Published by the Students of Johns Hopkins since 1896
April 16, 2024

In view of the economy, how far should countries go to strengthen their public health system?

While epidemics and prevalent public concerns must be addressed, countries are always faced with financial roadblocks that prevent them from funding large-scale eradication programs. In a recent study, epidemiologists studied hypothetical aftermaths of malaria eradication and suggested that it not only would benefit many countries, but it is also unlikely that malaria would reemerge. With this insight, the complete eradication of malaria may appear to be more appealing in the interests of a nation’s growth.

Malaria is a curable disease caused by parasites, which are spread by mosquitoes. The parasite enters a person’s bloodstream and multiplies, eventually leading to symptoms such as fever, chills, nausea, anemia, coma and even death. According to the World Health Organization, there were 219 million cases of malaria, leading to the deaths of 660,000 people in 2010. Several organizations, such as the 1955 Global Malaria Eradication Program, fought to combat this disease in the past. However, funding ceased in 1969, leaving malaria only partially exterminated in some parts of the world.

In a study recently published in Science, researchers examined a pair of numbers that described the amount of new malaria cases in two settings. The controlled setting took preventative steps such as the distribution of antimalarial drugs and a monitored mosquito population, while the uncontrolled setting counted malaria cases without aid.

The study revealed that case numbers were low in countries that had completely eliminated malaria. This means that the spread of the disease there is very limited even after the Global Malaria Eradication Program ceased. However, countries that failed to eliminate the disease in the past faced a new wave of malaria cases.

“If you get rid of malaria once and go through this very strict program of verifying that you got rid of it, it doesn’t tend to come back, and I think that’s significant,” David Smith, senior author of the study and professor in the Department of Epidemiology at the School of Public Health and the Malaria Research Institute, said. The question here is why is the reappearance of malaria unlikely in the places that have eliminated it in the past?

One possibility is economic development, which in turn, leads to improved public health systems and disease control. The study also suggests the idea that increasing numbers of healthy working people are joining the workforce.

“We don’t know which one is the right answer, and it may be different in different places. But it really matters whether malaria elimination causes its own stability ... or is caused by it,” Smith said.

For now, Smith said he will publish another study shortly that will explore ways malaria elimination can cause its own stability.

“It’s a very clever and elegant paper that comes up with some surprising and counterintuitive results,” Lee Hall, chief of the Parasitology and International Programs Branch in the National Institute of Allergy and Infectious Diseases Division of Microbiology and Infectious Diseases, said. The idea of malaria elimination reinforcing itself is considered unexpected, and realizing the means through which it does so may lead to improved approaches to counter the spread of malaria completely.

“If you understand the factors that are reducing transmissibility, then you may want to choose to design your control programs to emphasize those aspects, which will drive down transmissibility in a sustained manner as opposed to temporarily interrupting transmission,” Hall said.

With these hopes for the future, disease control and the different aspects of a country’s growth may appear to be more connected than previously thought, and perhaps this new understanding will eventually set public health in a new light.

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