Dear Colleagues

The malaria situation in Africa is a disgrace. It is about 100 years ago that Gorgas got control of mosquitoes and malaria during the construction of the Panama Canal using an integrated set of interventions ... and in the following 50 years there was much progress using variants of the integrated approach.

Since the use of DDT to combat malaria was discontinued several decades ago, malaria has become a more serious problem. Excessive use of anti-malarial medications and continuous reinfection has made resistance a problem ... but modern scientific knowledge and funding to implement integrated programs could overcome these difficulties and make malaria history.

In my own work on modeling malaria control, I am struck by how quickly it is possible to achieve progress in malaria reduction ... and equally how little progress is going to be achieved if the data are not used for practical operational decision making ... and how quickly malaria will take hold again until the transmission cycle is broken (to all extent) permanently.

Surprisingly few of the organizations interested in malaria are doing work that will have a cost effective outcome ... single focus bednets or IRS will have limited long term impact and the long term costs are high. Single focus drug treatment does little in situations where reinfection takes place almost instantly. Work on vaccines is scientifically interesting but should not be needed if the Gorgas model is followed.

There is a lot of solid science about mosquitoes and malaria ... but rather less data about costs and the results being achieved. Hopefully this will change as fund flows increase and donors begin to realise that the results being achieved are small relative to the costs.

Sincerely Peter Burgess Tr-Ac-Net