by Dr Shriram Nene
When we first moved to India from the US there were a lot of changes for me and my family, but overall it was very positive. I sought to advance medicine using media, technology and platforms in a country and a world that needed world-class medicine for all. It allowed me to reconnect with a culture that my parents took with them as immigrants to the UK in 1963 and the US in 1973, and embraced as our secret power of diversity. While enjoying the outdoors in the tropics, I contracted dengue fever three months after arriving in India. I thought I was in great shape, but I didn’t know what havoc awaited me. Likewise, my wife had contracted malaria and dengue fever on the sets while filming. Having both suffered and survived mosquito-borne diseases, we particularly appreciate a potentially preventable disease that continues to wreak havoc in many parts of the world and in India.
An article in The Economist from December of last year described malaria as one of the most important agents in our society. Rightly, the article highlighted some key historical events that marked the position of malaria in shaping some of the deepest challenges of our modern society. From playing his part in the proliferation of slavery in the United States, to hampering the power of Alexander the Great and Atila the Hun, he emphasized the ruthless power of malaria, unprecedented at its size.
Every year, malaria kills thousands of people around the world. In 2019 alone, malaria killed more than 400,000 people worldwide, with around two-thirds of deaths among children under five. India has also borne the brunt of malaria and lost thousands of lives to the disease over the past decade. An even more distressing aspect of malaria is its higher prevalence among the socio-economically lower strata of our society and its greater impact on children under five and pregnant women.
It is against the backdrop of these pressing realities that governments around the world, led by bodies such as the World Health Organization (WHO), have pledged to free their countries from the clutches of malaria. Our Prime Minister Narendra Modi also made the decision to end malaria and announced it at the East Asia Summit in 2014 to make India a malaria free country by 2030. It was a historic commitment and a key priority for a predominantly rural India. .
As we find ourselves at the start of a new decade – having prepared for the disruption of a pandemic – India looks forward to one of its most crucial ten years. Our efforts and commitment over these ten years will determine not only the fate of our resolution – to be a malaria-free country – but also the health and well-being of our future generations.
India’s relationship with malaria
India has its own history with malaria. It was here at the end of the 19th century that it was first discovered – by Sir Ronald Ross – that the malaria parasite is transmitted by a mosquito (anopheles), marking a monumental milestone in the fight against humanity against malaria.
In the context of the prevalence of the disease, India has had a very endemic relationship with malaria. Our country has been in a constant struggle with malaria and mosquito-borne diseases for as long as we can remember, and has even waged a war or two. In fact, in the midst of the pandemic-riddled monsoon last year, India fought unique battles, in which people were contracting COVID and mosquito-borne diseases at the same time. The double burden of the disease has raised serious concerns in states like Maharashtra, where the co-morbidities have claimed nearly 30 lives.
In the context of wars, India laid the first siege against malaria in the late 1950s, with the launch of the National Malaria Eradication Program in 1958. The program and the efforts of the public health authorities of the he era played a phenomenal role in reducing malaria, dropping its death toll from one million before independence to zero deaths and 0.1 million cases in 1965, virtually wiping out the disease from the country. However, the victory led to a feeling of complacency and resulted in a severe resurgence of malaria from the early 1970s.
India’s second war on malaria began in 2015, after Prime Minister Modi’s declaration to make India a malaria-free country. It is worth noting that since the declaration, India has made huge strides against malaria, reporting a steady year-over-year reduction in cases and deaths. The progress, which represents a reduction of more than 60% in the number of cases over the past five years, has been hailed globally and locally and has become a source of inspiration for other countries. In fact, according to the WHO World Malaria Report 2020, during the period 2000-2019, India contributed to the largest absolute reductions in malaria cases in Southeast Asia, and progress have even helped to target other countries in the WHO South-East Asia region for malaria. elimination.
However, there are some crucial realities in the fight against malaria in India that we cannot afford to ignore. For example, the World Malaria Report 2020 also highlighted that India contributed to the highest burden of malaria cases and deaths in the WHO Southeast Asia region in 2019. Likewise, the COVID19 pandemic has now disrupted a number of priority non-COVID health issues in India, including our continued efforts to fight malaria.
Lessons from history, priorities for a crucial decade:
If there is one lesson we need to learn from India’s past attempts to eradicate malaria, it is that we may be complacent. As we make steady progress against malaria, as India would have done in the 1960s, it is essential that we maintain our efforts and momentum and do not follow the path of our history, that is that is, complacency.
In addition, this pandemic has allowed us to verify the reality of the importance of tackling long-standing public health issues, so that we may be able to manage the (free) capacity of our healthcare infrastructure. and respond effectively to emerging needs, such as a pandemic. In retrospect, as countries like Sri Lanka, China and a number of European countries had the space to focus on COVID during the pandemic, India has also had to work to control other diseases. like dengue, malaria, encephalitis, etc. The diversity of the problems may not only have had an impact on our number of cases and our mortalities, but would have made the task of creating ever more complex health intervention strategies tiresome. It becomes a wake-up call to quickly and effectively address existing public health priorities.
There are also other malaria specific priorities on which India must remain focused. High-quality, broad-based case data collection, timely and proportionate provision of life-saving supplies – such as long-lasting insecticidal bednets, antimalarial drugs – in endemic areas. Working on these aspects will produce the best results for us.
As previously stated, our efforts over the next ten years will be crucial in determining whether the next generations of Indians will have to tackle the deadly impact of malaria and mosquito-borne diseases. The impact would be wary of the astronomical economic costs – an estimated annual sum of INR 11,000 crore – the cost of living and the disruption of thousands of households each year.
It is now more than ever in our hands to create a future where no Indian becomes ill or dies of malaria, which requires dedicated efforts in this crucial decade.
Dr Shriram Nene is a cardiovascular and thoracic surgeon. Currently, he is developing a medical platform “Pathfinder Health Sciences”, committed to improving lifestyles and lifespans through precise and personalized health approaches. He worked closely with MNM India on their Bite Ko Mat Lo Lite campaign.
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