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From The Mail & Guardian (Johannesburg) Africa News - Original


Malaria 'Out Of Control' In South Africa After Warm Winter

BYLINE: Paul Kirk

DATELINE: 8 October 1999

Johannesburg - Scientists and medical researchers are predicting that, after a long hot winter, South Africa may be facing the worst outbreak of malaria since 1932. Making the possibility of an epidemic more probable is the fact that the malaria parasite is now resistant to many of the drugs used to treat it.

Says Ros Page of the KwaZulu-Natal Department of Health: "The situation is very bad. In the first six months of this year we have already seen 3,000 more cases of malaria than we saw in the whole of last year. And we have not yet entered the peak malaria season. Things always get worse around summer."

The provincial health department - which has minimal resources to fight malaria after spending nearly 75% of its budget on HIV/Aids - has documented 17,757 cases of malaria until June this year. There were 11,223 cases for all of 1997 and 14,465 for 1998. The increase is attributed to a number of factors - most significantly the gradual increase in South Africa's average temperature due to global warming.

Dr Andrew Jamieson of British Airways travel clinics keeps a close watch on malaria figures so he can warn tourists of potential risks when travelling in Africa. "We have had a warm winter where the malaria-carrying Anopheles mosquito did not die off to the extent it normally does. As a result we are left with a far greater number of mosquitos that can carry malaria. Now that summer is upon us these mosquitos will breed and exponentially increase the risk of disease. The worst is nn still to come," he says.

Jamieson is increasingly hearing of malaria cases in areas where the disease had not previously occurred. "We must remember that historically much of South Africa is malarious. We are starting to see malaria in areas where the condition has not been seen in decades. In addition, we are seeing much more serious outbreaks of malaria in areas that we are used to seeing it in."

Malaria cases are being found south of Richards Bay, and isolated cases have been found close to Pretoria.

Jamieson says the disease is not confined to South Africa. For instance, more than half of the 6,500 workers assembling the Maputo aluminium smelter have been diagnosed with malaria.

Scientists are quick to point out that, while the situation is not yet an epidemic, it may well soon become one. Says Barry Bredenkamp of the Durban-based National Malaria Research Programme: "We are not yet facing a classic epidemic scenario where we have a widespread outbreak of malaria in areas which have never had it before. But the situation is very serious. It could well develop into an epidemic which would be absolutely crippling."

Scientists cite a number of reasons for the increase in malaria cases. Apart from the warmer weather the country - and the Southern African region - is experiencing, the increase in visitors to South Africa from neighbouring countries, many of whom are infected with the malaria parasite, is also contributing.

The breakdown of malaria control measures in neighbouring countries due to underfunding also contributes massively to the situation. Mozambique has not implemented malaria control measures for years because of the civil war that raged in that country. As a result it is now facing its worst outbreak in years and the disease is spreading.

Scientists are holding thumbs that a vaccine will soon be available - but the underfunding of research is likely to ensure that a malaria vaccine remains an impossible dream for years.

Many of the drugs prescribed to fight malaria are no longer effective -over the years malaria parasites have developed immunity. The drugs are also very expensive and many African governments simply cannot afford them.

"Many governments do not seem to have the political will to fight malaria. They find money for MiGs, but not malaria. Governments need to spend money on fighting the spread of the disease. A malaria vaccine is currently being worked on in Colombia, but at the moment, while some success has been achieved, the results are still not good enough," Bredenkamp says.

At present the best vaccine scientists can produce is only about 30% effective. Making a more effective vaccine may be possible - but it will also be expensive. As a result Southern Africa is likely to be the last place where the vaccine becomes available.

Says Michael Kremmer, senior fellow in Economic Studies at the Brookings Institute, a Washington think-tank that was set up in the 1920s to advise the United States government: "The critical problem is finding the money for vaccine research, development and distribution.

"There is simply not enough money in malaria, as drug companies know. Malaria is a tropical disease, in which a parasite is spread between humans by the bite of an infected mosquito. Since the mosquitoes can transmit the disease only in warm temperatures, the disease is highly concentrated in tropical climates.

"But people in the tropics are overwhelmingly poor and in no position to pay for vaccines, and so drug companies have little incentive to fund research. As a result, malaria vaccine research is carried out mainly in government research institutes, all suffering from scarce budgets. Worldwide malaria research amounts to $84-million annually, or perhaps $42 per malaria fatality.

"This expenditure is tiny compared to what is spent on diseases affecting richer and more temperate areas. For example, research funding for asthma is about $800-million annually or $500 per fatality. In short, the 2,4-billion people in the tropics who are vulnerable to malaria provoke remarkably little research effort."

Ironically, the very phenomenon that is leading to Southern Africa's increased malaria cases may actually save the subcontinent. Global warming is taking malaria to the rich. The World Health Organisation has reported that Europe has experienced a tenfold increase in malaria over the past two years. Last year 200,000 cases of malaria were reported in Europe.

Webmaster's Note:
  • Please read this article for a perspective on the situation two months later.
  • Note the point made about funding. HIV is such a problem in Africa that resources for other health problems are extremely scarce
  • The countries in Europe that have been reporting malaria cases are Turkey, Armenia, Azerbaijan, Belarus, and Russia [southern, obviously]. Italy, Greece, and Macedonia have not reported autochthonous [locally-transmitted] malaria cases since the 1960s. Many of the cases in Europe are connected to cessation or disruption of control efforts in the republics of the former USSR.
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