Funding

To battle three killer diseases--AIDS, Tuberculosis, and Malaria--the United Nations created the Global Fund in 2002 and now hopes to expand it into a Global Health Fund.

Since its creation, the Global Fund has seen spectacular accomplishments, making the fund "arguably the most successful innovation in foreign assistance of the past decade. As a result of Global Fund programmes, an estimated 2.5 million people are on antiretroviral Aids therapy. No fewer than 8 million people have been cured of TB. And more than 100 million long-lasting insecticide-treated bed nets have been distributed in the fight against malaria. In total, studies suggest that Global Fund programmes have saved 5 million lives."

Operational procedures allow the Global Fund to be successful. "Disease-specific committees, called the Country Co-ordination Mechanism (CCM), are constituted in each developing country. Each CCM is chaired by the national government, but incorporates input from non-government organisations to formulate national-scale, disease-specific plans for submission to the Global Fund. Once the Global Fund receives these plans, they are sent to a Technical Review Panel (TRP) to check that the plans are scientifically sound and feasible. If the TRP approves, the plan is sent to the board of the Global Fund, which then votes to approve financing."

Challenges facing the Global Fund include lack of continuous financing and the potential to broaden the Global Fund's mandate. Since 2002, the Global Fund has approved around $19bn in total funding. . .Unfortunately, the Global Fund is already in a state of fiscal crisis. It needs around $6bn per year in the next three years to cover expansion of programmes for the three diseases, but it has only around $3bn per year from donor countries. Unless this is corrected, millions of people will die unnecessarily."

Financial crisis hinders the Global Fund from reaching its new goal, which is to improve basic health and reduce "child and maternal mortality. Expanding the Global Fund's mandate to include financing for training and deployment of community health workers, construction and operation of local health facilities, and other components of primary health systems could ensure the development of these local systems."

"Many countries – including France, Japan, Norway, the United Kingdom, and the United States – have recently recognised the need to move beyond the financing of control of Aids, TB, and malaria to financing improvements in primary health systems more generally. But they seem to view the issue of health-system financing as an either/or choice: scale up control of Aids, TB, and malaria, or scale up financing of primary health systems. The truth, of course, is that both are needed, and both are affordable".

Read More: "Funding a Global Health Fund."

Source:
Sachs, Jeffrey. "Funding a Global Health Fund." Guardian.co.uk. http://www.guardian.co.uk/commentisfree/2010/mar/25/global-health-fund-funding-tb-aids

War of the parasites

Malaria, a disease that reportedly causes "more than 1 million deaths annually", is caused by a mosquito-borne parasite. But, another blood parasite--this one carried by ticks--may provide malaria resistance.

Like malaria, Babesia parasites "infect a wide variety of mammalian hosts". Of the human "population infected with Babesia microti, 25% of adults and 50% of children remain asymptomatic" (without noticeable symptoms). "A new study suggests that monkeys chronically infected with babesiosis, a tick-borne parasite, are able to suppress malaria infection when exposed to a simian malaria parasite." Other coinfection studies in rodents indicate cross-protection. Researchers conclude that "ongoing infection with B. microti parasites leads to suppression of malaria infection" and may provide a way to combat malaria.

Source:
American Society for Microbiology (2010, March 24). Infection with tickborne parasite may suppress malaria. Retrieved March 25, 2010.

Flying vaccinators

Everyone hates mosquitoes, right? But, what if a mosquito bite vaccinated you against malaria, a deadly disease that infects approximately 250 million people each year? "New research published in Insect Molecular Biology reveals that mosquito genetic engineering may turn the transmitter into a natural 'flying vaccinator', providing a new strategy for biological control over the disease."

The study, led by Shigeto Yoshida from Jichi Medical University, "targets the saliva gland of the Anopheles stephensi mosquitoes, the main vectors of human malaria."

"For the past decade it has been theorized that genetic engineering of the mosquito could create a 'flying vaccinator,' raising hopes for their use as a new strategy for malaria control. However so far research has been limited to a study of the insect's gut and the 'flying vaccinator' theory was not developed."

Mosquito bites offer a free and easy way to administer a vaccine. Continued "exposure to bites" is expected to produce "high levels of protective immunity, through natural boosting, for a life time. So the insect shifts from being a pest to being beneficial," according to Yoshida.

"While 'flying vaccinator' theory may now be scientifically possible the question of ethics hangs over the application of the research. A natural and uncontrolled method of delivering vaccines, without dealing with dosage and consent, alongside public acceptance to the release of 'vaccinating' mosquitoes, provide barriers to this method of disease control."

Is this idea too dangerous to be beneficial, or is it just radical enough to help eliminate malaria? The world has yet to decide.

Source:
Wiley-Blackwell (2010, March 19). 'Flying vaccinator': Can genetically engineered mosquitoes provide a new strategy against malaria?. ScienceDaily. Retrieved March 21, 2010, from http://www.sciencedaily.com­ /releases/2010/03/100318192658.htm

Significant progress

Drug "resistance is most alarming" in parts of "Africa where HIV rates are high and people are extremely vulnerable to infections" (Boseley). But, one of the infectious diseases that terrorizes this region is on the retreat, according to recent findings. "A new report from the Roll Back Malaria (RBM) Partnership confirms that current investment in malaria control is saving lives and providing far-reaching benefits for countries. But it warns that without sustained and predictable funding, the significant" progress could be reversed (Roll Back Malaria).

"Most of us by now have got the message that malaria control is working. The report says that an estimated 384,000 children's lives were saved in 12 countries, such as Ethiopia, Rwanda and Zambia, between 2000 and 2009 through distribution of mosquito nets and other preventive measures. A steady and impressive increase in funding for malaria prevention has brought this about, from $100 million to $1.5 billion over that time period" (Boseley).

Richard Cibulskis of the WHO's global malaria program, warns that "If we are not vigilant about the level of funding going to malaria, the progress we have seen will be quickly reversed". According to the Global Malaria Action Plan [plan to eradicate malaria], "$6 billion a year is needed to ensure universal coverage of malaria control measures".

The money collected for malaria relief "goes mostly to the smaller countries…where the impact is measurably greater" than it would be in a larger country. Recent efforts have reduced the number of malaria deaths, but diligent effort to prevent malaria infection and eradicate the disease is still needed by the global community.

Boseley, Sarah. "Drug resistant tuberculosis…" The Guardian. http://www.guardian.co.uk/society/sarah-boseley-global-health/2010/mar/18/tuberculosis-malaria-prevention. 18 March 2010.
Roll Back Malaria. "Roll back malaria report…" http://www.rollbackmalaria.org/globaladvocacy/pr2010-03-18.html

Duffy negative

"In a paradigm changing discovery," malaria illness "has been identified in a population historically thought to be resistant to the disease." The Duffy blood group protein, located on the surface of red blood cells, acts as a receptor for the malaria parasite and facilitates malaria illness in humans. Duffy-negative population groups (people who do not have the Duffy antigen) were considered resistant to malaria because their blood cells lacked the receptor through which malaria invades.

However, "according to researchers from Case Western Reserve University School of Medicine, Pasteur Institute, and the Madagascar Ministry of Health", Duffy-negative individuals may experience illness from malaria. "In a study of more than 600 individuals from eight communities covering the main malaria transmission areas of Madagascar, the researchers found that 10 percent of people experiencing clinical malaria were Duffy-negative and infected with P. vivax."

"Since the early 1920s, it has been widely accepted that people of African ancestry are resistant to P. vivax blood-stage infection and clinical malaria. The Duffy-negative blood group, one of the more than 30 blood types, is predominant in most African ethnic groups" (Case). "Duffy-negative people usually have relatively recent ancestors from historically malaria prone regions. The highest concentration of Duffy-negative people in the world is in West Africa, where more than 95% of people are missing the protein on their red blood cells. Reflecting their African ancestry, 68% of African-Americans are also Duffy-negative" (23andme).

Malaria parasites are changing. Mutations allow the parasite population to become resistant to commonly-used drugs, develop in areas of high altitude, and now may enable them to cause illness in Duffy-negative people.

People with "this blood type, can have P. vivax living dormant in their liver cells where it does not make people sick." What "distinguished Duffy-negatives from all others was that the malaria parasite was unable to cross the threshold from liver cells to blood cells." However, during this study the team documented "photographic evidence of the parasite's presence within red blood cells of many Duffy-negative people experiencing malarial illness."

"The study confirms that P. vivax is not dependent on the Duffy antigen for establishing blood-stage infection and disease in Madagascar. Evolution of new parasite strains, infiltrating a new group of people who are Duffy-negative, seems to be occurring within a population of people from different ethnic backgrounds," says Peter A. Zimmerman, Ph.D., the study's senior author and Professor of International Health, Genetics and Biology in the Center for Global Health and Diseases at Case Western Reserve University School of Medicine. "These findings will have a major impact on efforts to eliminate malaria worldwide, particularly in large regions of Duffy-negative west, central and southern Africa."

"In Madagascar, malaria is endemic to more than three-quarters of the island. With almost one million clinical cases reported each year, this disease is a major public health problem" (Case).

Sources:
23andMe. "Malaria resistance." https://www.23andme.com/health/Malaria-Resistance-Duffy-Antigen/howitworks/ [Image]

Case Western Reserve University. "Duffy-Negative Blood Types No Longer Protected from P. Vivax Malaria." ScienceDaily 15 March 2010. 16 March 2010 .

Horuk et al. (1993) . “A receptor for the malarial parasite Plasmodium vivax: the erythrocyte chemokine receptor.” Science 261(5125):1182-4.

Kasehagen et al. (2007) . “Reduced Plasmodium vivax erythrocyte infection in PNG Duffy-negative heterozygotes.” PLoS ONE 2(3):e336.

Michon et al. (2001) . “Duffy-null promoter heterozygosity reduces DARC expression and abrogates adhesion of the P. vivax ligand required for blood-stage infection.” FEBS Lett 495(1-2):111-4.

Protective barrier

Malaria is a parasite that affects many organisms, yet mosquitoes can carry the disease without it triggering an immune response. How?

"Scientists. . . have found that when the mosquito takes a blood meal, that act triggers two enzymes to form a network of crisscrossing proteins around the ingested blood. The formation of this protein barrier, the researchers found, is part of the normal digestive process that allows so-called "healthy" or commensal gut bacteria to grow without activating mosquito immune responses."

"But there is a downside: The barrier also prevents the mosquito's immune defense system from clearing any disease-causing agents that may have slipped into the blood meal, such as the Plasmodium malaria parasite, which in turn can be passed on to humans." However, scientists believe that disrupting "the protein barrier. . . can trigger mosquito immune defenses to intervene and protect the insect from infection." It is possible that the mosquito's immune defenses will combat and eliminate malaria parasites before they are passed on to humans. Researchers are investigating a vaccine that "would generate antibodies" in humans which, "after a mosquito feeds on" the vaccinated human, "could disrupt the barrier, reduce parasite survival in the mosquito and prevent malaria transmission."

Source:

NIH/National Institute of Allergy and Infectious Diseases (2010, March 14). Barrier in mosquito midgut protects invading pathogens. ScienceDaily. Retrieved March 14, 2010, from http://www.sciencedaily.com¬ /releases/2010/03/100311175043.htm

Improving malaria treatment

"WHO (World Health Organization) is releasing the first ever guidance on procuring safe and efficient anti-malarial medicines. The guidelines will help countries select and obtain effective, good quality medicines and save lives by improving the way patients are diagnosed and treated" (WHO).

New guidelines recommend "the use of diagnostic tests and a new artemisinin-based combination therapy". Robert Newman, "director of the WHO global malaria" program, said "It is time to move away from the idea that everyone with a fever is suspected to have malaria" (Bernama).

Tests to determine whether or not malaria is the febrile culprit are necessary to prevent further drug-resistant malaria from developing. However, reliable tests are expensive and unavailable in rural villages, where they are most needed. "The WHO. . . recommended the rural health clinics, where microscopes are often unavailable, use Rapid Diagnostic Tests because they are easy for community health workers to handle" (Bernama).

"Each year there are 250 million cases of malaria and 860,000 deaths as a result. Approximately 85 percent of the deaths are children" (Bernama).

Malaria treatment guidelines: http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html

Bernama. "WHO releases new malaria treatment guidelines." 10 March 2010. http://www.bernama.com/bernama/v5/newsworld.php?id=481148

WHO. "Improving malaria diagnosis and treatment." 09 March 2010. http://www.who.int/en/

Drug-resistant malaria

"In a dusty village near the Thai-Cambodia border, 24-year-old Oeur Samoeun sits on a dark green hammock recovering from a strain of malaria that has resisted the most powerful drugs available. . . Ravaged by days of fever and chills, he is considered lucky: the parasite has left his body. But for many others, the potentially deadly disease never quite disappears."

Pailin province, where Samoeun lives, is the unwitting nursery of drug-resistant malaria. It "is the epicenter of strains of malaria that have baffled healthcare experts worldwide, raising fears a dangerous new form of malaria could already be spreading across the globe."

Last year, a study published by the New England Journal of Medicine "showed that conventional malaria-fighting treatments derived from artemisinin took almost twice as long to clear the parasites that cause the disease in patients in Pailin and others in northwestern Thailand, suggesting the drugs were losing potency in the area." USAID, a U.S. development agency, agrees that traditional arteminsinin-based therapies are "now taking two to three times longer to kill malaria parasites along the Thai-Cambodian border than elsewhere."

Three drug-resistant malaria parasites have emerged from this province over the past five decades. "Thanks to prolonged civil conflict, dense jungles and movement of mass migrants in the gem mines in the 1980s and 90s, the strains multiplied and dispersed through Myanmar, India and two eventually reached Africa."

"Few can say why it is a hotbed for drug-resistant malaria", but experts point to "a combination of sociological factors and a complicated history spanning the Khmer Rouge era when 1.7 million people, nearly a quarter of Cambodia's population, perished from execution, overwork or torture during their 1975-79 rule."

Insurgents clung to Pailin, and it was "one of their last holdouts" before their defeat in the late 1990s. During the era of the Khmer Rouge, people resided in Pailin illegally. When they contracted malaria, they bought medication through black markets and self-medicated.

Self-medication was the only way to curb the rising number of malaria cases, so Cambodia made the decision to make anti-malarial drugs available over the counter. "The strategy carried risks. Easy access reduced the number of cases but also led to incorrect dosages and substandard or counterfeit medicine". Instead of eradicating the malaria parasites, over-the-counter treatments made the parasitic population stronger against widely used medications.

Without adequate drugs to combat the disease, drug-resistant malaria parasites threaten the world. Preventative measures, such as the use of bed-nets to avoid mosquito bites, may be our best defense against malaria. Donate a bed net through Nothing But Nets.

Source:
Win, Thin Lei. Reuters. "Cambodia drug-resistant malaria stirs health fears." 6 March 2010.

Malaria enters the US

"Nearly a dozen cases of Malaria has been confirmed here in the United States. All of the cases were acquired in Haiti after the January 12th, 2010 earthquake" (Gibbons). "Seven emergency responders, three Haitian residents now in the United States and one American traveler are known to have caught malaria in Haiti after the Jan. 12 earthquake, United States health officials said Thursday. Malaria is endemic throughout Haiti, so Haitians now living outdoors and relief workers are 'at substantial risk for the disease,' the Centers for Disease Control and Prevention said" (McNeil).

"Haiti already had a problem with malaria, which is spread by mosquitoes that will have more places to breed in the cities and towns wrecked by the giant quake" (Reuters). Displaced people living in temporary shelters our outdoors are at substantial risk of contracting malaria. Health workers who flooded to Haiti after the earthquake to offer aid are also at risk. "U.S. health officials advise people travelling to Haiti should take medications to prevent malaria" (UPI).

"Six out of eight patients, including seven emergency responders, had been advised to take drugs to prevent malaria but had not done so, the PAHO experts said." Three of the cases that the CDC cited "occurred among Haitian residents traveling to the United States and one case involved a U.S. resident who was visiting Haiti. All are expected to recover fully" (Reuters).

Individuals in Haiti are still at risk. "Each year, Haiti reports about 30,000 confirmed cases of malaria to the Pan American Health Organization, but the CDC estimates as many as 200,000 may occur each year. According to the CDC, malaria transmission peaks after the two rainy seasons -- November to January and again during May to June" (Reuters). The peak season is still months away, but anti-malarial medications are already needed to treat those who are infected and reduce the number of possible cases.

"There is no vaccine against the parasite that causes the illness[,] and it quickly evolves resistance against drugs"; however some drugs are known to treat and reduce malaria illness (Reuters).

The CDC indicates that "anyone traveling to Haiti should take drugs to help prevent infection" (Reuters).


Sources:
Gibbons, Sabrina. WSB News. "Malaria from Haiti Now in US." 4 March 2010.

McNeil, Donald G Jr. The New York Times. "U.S. Warns of Malaria Risk in Haiti". 4 March 2010.

Reuters. "Travelers from Haiti bringing Malaria to the US." 4 March 2010.

UPI. "Malaria Drugs for those going to Haiti." 4 March 2010.

Climate and behavioral change

In recent years, "malaria has been spreading into highland areas of East Africa, Indonesia, Afghanistan, and elsewhere" it was previously unknown. High elevations, low temperature, and temperate rainy seasons prevented malaria from entering these regions before. Now, the deadly disease is contracted locally in these previously malaria-safe environments. Malaria "is on the rise in some parts of the world" partly due to climate change. Other "factors such as migration and land-use changes are likely also at play."

"We assessed...conclusions from both sides and found that evidence for a role of climate in the dynamics is robust," write study authors Luis Fernando Chaves from Emory University and Constantianus Koenraadt of Wageningen University in the Netherlands. "However, we also argue that over-emphasizing a role for climate is misleading for setting a research agenda, even one which attempts to understand climate change impacts on emerging malaria patterns."

"Malaria, a parasitic disease spread to humans by mosquitoes, is common in warm climates of Africa, South America and South Asia." Development and survival of the mosquito and parasite depend on warm temperatures; therefore, "the disease has been spreading to the highlands, and many studies link the spread to global warming. But that conclusion is far from unanimous. Other studies have found no evidence of warming in highland regions, thus ruling out climate change as a driver for highland malaria."

Most studies, which conclude that climate change plays a significant role in highland malaria, tend to be statistically strong. Clearly, climate change does impact the range of malaria endemic regions; however, it may not be the only contributing factor. "What is needed, the researchers say, is a research approach that combines climate with other possible factors."

"Even if trends in temperature are very small, organisms can amplify such small changes and that could cause an increase parasite transmission," a researcher said. "More biological data will improve our overall understanding of malaria and will allow scientists to propose more general and accurate models on the impacts of climate change on malaria transmission."

Some factors contributing to the spread of malaria may be migration and agriculture. People "migrating from lowlands may be introducing the malaria parasite into highland regions. Changes in farming practices may also play a role. Irrigation associated with more intensive farming may be creating more places for mosquitoes to breed."

"The spread of malaria in highlands is of great concern to those who work to contain the disease. But understanding the many factors that influence the spread of highland malaria could help with efforts to control the disease worldwide."

Source:
University of Chicago Press Journals (2010, March 4). Climate change one factor in malaria spread. ScienceDaily. Retrieved March 4, 2010, from http://www.sciencedaily.com­ /releases/2010/03/100303162906.htm

Anti-malarial treats cancer

"Can a drug that has been used to treat malaria for years possibly be used to treat breast cancer before it becomes invasive? That's what researchers at George Mason University's Center for Applied Proteomics and Molecular Medicine (CAPMM) and Inova Breast Care Institute (IBCI) are trying to prove." We already know that artemisinin may target and kill cancer cells in breast-cancer patients, but now it appears that chloroquine, a drug commonly administered to treat malaria, may also treat cancer.

In a three-year clinical trial, researchers "will test the effectiveness of the anti-malarial drug chloroquine in treating 90 women with ductal carcinoma in situ (DCIS), a type of breast cancer in which the cancer cells start in the milk ducts but have not yet become invasive and spread in the breast. Once the cancer cells start to spread in the breast and throughout the body, the condition is considered invasive and can often be fatal."

Breast cancer is the most common form of cancer in women (American Cancer Society). In 2009, 254,650 patients were diagnosed. This treatment will "prevent breast cancer cells from becoming deadly by killing pre-invasive cancer cells". A novel therapy that uses chloroquine, which has been used to treat malaria in the past, may prevent deaths from breast cancer in the near future.

Source:
George Mason University (2010, March 2). Trial launched to test new treatment for pre-invasive breast cancer. ScienceDaily. Retrieved March 3, 2010, from http://www.sciencedaily.com¬ /releases/2010/03/100302123120.htm