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New cures for an old fever

As an infectious disease that affects two million people in India annually, malaria continues to be a significant public health challenge. India has a much lower death rate from malaria than Africa, where nearly a million children die of the infection every year. National policy aims at consolidating the gains made over time. This means reducing the reservoir of infection through preventive measures and improving the availability of potent drug combinations that can overcome resistance to treatment displayed by the malarial parasite. One hundred and twenty five years after Charles Louis Alphonse Laveran discovered the causative organism, prospects of achieving better disease control appear bright with the reported efficacy in clinical trials of two vaccines against the malarial parasite, Plasmodium falciparum. Early results from trials of a vaccine developed by scientists at the Pasteur Institute are encouraging, the open-access journal PLoS Medicine reports; the vaccine helped individuals develop strong immune responses against a protein present on the surface of the parasite and showed promise in inhibiting its growth. The medical community has also been encouraged by results published late last year by the Journal of the American Medical Association (JAMA); these were results of the largest trial conducted in Africa of the vaccine RTS,S/AS02A developed by a pharmaceutical company. While the world waits for a potent vaccine, the challenge before Indian health policy is to bridge the treatment gap between the well-covered States and some of the remote and less developed ones.

The national anti-malaria initiatives, some of which receive substantial international funding, must strive to improve care levels in the affected States. Orissa, Gujarat, Chhattisgarh, West Bengal, Jharkhand, Karnataka, Uttar Pradesh and Rajasthan have a high incidence of malaria, and mortality is depressingly high in Orissa, West Bengal, parts of the Northeast, and Karnataka. At the initiative of Union Minister for Health Anbumani Ramadoss, the National Vector Borne Disease Control Programme rightly focusses its effort on filling the gaps in access to treatment with combination drugs such as Sulfadoxine-pyrimethamine and artesunate (derived from artemisinin, a plant extract). This mix has achieved good outcomes against the background of resistance developed by the parasite to older medicines such as chloroquine. Indian scientists under the Council of Scientific and Industrial Research have made a sterling contribution to malaria control initiatives by developing an artemisinin derivative that came to market several years ago. The decision to include artesunate presents an additional opportunity to research the efficacy of combination drug protocols involving different derivatives. The impending malaria vaccine trials in Orissa and Madhya Pradesh will be watched keenly, in the hope they will take the medical community closer to the goal of eradicating malaria.

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