Sunday, 23 December 2007

Malaria 2007: Turning back the clock to march forwards with closed eyes

As much as I would like to point to progress in 2007 comparable to last year’s advances, I feel compelled to point out that in international health, a development is taking place that may lead to wastage of resources, disillusionment, and ultimately loss of human life. A number of global leaders have now turned their eyes to elimination and eradication of malaria,[1] and malaria control is once again becoming a dirty word as it was in the 1950s, when malaria experts had convinced themselves and political leaders that the only right choice was to use insecticide spraying to ensure the eradication of malaria from Earth within 5 to 10 years. Candau, Pampana, Soper, Macdonald, Russell and others leading the global eradication initiative in the 1950s knew that they made the world take a risk, and they had calculated that it was worth taking on the basis of models, which were scientifically defensible at that time. By the late 1970s the epidemiological and biological evidence had shown that mankind did not possess the tools that would be required for global malaria eradication. Despite some good technical developments, such tools are still not available, and an analysis of the potential of new tools that could be developed also does not suggest that we are likely to get rid of malaria parasites.

To be positive about all this, I should recognize that the aim for eradication may stimulate more investment in improving health systems, where this is most needed, as much as investment can buy such progress at all, and research for new and better tools to combat malaria. Surely, the powerful people, who have decided to take the international community in this direction, have been led by their good hearts. They are not the kind, who would abide by cardinal de Retz’ maxim, L’ambition dont on n’a pas les moyens est un crime. Leadership manifests itself by deviating from such wisdom. But it also does not distinguish itself by disregarding the combination of past experience and current scientific knowledge.



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