Anti-malaria Policies and Practices in America and South Africa - Essay Example

? Anti-malaria Policies and Practices in America and South Africa ANTI-MALARIA POLICIES AND PRACTICES IN AMERICA AND SOUTH AFRICA Introduction Countries that suffer from the malaria pandemic are generally poor developing countries with the disease close to total eradication in the United States. A macro-economic analysis of malaria’s burden in South Africa shows that it claims approximately two percent of the country’s GDP. The burden exceeded $100 million in South Africa, which contrasts with America that now uses the same amount to counter malaria in developing countries in the developing nations, including South America. The overall burden that malaria has on the economy of South Africa has forced the country to invest heavily on the management and eradication of malaria. This can be compared to the manner in which the United States was forced to counter the threat of malaria, especially in the south after the disease greatly affected workers and soldiers moving to work on American projects and wars abroad. Drug insusceptibility has been one of the greatest challenges to South Africa’s efforts to combat the disease since the 70s with Chloroquine, the most reliable drug until that point, losing its therapeutic and prophylactic value, as it has in most developing countries in the tropics. This has seen the country turn to drug combinations for a first line treatment weapon for therapeutic regimens. After losing the best measure for the protection of its citizens against infection, South Africa, was forced to look elsewhere, as well as case management, which is becoming more difficult. Malaria directly influences the economy of both countries. For the United States, the government uses a significant budgetary allocation to combat the disease in developing nations as part of its MDG promises while South Africa needs to protect its work force, especially in areas where labor-intensive mining is required. Foreign American employees need to be protected from the disease since their immunity to the disease is lower than that for those living in developing tropical countries (Crosse, 2006; p56). The United States Congress was presented, with a rationale to support the eradication of malaria around the world, arguing that the presence of malaria in developing nations imposed a tax increase on imported products. Additionally, conventional business-related concerns in malaria-affected countries assume many responsibilities for the US (Biscoe et al, 2010; p98). The eradication of malaria in South Africa has progressed at a much slower rate than it did in the US, which can be attributed to lack of funds and goodwill of the previous apartheid government. This paper seeks to compare and contrast the policies and practices taken by both countries in the eradication of malaria. For the US, where malaria is almost eradicated totally, the process of this eradication will be used (Casman & Dowlatabadi, 2012; p91). The criteria for malaria eradication in 1951 by the National Malaria Association was that, malaria could be assumed as totally eradicated in any given region where there has been no primary indigenous case for a period of 3 years. The definition has evolved since then with the term; elimination now used when there has been no malaria transmission occurring in the specific geographic region. Eradication has now been turned to mean the elimination of the pandemic around the world. The Office of Malaria Control in War Areas, the predecessor for the CDC, was established to limit malaria’s impact in 1942 during the Second World War, especially in military bases around the world, as well as its territories, where malaria still portended a risk. It was located in Atlanta since the south part of America had the highest rates of transmission of malaria (Davey, 2009; p23). In South Africa, Becton Dickinson and Company began their first malaria-related activity that was designed, as a means to develop devices for control in 1960. The program began when the then Apartheid government encouraged a group of scientists, to modify a traditional device that came to be referred to as the Quantity Buffy Coat apparatus. The academic scientists pursued this in public service spirit with no indication of immediate investment returns. The effort was initially successful with the device they came up with being distributed to villages, although there was a bias towards white neighborhoods. This came back at them since the malaria was not fought in other areas and thus could not be eliminated (Goklany, 2011; p103). It was only in 1988 that the Apartheid government began to combat malaria in predominantly black regions seriously with new tests being introduced, which were more sensitive to the standard microscopy that was available for these people at the time. The test took five minutes compared to an hour for the earlier one or blood smear microscopy with no requirement for specialized personnel. Private health establishments appreciated this new method, although the costs were still prohibitive for public sector use. The century old standard microscopy remained as the main method of malaria diagnosis until the QBC was made available to the market (Davey, 2009; p26). However, the most important development for diagnosis of malaria, which was vital in combating the disease, was the creation of a tropical diagnostics industry. Following this, technology was used by many industrial and academic concerns. The mining industry in South Africa was especially keen on this technology as malaria was affecting its work force with a high turnover of staff. The recently developed RTD, rapid diagnostics test, however, lacks sensitivity to low parasite levels with the detection threshold of this test in the 40-100 parasites/ml range in comparison to 5-10 for standard microscopy. They also cost much more than standard microscopy at approximately $3 per test. They are, however, cost effective where resistance to drugs had led to reliance on more expensive drugs. As the use of RTDs increase, it is expected that the costs should decline (Heyen, 2011; p99). American efforts to eradicate malaria became a success and by the end of the war and the CDC being founded, its initial task included the completion of malaria’s elimination as a health problem that is experienced in the United States. The national malaria Eradication Program began as an undertaking by local and state health agencies of thirteen states in the southeastern region of the country, and the CDC of the United States’ Public Health Service that had been proposed by Dr. L. Williams. The operations commenced on July 1 1947 and consisted, essentially, of DDT use on the interior surfaces of premises and rural homes in the United States and countries in which they worked that had prevalent rates of malaria transmissions (Macklin, 2010; p67). By 1949, over 4.65 million house sprays were applied, including in drainage pipes and trenches, spraying of insecticides, and the removal of breeding sites for mosquitoes. Total transmission elimination was achieved slowly with the year 1949 seeing the country being declared a malaria free region. The CDC, by 1951, had gradually withdrawn from participation in operational phases of the institution, which made a switch to surveillance of the disease. The CDC ceased operations altogether as far as malaria control was concerned. The CDC now also assists in worldwide efforts for the elimination and control of malaria in developing countries (Mouchet et al, 2008; p90). The emergence of resistance to common anti-malarial drugs, on the other hand, has become a major challenge to case management effectiveness for South Africa. Although the insusceptibility of the parasite to Chloroquine has compromised the drug’s usefulness in South Africa, it is the insusceptibility to pyrimethamine is another major drawback in the country, as well as insusceptibility to mefloquine. The new generation of drugs available in South Africa is too expensive for the country’s poor citizens, with the South African government urging the international community to aid in the development and distribution of anti-malarial drugs free (Goklany, 2011; p 34). South Africa has also made strategic deals with insecticide companies that have operated in low-profit fashion. ICI, the British chemical company, has been a leader in pyrethrum-based insecticide development. The unique properties of deltamethrin and permethrin, which are the prominent constituents of these insecticides, qualify them as the prime ingredient in the impregnation of curtains and bed nets that are distributed to South Africans. ICON also soon joined these constituents as ICI malaria assets. This insecticide is adapted as an application agent on the walls of houses, and it became a vital alternative for DDT, which was becoming too dangerous for use due to its slow degradation after application (Sosa, 2010; p88). The South African government then established a unit that carried out distribution of this compound to South Africans. There was little profit sought in the beginning with the supply donated to the WHO for the elimination of malaria. The country’s government also encouraged other companies, especially mining companies to join the venture including Aventis and Bayer. These residue chemicals were then distributed at low prices and in some cases, free of charge in the mining town slums. However, these new generation insecticides still remain unaffordable for a significant number of poor residents and fail in the provision of interventions against the disease’s vectors (United Nations Department of Public Information, 2008; p3). The South African government has also invested heavily in anti-helminthics by distributing the chemicals at discounted prices. The first and best known of anti-helminthics includes Ivermectin that is distributed in conjunction with Merck from the United States, which donates the drug free of charge, as well as GSK that distributes albendazole free of charge. Both drugs indirectly affect malaria via a collateral effect on infection by hookworms reducing the effects of anemia (Packard, 2009; p12). The reason for the philanthropic actions by the US is the market for products destined for South Africa remaining limited, severely limiting their profitability. In order to explore measures to alleviate the marketing problem, the United States came up with a system to guarantee markets for vaccines against malaria that were developed at Harvard’s Center for International Development. USAID established a five-year program with the South African private sector to stimulate a market for materials treated with insecticides. The South African government has also proposed to use public funds to stimulate research and development along this line (Goklany, 2011; p 74). The South African government’s support for the elimination of malaria is based on assessments made on the status of local health and needs guided by strategic plans on health. The initial commitment focused on making plans for organizational capacity, as well as upgrading of diagnostic and laboratory facilities. The plan has its basis on a comprehensive program involving nets, education, training of health care workers, and participation of community elders (Russell & Howson, 2011; p9). It also involves organizing of an information campaign that aims to sensitize communities on net treating techniques, distribution of the nets, and the development of tools for measuring the program’s effectiveness. The South African government, in collaboration with the private sector, also supports research in the development and production of drugs via the Medicine for malaria Venture together with the Harvard malaria Initiative with a donation of over half a billion dollars to the project. The South African government is also a recipient of aid from the Bill and Melinda Gates Foundation (National Communicable Disease Center (U.S.), 2009; p5). Both the United States and South Africa have a relatively small number of anti-malarial drugs that are effective. Although both countries have come up with new drugs in the last 20 years, such as mefloquine and artemisin in South Africa and atovaquone and halofantrine used by US soldiers in tropical countries, both countries have invested millions in affordable and new drugs, as well as new formulations of the drugs already in existence (Targett, 2011; p120). The problem has been compounded by the emergence of resistance, as already discussed, especially to initially effective drugs like Chloroquine by pathogens of malaria. This has even seen a concerted effort by both countries in the development of malarial vaccines, with the hope being that effective vaccines will be made available in the coming seven to fifteen years. Both countries are working on anti-sporozoite vaccines that are aimed at the prevention of infection, as well as anti-asexual blood stage based vaccines that are meant to reduce complicated and severe manifestation of the malaria pandemic. Harvard University also has a partnership with Rustenburg University to come up with vaccines that block transmission and arrest the development of the malaria parasite (Davey, 2009; p 23). Malaria has also been fought against using traditional functional methods in both countries. The Americans turned to the bark of trees that had quinine in order to fight malaria. Today, both countries are using traditional functional genomics with one study describing how targeted disruption of the circumsporozite protein genes, as well as thrombospondin adhesive protein and related proteins. These studies have been confirmed in both countries and seem to have a critical role in the disease, which makes it a validated target for therapeutics in both countries. As more of these genes are validated to be targets, they are expected to lead invariably in increasingly precise targeting therapies (National Research Council (U.S.), 2008; p2). Conclusion It is clear that malaria is a disease that mostly afflicts poor nations with the United States having eliminated the disease from its borders. However, South Africa is still in the depths of the malaria pandemic as discussed. It is vital to note that South Africa has been unable to handle the malaria pandemic by itself and have had to seek help from the international community, especially from the United States that has already dealt with the disease. The use of insecticides is a common thread for both countries, although South Africa did away with the chemical after it was found to be unfriendly to the environment. It can be concluded that the use of DDT by the Americans is one of the main reasons why they managed to eliminate the malaria vector. By the time that South Africa attempted to use it, the chemical’s harm had already been discovered. Finally, it is clear that developing countries, especially those in the tropics will find it difficult to eliminate malaria due to lack of funds. References Biscoe, Melanie., Mutero, Clifford., & Kramer, Randall. (2010). Current policy and status of DDT use for malaria control in Ethiopia, Uganda, Kenya and South Africa. 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