The "simple" challenge of malaria elimination: a response to Ken Opalo's post

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This post was originally written on 10 November 2016.

I recently read an article from Ken Opalo, a prominent African political blogger who I admire, entitled: How to eliminate malaria. Mr. Opalo (who I will now, respectfully refer to as Ken) lauded the success of the Sri Lankan government’s efforts that combined vector control strategies with persistence even during the civil war.  This was all well and good until this statement: “Someone tell African policymakers that bed nets and behaviour change are not enough”. He continued with this reproof and concluded with emotive, albeit factual, malaria statistics that highlight that nine in ten malaria deaths are in sub Saharan Africa.  After reading this post, I found myself very frustrated with Ken—who is generally someone who I often referred to for a smart analysis of African issues. 

To start, in this post he erroneously juxtaposes a country of 20.5 million to a continent of 1.2 billion. As an infectious disease epidemiologist it pained me to see Ken cast uniform blame on 54 countries without any mention of the variable factors that influence malaria persistence and the unique epidemiological characteristics that influence malaria transmission and risks. These factors include, but are not limited to: the strength of the health system, issues of insecticide and drug resistance, differences in climate, amount of existing infrastructure, even rainfall… I could go on and on. Instead, I would like to highlight a few areas where Ken missed the mark with his criticism.

In order to eliminate a disease the government must first contain it. Malaria spreads when a mosquito bites a person who is infected with the causative parasite and then goes and bites a non-infected person. In Africa, most borders are porous and even if one country does a phenomenal job in combatting malaria, an infected individual who migrates from a bordering country can regress efforts or initiate outbreaks. Naturally, it is much more difficult to migrate onto islands; geographic realities drastically decrease the amount of imported cases and contamination. This is one reason several islands are on the path to eliminating malaria, including Mayotte and Cape Verde.

Ken goes on to condemn the ostensible monolithic African government and posits that the disproportional malaria burden is a result of “misplaced priorities of public health officials, donors, development agencies, and academic researchers”. The slew of global initiatives and funding for malaria elimination and the heroic work of many National Malaria Control Programmes and partners would counter this accusation.  That being said, there is some truth to his claim: one of the biggest threats to malaria elimination in Africa is complacency.

I believe that Sri Lanka has earned the recognition for this historic feat. I also agree that we should hold our leaders accountable and expect that they do whatever they can to stifle diseases like malaria. We do indeed have a way to go. Still, I hope that in the future Ken would acknowledge that though malaria elimination might sound simple, it often is not.