IRD - Suds en ligne : les dossiers thématiques de l'IRD

Overcoming Malaria

Le paludisme, infection due à un parasite transmis à l’homme par un moustique, tue chaque année plus d’un million de personnes. Cette maladie menace un tiers de l’humanité, essentiellement dans les régions tropicales. Obstacle majeur au développement, le paludisme représente un véritable défi pour la recherche.

Overcoming Malaria > Conclusion

Conclusion

Nearly 200 years after Caventou and Pelletier first extracted quinine from Cinchona bark, 132 years after the discovery of Plasmodium by Laveran, and 50 years after the failure of the so-called "malaria eradication" campaigns by WHO, malaria remains a leading killer among infectious diseases in the world. In the 2000s, it was estimated that between 350-500 million people were infected with malaria each year, with more than one million deaths, mostly in children, and especially in Africa (Global Malaria Action Plan, Roll Back Malaria, 2008).
An increased awareness of the scourge and the injustice that is malaria led to the holding of international summits, the involvement of major institutional donors and private funds (Global Fund, WHO, Bill and Melinda Gates Foundation, Welcome Trust Foundation, large pharmaceutical companies ...) and to a real increase in research and in operational tactics against this disease. Massive actions focused on the diagnosis, management, development and use of drugs, and vector control have led to a decrease in malaria incidence worldwide particularly in areas of relatively low incidence (Europe, America and Western Pacific)for the first time in decades. In Africa, where over 80% of cases worldwide occur, the decrease in incidence is less important and most often limited to certain countries. Although engaged budgets are very important (more than $2 billion),  WHO considers that $5 billion would be needed for a lasting effect in accordance with the Millennium Development Goals.
According to WHO, 216 million episodes of malaria were reported in 2010, 81% in the African region. The number of deaths due to malaria in 2010 is estimated at 655,000 of which 91% occurred in Africa (WHO 2011 Report on the global malaria). These figures show undeniable success in malaria control since the 2000s.
Optimism must be tempered, however: after decades of research, we still do not have a usable vaccine. The last vaccine trials with the promising RTSs vaccine show only 30-50% protection (see New England Journal of Medicine November 9, 2012), few new antiparasital molecules are appearing on the market, and Plasmodium are increasingly resistant to current molecules (with early signs of resistance to artemisinin in Myanmar and Viet Nam). Despite the undeniable success of the massive coverage of at-risk populations with pesticide impregnated nets, vector control has reached its limits, selecting mosquitoes genetically resistant to insecticides or developing avoidance behaviours.
Research and public health efforts should be not only maintained, but enhanced (implying an increase in funding for these activities), so that malaria in the poorest countries rapidly becomes a thing of the past, as was the case in the northern countries, nearly a century ago.