners, right, speaking before the Supreme Court in March. King v. Burwell, a major test of the Affordable Care Act, could halt health care premium subsidies in all the states where the federal government runs the insurance marketplaces. (AP Photo/Dana Verkouteren)

In all the rending of garments and gnashing of teeth about the Supreme Court’s decision in the Burwell case today, you’d be lucky to learn what the Court actually said.

Here are the key paragraphs of the majority’s decision (links added here), as written by Chief Justice John Roberts:

Reliance on context and structure in statutory interpretation is a “subtle business, calling for great wariness lest what professes to be mere rendering becomes creation and attempted interpretation of legislation becomes legislation itself.” Palmer v. Massachusetts, 308 U. S. 79, 83 (1939). For the reasons we have given, however, such reliance is appropriate in this case, and leads us to conclude that Section 36B allows tax credits for insurance purchased on any Exchange created under the Act. Those credits are necessary for the Federal Exchanges to function like their State Exchange counterparts, and to avoid the type of calamitous result that Congress plainly meant to avoid.

*    *    *

In a democracy, the power to make the law rests with those chosen by the people. Our role is more confined—“to say what the law is.” Marbury v. Madison, 1 Cranch 137, 177 (1803). That is easier in some cases than in others. But in every case we must respect the role of the Legislature, and take care not to undo what it has done. A fair reading of legislation demands a fair understanding of the legislative plan.

Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter. Section 36B can fairly be read consistent with what we see as Congress’s plan, and that is the reading we adopt.

The judgment of the United States Court of Appeals for the Fourth Circuit is

Affirmed.

Go read the rest of the 47 pages (in the .pdf from the Supreme Court), if you wish to be well-informed.  The case probably isn’t at all what’s being reported in most venues.


I get e-mail: Nothing But Nets needs your help with Congress, to fight malaria

May 26, 2015

Money, not DDT.

Among other goals of the hoaxsters who claim Rachel Carson was wrong and evil, and that the imaginary ban on DDT to fight malaria causes “millions of deaths,” is the erosion of trust in international  organizations that lead the fight against malaria, especially WHO, UNICEF and USAID.  Sadly, the hoaxsters have friends in Congress who threaten to withhold funding to fight malaria, often insisting that now-mostly-ineffective DDT be used instead of good, working preventive measures and medicines to cure humans of malaria.

And so, Nothing But Nets writes to ask for help:

Email your members of Congress and let them know that you support full funding for malaria prevention programs.                                       

Dear Ed,

Imagine this: working from 4:00 AM until well into the night, getting very little sleep, traveling along unpaved roads for hours at a time – all to deliver 2,000 bednets per day to the hardest-to-reach children and families.

Email your members of Congress and let them know that you support full funding for malaria prevention programs.

Take Action

In Mozambique, this is a typical day for health workers as they distribute nets to save lives as part of a campaign funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Thanks to the work of the Global Fund and other partners – including UN agencies and local communities on the ground – bednet coverage in Mozambique has gone from less than 5 percent of the population in 2000 to an impressive 60 percent today.

But without continued support from Congress, the life-saving impact of these nets could be lost.

Your member of Congress will vote soon on how much assistance the U.S. will provide to the Global Fund, along with partners like the President’s Malaria Initiative and the United Nations, the core agencies leading the fight against malaria. By showing your support to your representatives in Washington, you can help to make them champions in the fight against malaria and ensure that these bednets continue to make it to families who need them the most.

Thousands of people have already asked their members of Congress to support the crucial work of the Global Fund and other partners in the fight against malaria—will you join them today?

From all of us at Nothing But Nets, thanks for helping community health workers reach the last mile!

Dan Skallman
Senior Campaign Associate, Nothing But Nets

Original story and photo from The Global Fund to Fight AIDS, Tuberculosis and Malaria.

Take Action


One billion nets to Africa

May 21, 2015

Malaria No More reports a billion mosquito nets in Africa produce great results in the fight against malaria.

Malaria No More reports a billion mosquito nets in Africa produce great results in the fight against malaria.

Interesting week.

All that, and the World Health Assembly 68 is meeting in Geneva, Switzerland.  Among top items on the agenda of the world’s top public health experts: What are the next steps in fighting malaria?

Malaria No More produced this short video in time for World Malaria Day, April 25, 2015 — but I just saw it this week.  It depicts the Ochieng family in Kenya, and the effects of malaria, and beating malaria, have on the family:

One Billion Nets to Africa

Description of the film:

Meet the Ochieng family. They are one of the families that received the #OneBillionNets to Africa and is now protected from malaria-transmitting mosquitoes because of this unprecedented global effort. See more at 1BillionNets.org

  • Music:  “Eyes Wide Open” by Tony Anderson

This film caught my interest on a personal scale.  One of my great students at Molina High School in Dallas was a Kenyan immigrant, named Ochieng.  Can’t help but wonder if there is a relation.

Bednets, and a concentrated, international campaign to prevent mosquito bites and cure infected humans of the disease, have cut malaria deaths from just over 1 million per year in 2000, to fewer than 600,000 per year in 2014.  This progress produces hope again that malaria can be beaten, though there are many more hurdles blocking the path.

You may have noted: The malaria fighters at Malaria No More make no plea for more DDT, nor do they claim any handicap from the U.S. having banned the use of DDT on agricultural crops in the U.S.  In saving lives, disease fighters don’t have time to deal with destructive hoaxes.

Tip of the old scrub brush to PMI, the President’s Malaria Initiative:
http://twitter.com/PMIgov/status/596689144618823680


WHO’s malaria fact sheet, April 2015 edition

May 17, 2015

Progress against the diseases we know as malaria — parasitic infections — is dramatic and rapid since several non-governmental organizations (NGOs) entered the fight seriously at the turn of the last century. But problems arise and also rapidly become serious.

Bednets prove the best single method of preventing the spread of malaria. Distribution of bednets in malaria-prone regions greatly aided the 47% reduction in malaria deaths since 1999.  WHO photo.

Bednets prove the best single method of preventing the spread of malaria. Distribution of bednets in malaria-prone regions greatly aided the 47% reduction in malaria deaths since 1999. WHO photo.

For political reasons often obscure, there is an industry in creating misinformation and propaganda against malaria-fighting groups like the World Health Organization, the Bill and Melinda Gates Foundation, and other groups who advocate bednet preventive measures. The propagandists often make absurd and false claims against medical workers, against scientists and activists including people they pejoratively call environmentalists, and in favor of the deadly poison DDT.

Factual matter takes longer to spread — truth has a smaller public relations budget.

What are the facts about malaria?

Here is WHO’s fact sheet on malaria, current as of the first of this month 2015.

WHO’s fact sheet is almost dull in its recitation of the facts.  What you don’t see recorded here is that the death toll of over 500,000 last year, is the lowest death toll from malaria since World War II, the lowest death toll estimated in the past 120 years, and perhaps the lowest death toll in recorded human history.  Similarly, while nearly 200 million malaria infections seems an enormous number, that number records a dramatic reduction from the 500 million estimated in the 1960s.

Malaria is not Rachel Carson’s fault. DDT is not a magic cure for the disease. It’s beatable, but beating a disease requires constant vigilance, militant prevention and treatment — and that costs money. The propagandists won’t tell you those facts, and malaria wins when bad information chases out the good.

For the record:

Malaria

Fact sheet N°94
Reviewed April 2015


Key facts

  • Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected mosquitoes.
  • In 2013, malaria caused an estimated 584 000 deaths (with an uncertainty range of 367 000 to 755 000), mostly among African children.
  • Malaria is preventable and curable.
  • Increased malaria prevention and control measures are dramatically reducing the malaria burden in many places.
  • Non-immune travellers from malaria-free areas are very vulnerable to the disease when they get infected.

According to the latest estimates, released in December 2014, there were about 198 million cases of malaria in 2013 (with an uncertainty range of 124 million to 283 million) and an estimated 584 000 deaths (with an uncertainty range of 367 000 to 755 000). Malaria mortality rates have fallen by 47% globally since 2000, and by 54% in the WHO African Region.

Most deaths occur among children living in Africa where a child dies every minute from malaria. Malaria mortality rates among children in Africa have been reduced by an estimated 58% since 2000.

Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected Anopheles mosquitoes, called “malaria vectors”, which bite mainly between dusk and dawn.

There are four parasite species that cause malaria in humans:

  • Plasmodium falciparum
  • Plasmodium vivax
  • Plasmodium malariae
  • Plasmodium ovale.

Plasmodium falciparum and Plasmodium vivax are the most common. Plasmodium falciparum is the most deadly.

In recent years, some human cases of malaria have also occurred with Plasmodium knowlesi – a species that causes malaria among monkeys and occurs in certain forested areas of South-East Asia.

Transmission

Malaria is transmitted exclusively through the bites of Anopheles mosquitoes. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment.

About 20 different Anopheles species are locally important around the world. All of the important vector species bite at night. Anopheles mosquitoes breed in water and each species has its own breeding preference; for example some prefer shallow collections of fresh water, such as puddles, rice fields, and hoof prints. Transmission is more intense in places where the mosquito lifespan is longer (so that the parasite has time to complete its development inside the mosquito) and where it prefers to bite humans rather than other animals. For example, the long lifespan and strong human-biting habit of the African vector species is the main reason why about 90% of the world’s malaria deaths are in Africa.

Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.

Human immunity is another important factor, especially among adults in areas of moderate or intense transmission conditions. Partial immunity is developed over years of exposure, and while it never provides complete protection, it does reduce the risk that malaria infection will cause severe disease. For this reason, most malaria deaths in Africa occur in young children, whereas in areas with less transmission and low immunity, all age groups are at risk.

Symptoms

Malaria is an acute febrile illness. In a non-immune individual, symptoms appear seven days or more (usually 10–15 days) after the infective mosquito bite. The first symptoms – fever, headache, chills and vomiting – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness often leading to death. Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ involvement is also frequent. In malaria endemic areas, persons may develop partial immunity, allowing asymptomatic infections to occur.

For both P. vivax and P. ovale, clinical relapses may occur weeks to months after the first infection, even if the patient has left the malarious area. These new episodes arise from dormant liver forms known as hypnozoites (absent in P. falciparum and P. malariae); special treatment – targeted at these liver stages – is required for a complete cure.

Who is at risk?

Approximately half of the world’s population is at risk of malaria. Most malaria cases and deaths occur in sub-Saharan Africa. However, Asia, Latin America, and to a lesser extent the Middle East and parts of Europe are also affected. In 2014, 97 countries and territories had ongoing malaria transmission.

Specific population risk groups include:

  • young children in stable transmission areas who have not yet developed protective immunity against the most severe forms of the disease;
  • non-immune pregnant women as malaria causes high rates of miscarriage and can lead to maternal death;
  • semi-immune pregnant women in areas of high transmission. Malaria can result in miscarriage and low birth weight, especially during first and second pregnancies;
  • semi-immune HIV-infected pregnant women in stable transmission areas, during all pregnancies. Women with malaria infection of the placenta also have a higher risk of passing HIV infection to their newborns;
  • people with HIV/AIDS;
  • international travellers from non-endemic areas because they lack immunity;
  • immigrants from endemic areas and their children living in non-endemic areas and returning to their home countries to visit friends and relatives are similarly at risk because of waning or absent immunity.

Diagnosis and treatment

Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to reducing malaria transmission.

The best available treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT).

WHO recommends that all cases of suspected malaria be confirmed using parasite-based diagnostic testing (either microscopy or rapid diagnostic test) before administering treatment. Results of parasitological confirmation can be available in 15 minutes or less. Treatment solely on the basis of symptoms should only be considered when a parasitological diagnosis is not possible. More detailed recommendations are available in the “Guidelines for the treatment of malaria” (second edition). An updated edition will be published in 2015.

Antimalarial drug resistance

Resistance to antimalarial medicines is a recurring problem. Resistance of P. falciparum to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1970s and 1980s, undermining malaria control efforts and reversing gains in child survival.

In recent years, parasite resistance to artemisinins has been detected in 5 countries of the Greater Mekong subregion: Cambodia, Laos, Myanmar, Thailand and Viet Nam. While there are likely many factors that contribute to the emergence and spread of resistance, the use of oral artemisinins alone, as monotherapy, is thought to be an important driver. When treated with an oral artemisinin-based monotherapy, patients may discontinue treatment prematurely following the rapid disappearance of malaria symptoms. This results in incomplete treatment, and such patients still have persistent parasites in their blood. Without a second drug given as part of a combination (as is provided with an ACT), these resistant parasites survive and can be passed on to a mosquito and then another person.

If resistance to artemisinins develops and spreads to other large geographical areas, the public health consequences could be dire.

WHO recommends the routine monitoring of antimalarial drug resistance, and supports countries to strengthen their efforts in this important area of work.

More comprehensive recommendations are available in the “WHO Global Plan for Artemisinin Resistance Containment (GPARC)”, which was released in 2011. For countries in the Greater Mekong subregion, WHO has issued a regional framework for action titled “Emergency response to artemisinin resistance in the Greater Mekong subregion” in 2013.

Prevention

Vector control is the main way to reduce malaria transmission at the community level. It is the only intervention that can reduce malaria transmission from very high levels to close to zero.

For individuals, personal protection against mosquito bites represents the first line of defence for malaria prevention.

Two forms of vector control are effective in a wide range of circumstances.

Insecticide-treated mosquito nets (ITNs)

Long-lasting insecticidal nets (LLINs) are the preferred form of ITNs for public health distribution programmes. WHO recommends coverage for all at-risk persons; and in most settings. The most cost effective way to achieve this is through provision of free LLINs, so that everyone sleeps under a LLIN every night.

Indoor spraying with residual insecticides

Indoor residual spraying (IRS) with insecticides is a powerful way to rapidly reduce malaria transmission. Its full potential is realized when at least 80% of houses in targeted areas are sprayed. Indoor spraying is effective for 3–6 months, depending on the insecticide used and the type of surface on which it is sprayed. DDT can be effective for 9–12 months in some cases. Longer-lasting forms of existing IRS insecticides, as well as new classes of insecticides for use in IRS programmes, are under development.

Antimalarial medicines can also be used to prevent malaria. For travellers, malaria can be prevented through chemoprophylaxis, which suppresses the blood stage of malaria infections, thereby preventing malaria disease. In addition, WHO recommends intermittent preventive treatment with sulfadoxine-pyrimethamine for pregnant women living in high transmission areas, at each scheduled antenatal visit after the first trimester. Similarly, for infants living in high-transmission areas of Africa, 3 doses of intermittent preventive treatment with sulfadoxine-pyrimethamine is recommended delivered alongside routine vaccinations. In 2012, WHO recommended Seasonal Malaria Chemoprevention as an additional malaria prevention strategy for areas of the Sahel sub-Region of Africa. The strategy involves the administration of monthly courses of amodiaquine plus sulfadoxine-pyrimethamine to all children under 5 years of age during the high transmission season.

Insecticide resistance

Much of the success to date in controlling malaria is due to vector control. Vector control is highly dependent on the use of pyrethroids, which are the only class of insecticides currently recommended for ITNs or LLINs. In recent years, mosquito resistance to pyrethroids has emerged in many countries. In some areas, resistance to all 4 classes of insecticides used for public health has been detected. Fortunately, this resistance has only rarely been associated with decreased efficacy, and LLINs and IRS remain highly effective tools in almost all settings.

However, countries in sub-Saharan Africa and India are of significant concern. These countries are characterized by high levels of malaria transmission and widespread reports of insecticide resistance. The development of new, alternative insecticides is a high priority and several promising products are in the pipeline. Development of new insecticides for use on bed nets is a particular priority.

Detection of insecticide resistance should be an essential component of all national malaria control efforts to ensure that the most effective vector control methods are being used. The choice of insecticide for IRS should always be informed by recent, local data on the susceptibility target vectors.

In order to ensure a timely and coordinated global response to the threat of insecticide resistance, WHO has worked with a wide range of stakeholders to develop the “Global Plan for Insecticide Resistance Management in malaria vectors” (GPIRM), which was released in May 2012. The GPIRM puts forward a five-pillar strategy calling on the global malaria community to:

  • plan and implement insecticide resistance management strategies in malaria-endemic countries;
  • ensure proper and timely entomological and resistance monitoring, and effective data management;
  • develop new and innovative vector control tools;
  • fill gaps in knowledge on mechanisms of insecticide resistance and the impact of current insecticide resistance management approaches; and
  • ensure that enabling mechanisms (advocacy as well as human and financial resources) are in place.

Surveillance

Tracking progress is a major challenge in malaria control. In 2012, malaria surveillance systems detected only around 14% of the estimated global number of cases. Stronger malaria surveillance systems are urgently needed to enable a timely and effective malaria response in endemic regions, to prevent outbreaks and resurgences, to track progress, and to hold governments and the global malaria community accountable.

Elimination

Malaria elimination is defined as interrupting local mosquito-borne malaria transmission in a defined geographical area, i.e. zero incidence of locally contracted cases. Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by a specific agent; i.e. applies to a particular malaria parasite species.

On the basis of reported cases for 2013, 55 countries are on track to reduce their malaria case incidence rates by 75%, in line with World Health Assembly targets for 2015. Large-scale use of WHO-recommended strategies, currently available tools, strong national commitments, and coordinated efforts with partners, will enable more countries – particularly those where malaria transmission is low and unstable – to reduce their disease burden and progress towards elimination.

In recent years, 4 countries have been certified by the WHO Director-General as having eliminated malaria: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), and Armenia (2011).

Vaccines against malaria

There are currently no licensed vaccines against malaria or any other human parasite. One research vaccine against P. falciparum, known as RTS, S/AS01, is most advanced. This vaccine has been evaluated in a large clinical trial in 7 countries in Africa and has been submitted to the European Medicines Agency under art. 58 for regulatory review. A WHO recommendation for use will depend on the final results from the large clinical trial and a positive regulatory review. The recommendation as to whether or not this vaccine should be added to existing malaria control tools is expected in late 2015.

WHO response

The WHO Global Malaria Programme (GMP) is responsible for charting the course for malaria control and elimination through:

  • setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies, and guidelines;
  • keeping independent score of global progress;
  • developing approaches for capacity building, systems strengthening, and surveillance;
  • identifying threats to malaria control and elimination as well as new areas for action.

GMP serves as the secretariat for the Malaria Policy Advisory Committee (MPAC), a group of 15 global malaria experts appointed following an open nomination process. The MPAC, which meets twice yearly, provides independent advice to WHO to develop policy recommendations for the control and elimination of malaria. The mandate of MPAC is to provide strategic advice and technical input, and extends to all aspects of malaria control and elimination, as part of a transparent, responsive and credible policy setting process.

WHO is also a co-founder and host of the Roll Back Malaria partnership, which is the global framework to implement coordinated action against malaria. The partnership mobilizes for action and resources and forges consensus among partners. It is comprised of over 500 partners, including malaria endemic countries, development partners, the private sector, nongovernmental and community-based organizations, foundations, and research and academic institutions.

For more information contact:

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

WHO provides a short video summary of many of these facts.


Malaria fight, February 2015

February 20, 2015

Timely infographic from Agence France Presse.

Some background:  The newly-formed World Health Organization (WHO) estimated worldwide malaria deaths at more than 5 million per year, when it kicked off the ambitious but ultimately unsuccessful malaria eradication program in 1955.  Eradication hopes hung on the use of DDT, sprayed on the walls of homes in affected areas (Indoor Residual Spraying, or IRS), to temporarily knock down mosquito populations so that humans infected with malaria could be cured.  After early successes in temperate zones, malaria fighters took the fight to tropical Africa in 1963.  There they discovered that overuse and abuse of DDT had already bred mosquitoes resistant to the pesticide.  With no substitute for DDT available, WHO wound down the campaign on the ground by 1965, and officially abandoned it in 1969.

Nations who had pledged money for the fight early, cut back when DDT failed.  In 1963, about 4 million people died from malaria, worldwide.

Despite the lack of an international, worldwide fight against malaria, malaria fighters soldiered on.  Better housing and better medicines made gains.  By the time the U.S. banned DDT use on crops in 1972, pledging all U.S. production of DDT to fight disease elsewhere, annual malaria deaths had fallen to just over 2 million per year. By 1990, the annual death toll was cut to about a million per year.  Through the 1980s, malaria parasites themselves developed resistance to the main pharmaceuticals used to cure humans.

By the end of the 1990s, international agencies and especially NGOs like the Bill and Melinda Gates Foundation brought new funding and new urgency to the fight against malaria.  Expansion of production of artemisinin-based pharmaceuticals provided a new tool for health workers.  Funding from the U.S., through the President’s Malaria Initiative, helped a lot.  In 2000, about a million people died from malaria.  By 2014, malaria deaths fell to under 600,000.

Parasite resistance to the new pharmaceuticals poses a new threat to continued progress.  Funding is still far short of what experts estimate to be needed, and short of pledges from developed nations.  Mosquitoes that carry malaria parasites from human to human (after a step of the life cycle in infected mosquitoes) quickly evolve resistance to pesticides; malaria parasites develop resistance to pharmaceuticals used to treat humans.  Funding to rotate pesticides and drugs falls short, causing improper use of both, and quicker evolution of resistance in mosquitoes, and parasites.

Infgraphic from Agence France Presse, on the fight against malaria, February 2015.

Infgraphic from Agence France Presse, on the fight against malaria, February 2015.


World Malaria Report 2014: Dramatic progress (no call for DDT)

December 9, 2014

World Malaria Report 2014 dropped this week.  It’s the annual report from the World Health Organization (WHO) on the fight against malaria, the problems, critical needs — and this year, wonderful news of progress.

Cover of WHO's World Malaria Report 2014, a child, and the red blood cells the malaria parasites attack.

Cover of WHO’s World Malaria Report 2014, a child, and the red blood cells the malaria parasites attack.

Copies of the report in .pdf format come in English, French and Spanish.  A host of supplemental materials and statistical compilations accompany the report every year.

The World Malaria Report 2014 summarizes information received from malaria-endemic countries and other sources, and updates the analyses presented in the 2013 report.

It assesses global and regional malaria trends, highlights progress towards global targets, and describes opportunities and challenges in controlling and eliminating the disease. The report was launched in the United Kingdom Houses of Parliament on 9 December 2014.

The press release on the report, from WHO:

Scale-up in effective malaria control dramatically reduces deaths

News release

The number of people dying from malaria has fallen dramatically since 2000 and malaria cases are also steadily declining, according to the World malaria report 2014. Between 2000 and 2013, the malaria mortality rate decreased by 47% worldwide and by 54% in the WHO African Region – where about 90% of malaria deaths occur.

New analysis across sub-Saharan Africa reveals that despite a 43% population increase, fewer people are infected or carry asymptomatic malaria infections every year: the number of people infected fell from 173 million in 2000 to 128 million in 2013.

“We can win the fight against malaria,” says Dr Margaret Chan, Director-General, WHO. “We have the right tools and our defences are working. But we still need to get those tools to a lot more people if we are to make these gains sustainable.”

Between 2000 and 2013, access to insecticide-treated bed nets increased substantially. In 2013, almost half of all people at risk of malaria in sub-Saharan Africa had access to an insecticide-treated net, a marked increase from just 3% in 2004. And this trend is set to continue, with a record 214 million bed nets scheduled for delivery to endemic countries in Africa by year-end.

Access to accurate malaria diagnostic testing and effective treatment has significantly improved worldwide. In 2013, the number of rapid diagnostic tests (RDTs) procured globally increased to 319 million, up from 46 million in 2008. Meanwhile, in 2013, 392 million courses of artemisinin-based combination therapies (ACTs), a key intervention to treat malaria, were procured, up from 11 million in 2005.

Moving towards elimination

Globally, an increasing number of countries are moving towards malaria elimination, and many regional groups are setting ambitious elimination targets, the most recent being a declaration at the East Asia Summit to eliminate malaria from the Asia-Pacific region by 2030.

In 2013, 2 countries reported zero indigenous cases for the first time (Azerbaijan and Sri Lanka), and 11 countries succeeded in maintaining zero cases (Argentina, Armenia, Egypt, Georgia, Iraq, Kyrgyzstan, Morocco, Oman, Paraguay, Uzbekistan and Turkmenistan). Another 4 countries reported fewer than 10 local cases annually (Algeria, Cabo Verde, Costa Rica and El Salvador).

Fragile gains

But significant challenges remain: “The next few years are going to be critical to show that we can maintain momentum and build on the gains,” notes Dr Pedro L Alonso, Director of WHO’s Global Malaria Programme.

In 2013, one third of households in areas with malaria transmission in sub-Saharan Africa did not have a single insecticide treated net. Indoor residual spraying, another key vector control intervention, has decreased in recent years, and insecticide resistance has been reported in 49 countries around the world.

Even though diagnostic testing and treatment have been strengthened, millions of people continue to lack access to these interventions. Progress has also been slow in scaling up preventive therapies for pregnant women, and in adopting recommended preventive therapies for children under 5 years of age and infants.

In addition, resistance to artemisinin has been detected in 5 countries of the Greater Mekong subregion and insufficient data on malaria transmission continues to hamper efforts to reduce the disease burden.

Dr Alonso believes, however, that with sufficient funding and commitment huge strides forward can still be made. “There are biological and technical challenges, but we are working with partners to be proactive in developing the right responses to these. There is a strong pipeline of innovative new products that will soon transform malaria control and elimination. We can go a lot further,” he says.

While funding to combat malaria has increased threefold since 2005, it is still only around half of the US$ 5.1 billion that is needed if global targets are to be achieved.

“Against a backdrop of continued insufficient funding the fight against malaria needs a renewed focus to ensure maximum value for money,” says Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “We must work together to strengthen country ownership, empower communities, increase efficiencies, and engage multiple sectors outside health. We need to explore ways to do things better at all levels.”

Ray Chambers, who has served as the UN Secretary-General’s Special Envoy for Malaria since 2007, highlights the remarkable progress made in recent years. “While staying focused on the work ahead, we should note that the number of children dying from malaria today is markedly less than 8 years ago. The world can expect even greater reductions in malaria cases and mortality by the end of 2015, but any death from malaria remains simply unacceptable,” he says.

Gains at risk in Ebola-affected countries

At particular risk is progress on malaria in countries affected by the Ebola virus. The outbreak in West Africa has had a devastating impact on malaria treatment and the roll-out of malaria interventions. In Guinea, Sierra Leone and Liberia, the 3 countries most severely affected by the epidemic, the majority of inpatient health facilities remain closed, while attendance at outpatient facilities is down to a small fraction of rates seen prior to the outbreak.

Given the intense malaria transmission in these 3 countries, which together saw an estimated 6.6 million malaria cases and 20 000 malaria deaths in 2013, WHO has issued new guidance on temporary measures to control the disease during the Ebola outbreak: to provide ACTs to all fever patients, even when they have not been tested for malaria, and to carry out mass anti-malaria drug administration with ACTs in areas that are heavily affected by the Ebola virus and where malaria transmission is high. In addition, international donor financing is being stepped up to meet the further recommendation that bednets be distributed to all affected areas.

Note to editors

Globally, 3.2 billion people in 97 countries and territories are at risk of being infected with malaria. In 2013, there were an estimated 198 million malaria cases worldwide (range 124-283 million), 82% of which were in the WHO African region. Malaria was responsible for an estimated 584 000 deaths worldwide in 2013 (range: 367 000 – 755 000), killing an estimated 453 000 children under five years of age.

Based on an assessment of trends in reported malaria cases, a total of 64 countries are on track to meet the Millennium Development Goal target of reversing the incidence of malaria. Of these, 55 are on track to meet Roll Back Malaria and World Health Assembly targets of reducing malaria case incidence rates by 75% by 2015.

The World malaria report 2014 will be launched on 9 December 2014 in the United Kingdom Houses of Parliament. The event will be co-hosted by the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG) and Malaria No More UK.

Contacts for press queries will be found at the link above.

Canadian-educated, Dr. Margaret Chan of the Peoples Republic of China heads the World Health Organization.

Canadian-educated, Dr. Margaret Chan of the Peoples Republic of China heads the World Health Organization, the world’s leading anti-malaria organization.

You may note that the press release says nothing about DDT, the pesticide most famous in the malaria fight after World War II.  WHO abandoned its ambitious campaign to eradicate malaria from the Earth, in the mid-1960s, when it was discovered that mosquitoes in central Africa and other malaria-endemic regions near the tropics were already resistant or immune to the pesticide.  DDT had been used by super-mosquito fighter Fred Soper, in campaigns by the Rockefeller Foundation and WHO, to knock down mosquito populations temporarily, to get breathing room to beat malaria.  While the populations were temporarily reduced, health workers would frantically work to diagnose and completely treat to a cure, malaria infections in humans. Then, when the mosquito populations came roaring back, the bugs would have no well of disease from which to draw parasites for new infections.

Soper’s methods used DDT sprayed on walls of homes, to specifically get those mosquitoes that bite humans. Anopheles spp. mosquitoes carry malaria parasites through a critical part of the parasites’ life cycle; those mosquitoes typically bite from about dusk to just after midnight.  After a blood meal, mosquitoes pause to rest on nearby vertical structures — walls in this case — to squeeze out excess water from the blood they’ve ingested, so they’re light enough to fly.  When the mosquito encounters DDT on the walls, the hope is that the DDT kills the mosquito, ending the transmission cycle.

A brutal public relations campaign in Africa, the U.S. and Europe through the late 1990s to now, has vilified science writer Rachel Carson for her indictment of DDT in Silent Spring, her brilliant book on the dangers of indiscriminate use of untested new chemicals.

So it’s important to note that the world’s leading organization that fights malaria makes no call for more DDT.  Professional health care workers worldwide have not been hornswoggled by pro-DDT, anti-environment, anti-science, anti-WHO propaganda.  That’s good news, too.

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U.N. General Assembly notes progress against malaria

September 16, 2014

In Ghana:  Community members perform a scene to educate others on how and why to use bednets. (USAID/Kasia McCormick) 2012. USAID Africa Bureau

In Ghana: Community members perform a scene to educate others on how and why to use bednets. (USAID/Kasia McCormick) 2012. USAID Africa Bureau, via Wikimedia

In stark contrast to the usual hoax stories we get in the U.S. about malaria and DDT, the United Nations General Assembly this past week passed a resolution noting progress made in fighting the parasitic disease.

Quoting wholesale from Ghana Web:

The United Nations General Assembly at its 68th Session, adopted Resolution A/68/L.60, “Consolidating Gains and Accelerating Efforts to Control and Eliminate Malaria in Developing Countries, Particularly in Africa, by 2015” by consensus.

Recognising progress made through political leadership and a broad range of national and international actions to scale-up malaria control interventions, this annual resolution urges governments, United Nations agencies, and all stakeholders to work together to meet the targets set out in the Roll Back Malaria Partnership’s Global Malaria Action Plan (GMAP) and the UN’s Millennium Development Goals (MDGs).

An official statement issued in Accra and copied the Ghana News Agency said with just less than 500 days until the 2015 deadline of the MDGs, the adoption of this resolution by the General Assembly reiterates the commitment of UN Member States to keep malaria high on the international development agenda.

“We have seen tremendous progress against this killer disease in recent years, but continued success will require increased political and financial commitment from donor and endemic governments alike. Together we can scale-up efforts and continue saving lives,” it said.

The statement said since 2001, the World Health Organisation (WHO) estimated that malaria death rates have decreased by nearly 50 per cent in Africa alone, where 90 per cent of all malaria-related deaths still occur – contributing to a 20 per cent reduction in global child mortality and helping drive progress towards UN MDG 4.

“Between 2001 and 2012, collective efforts helped avert an estimated 3.3 million deaths (69 per cent) of which were in the 10 countries with the highest malaria burden in 2000 and more than half of the 103 countries that had ongoing malaria transmission in 2000 are meeting the MDG of reversing malaria incidence by 2015.

“Despite these advances, almost half of the world’s population remains at risk from malaria, with an estimated 207 million cases of infection around the world each year and 627,000 deaths. Around the world, a child still dies from malaria every minute.

“The resolution calls for donor and endemic governments alike to support global malaria control efforts, including the secretariat of the Roll Back Malaria Partnership, and to intensify efforts to secure the political commitment, partnerships and funds needed to continue saving lives.

“Increased financing will be critical to further advancements, as current international and domestic financing for malaria of US 2.5 billion dollars in 2012 amounts to less than half of the US 5.1 billion dollars estimates to be needed annually through 2020 to achieve universal coverage of malaria control interventions,” the statement said.

In 2012, United Nations Secretary-General Ban Ki-moon named malaria as a top priority of his second mandate. Malaria control has consistently proven to be a strong global health investment, generating high return on low investments.

Impacting all eight of the United Nations MDGs, malaria prevention and treatment serves as an entry point to help advance progress against other health and development targets across the board by reducing school absenteeism, fighting poverty, and improving maternal and child health.

Did you see that report in your local newspapers, or on radio or television?

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