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By Joye F. Jones, Pastor

Good Shepherd UMC, Silver Spring

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1949 was a watershed year in public health. The United States was declared to be free of malaria. If you were born after 1945, you probably didn’t even know that malaria was once a serious problem in this country. Concentrated mainly in the warm, humid southeast, malaria was found as far north as the District of Columbia. The defeat of malaria in the U.S. was as significant as overcoming polio and smallpox.

Fast forward more than 60 years. Worldwide, malaria is one of the leading causes of death in children under the age of 5. In Sub-Saharan Africa, approximately 24 percent of all early childhood deaths are due to malaria. That’s a staggering number, but unless you have had malaria or seen someone in the grip of the disease, it’s hard to imagine the suffering.

During the fever phase, the child is racked with shivering so severe that you think you can hear the bones rattling. Severe anemia and brain damage can lead to death. In addition, babies born to women with malaria often have complications at birth and may die.

Some 40 years ago, I was a Peace Corps volunteer teaching science in Malawi, a country that still has a high incidence of malaria.

I can remember teens and young adults sitting in class, wrapped in blankets, shaking. “Go to the hospital,”I would say.

“Oh, no, madam,” came the reply. “It’s just malaria.” These were the survivors, the ones who had had malaria as young children and lived to have it again.

Why is this ancient scourge still around? Why didn’t we apply the techniques used in the U.S. to other parts of the world where malaria is still a leading cause of illness and death?

We did.

And they didn’t work.

Malaria is caused by microscopic parasites called plasmodia. There are four kinds of human malaria, each caused by a different kind of plasmodium. Humans get malaria from the bite of an infected anopheles mosquito. The parasite has two necessary life cycles, one in humans and one in anopheles mosquitoes. Only by completing both life cycles can plasmodia continue to live – and thrive.

The U.S. eliminated malaria by attacking mosquitoes and mosquito breeding places. Massive amounts of DDT were sprayed at ground level and from the air, killing mosquitoes. Swamps were drained, and pesticides that would kill mosquito larvae were used where drainage wasn’t possible. And it worked. But, it was expensive. And DDT caused terrible damage to the environment, nearly exterminating a number of species of birds. Worst of all, mosquitoes developed resistance to DDT, and it was no longer effective.

With DDT banned and mosquitoes worldwide developing resistance to many pesticides, researchers had to look for other ways to attack this terrible disease.

One way that held promise for a long time was the use of medicines to prevent malaria in the first place. But over time, the parasites became resistant to nearly every drug researchers were able to develop.

Indeed, one of the big problems right now is that the number of drugs available to treat malaria is rapidly shrinking, as the parasites become resistant to drugs faster than scientists can find new ones. Even so, children and infants who get malaria and are treated immediately have a good chance of survival, if, of course, they can get medical help in time.

The big leap forward was the development of insecticide-treated mosquito nets – the “Nothing but Nets” program that the UMC helped launch. These work, and work well. They are probably the single most important reason for the reduction in child deaths caused by malaria from one death every 30 seconds to one every 60 seconds (still an unacceptably large number).

Nets remain critically important tools in the worldwide fight against malaria, but there are not enough for everybody. In most places where malaria is common, people don’t have the nets. We just can’t get enough nets to people fast enough. And very recently, researchers have found some mosquitoes that are resistant to the insecticide used in the nets. This is scary indeed.

The greatest hope for totally eliminating malaria is what has worked for diseases such as smallpox and polio – a vaccine. But no one has ever developed a vaccine to prevent any parasitic disease. The complex life-cycle of plasmodia make them very difficult targets for vaccine.

But there is reason for optimism. Researchers know that people can develop immunity to malaria. If you survive your first case of malaria, you may get it again, but it usually won’t be as severe. Now, researchers have reported promising results of a vaccine developed for infants and children. For the first time, a vaccine has reduced the rate of infection and disease in areas where malaria is endemic. The results are not as good as everyone wanted, but there is promise that things may be going in the right direction.

So as we try to imagine a world with no malaria, we remain a people of hope. Using God-given gifts of talent, imagination and doggedness, coupled with the willingness to spend money and not give up, researchers are trying new ideas. Someday, we can indeed rid the world of this terrible disease that kills so many before they have a chance to live.

The Rev. Joye F. Jones has a PhD in parasite immunology– the study of how the immune system fights parasites and how parasites evade immune responses.