The discovery of the fact that malaria—one of the deadliest vector-borne diseases in the world—is spread by mosquitoes was a defining moment for global health science and technology. This August marks 125 years of the momentous discovery by Dr Ronald Ross of the British army in Secunderabad, India. Born on 13 May 1857 in the picturesque hill-town of Almora in Uttarakhand, Ross received the 1902 Nobel Prize in Physiology and Medicine for his path-breaking revelation.
Ross’ discovery paved the way for combatting malaria by targeting mosquitoes. The use of insecticide DDT, for example, became the backbone of the World Health Organization’s (WHO)’s malaria eradication program in the 1950s. Today, technologies geared toward eradicating vector-borne infectious diseases like malaria have become more cutting edge. Researchers are trying to combat malaria through new-age methods like genetic modification, advanced surveillance systems, and entomology—the scientific study of insects.
While some parts of the world have eliminated malaria, it remains a huge problem in Africa, Southeast Asia and Latin America. But India has always persisted in its efforts to eradicate the disease. Backed by political commitment at the highest level, For instance, India launched an aggressive malaria elimination drive in 2016, which yielded positive results. The National Framework for Malaria Elimination (NFME) and National Strategic Plan (NSP) for Malaria Elimination 2017-2022 propelled this move. The resulting decline in malaria was hailed by the WHO.
Turning setbacks into progress
Globally and in India, progress in malaria elimination suffered a setback due to Covid-19. We witnessed a massive surge in 2020, with mosquitoes causing 241 million malaria cases and 627,000 malaria deaths. The pandemic disrupted routine vector control activities, such as distributing insecticidal mosquito nets, indoor spraying of insecticide, as well as testing and treatment efforts. It is critical that we take all steps necessary to undo this damage and push to end malaria once and for all.
For the Vector Control Research Centre in Puducherry, the push toward ending malaria and other VBDs has always been at the centre stage. Our first priority is to create a cohort of trained entomologists who will form the backbone of vector-borne disease elimination programmes. In India, the numbers of entomologists are alarmingly low. To ensure that we build a systematic ecosystem for malaria elimination and achieve a malaria-free India, our priority is to equip scientific personnel with the skills and tools required to beat the disease, in line with the WHO’s Global Vector Control Response (GVCR-2017).
Once trained, entomologists can use available technologies and infrastructure to monitor the spread of malaria. To tackle Covid, India built a massive laboratory infrastructure (greater than 3,000 labs), in a short time. We have already proposed that labs that were being used for RT-PCR testing be repurposed now that they are largely underutilised. This could boost the monitoring of infections in the insects that transmit disease and help gauge levels of potential disease spread in regions.
Staying ahead and prepared for challenges
Strong knowledge and understanding of the potential spread of malaria and other VBDs can help us stay prepared for future challenges. It could allow us to adequately equip target districts and blocks with nets, diagnostics and medicines in an integrated manner. Focused community mobilisation activities could inform people about the urgent need for action to protect themselves through site-specific behavioural change communications.
Meanwhile, exciting, cutting-edge technology is also being used to render mosquitoes harmless to humans by eliminating the disease-causing pathogens they might carry. For four years, VCRC has been preparing mosquitoes that carry strains of a bacteria called Wolbachia, which can reduce pathogen transmission in mosquitoes. Wolbachia is harmless to humans and animals. Releasing mosquitoes with Wolbachia into the environment can be successful in reducing levels of viral diseases such as dengue and chikungunya and, according to recent research, maybe even malaria. However, it is a highly regulated area and needs governmental permission for piloting and deployment.
The start of Our fight against malaria was sparked by science and scientific discovery has brought us closer than ever to achieving elimination. The recent accomplishments of the malaria elimination programme have instilled confidence that the dream of a malaria-free India is very much in sight. Greater prioritisation of scientific research and development may just be what we need to end the suffering and deaths that malaria continues to cause in India.
Dr Ashwani Kumar is the Director of ICMR-Vector Control Research Centre, Indira Nagar, Puducherry. Views are personal.
(Edited by Zoya Bhatti)