by Dr. Shriram Nene
When we first moved to India from the US, there were many changes for me and my family, but for the most part it was very positive. I sought to scale medicine using media, technology and platforms in a country and world that needed world class evidenced medicine for all. It allowed me to reconnect with a culture which my parents had taken 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 of the tropics, I contracted Dengue, three months after arriving in India. I thought I was in great shape, but little did I know what havoc awaited me. In similar fashion, my wife had contracted malaria and Dengue on the sets, while shooting. Both having suffered and survived the mosquito borne diseases, we had a special appreciation for a potentially preventable illness that continues to wreak havoc in many parts of the world and in India.
An article in The Economist from December last year described Malaria as one of the most consequential agents of our society. Rightly so, the article pointed out some key historic events which signified malaria’s position in shaping some of the deepest challenges of our modern day society. From playing its part in proliferation of slavery in the United States, to hindering the might of Alexander the Great and Atila the Hun, it underscored the ruthless power of malaria, unparalleled to its size.
Every year, malaria kills thousands of people around the world. In 2019 alone, malaria killed more than 400, 000 people globally, with an estimated two thirds of the deaths among children under the age of five. India has also borne the brunt of malaria, and has lost thousands of lives to the disease in the past decade. An even more distressing aspect of malaria is its higher prevalence amongst socio-economically weaker sections of our society, and greater impact on children under the age of five and pregnant women.
It’s within the context of these pressing realities that Governments around the world, led by bodies such as the World Health Organization (WHO), pledged to free their countries from the clutches of malaria. Our Prime Minister Narendra Modi also made a decision to end malaria, and announced it during the East Asia Summit in 2014, to make India a malaria free country by 2030. This was a historic pledge, and a key priority for a rural-dominant India.
Now as we stand at the start of a new decade – having braced the disruption of a pandemic – India is looking forward to one of its most crucial ten years. Our efforts and commitment throughout these ten years will not only determine the fate of our resolution – to be a malaria-free country – but also the health & well-being of our future generations.
India’s relationship with Malaria
India has its own history with malaria. It was here in the late 19th century when it was first discovered – by Sir Ronald Ross – that malaria parasite is transmitted by (anopheles) mosquito, marking a monumental step in humanity’s fight against malaria.
In the context of disease prevalence, India has had a very endemic relationship with malaria. Our country has been in a constant battle with malaria and mosquito-borne diseases for as long as we can remember, and has even waged a war or two. In-fact, amidst the pandemic riddled monsoon last year, India fought unique battles, wherein people were contracting COVID and mosquito-borne diseases at the same time. The dual-disease burden had caused major concerns in states like Maharashtra, where such co-morbidities claimed nearly thirty lives.
Within the context of wars, India laid the first siege against malaria in the late 1950s, with the launch of National Malaria Eradication Program in 1958. The program and efforts of the then public-health authorities played a phenomenal role in reducing malaria, declining its death toll from one million before independence to zero deaths and 0.1 million cases in 1965, virtually eliminating the disease from the country. However, the victory led to a sense of complacency, and resulted to severe resurgence of malaria from early 1970s.
India’s second war against malaria started in 2015, after the declaration by PM Modi to make India malaria free country. It’s noteworthy that since the declaration, India made a tremendous progress against malaria, reporting consistent year-on-year reduction in cases and deaths. The progress, which is more than 60% reduction in cases over the past five years, has been commended globally and locally, and has become an inspiration for other countries. In fact, according to WHO’s 2020 World Malaria Report, in 2000-2019 period India contributed largest absolute reductions in malaria cases in South-East Asia, and the progress even helped put other countries in the WHO’s South-East Asia region on target for malaria elimination.
However, there are some crucial realities for India’s malaria fight which we cannot afford to overlook. Such as, the World Malaria Report 2020 had also pointed out that India contributed to the highest caseload and malaria mortalities in the WHO’s South-East Asia region in 2019. Similarly, the COVID19 pandemic has now caused disruption to a number of non-COVID health priorities in India, including our constant efforts to combat malaria.
Lessons from History, Priorities for a Crucial Decade:
If there is one lesson that we must take from India’s past attempts to eliminate malaria, is that there is scope for us to be complacent. As we make consistent gains against malaria, like India would’ve made in the 1960s, it’s crucial that we keep-up our efforts and momentum and not tread down the path of our history i.e. complacency.
Additionally, this pandemic gave us a reality check about the importance of tackling longstanding public-health challenges, so we can be able to manage (free) capacity of our healthcare infrastructure and efficiently deal with emerging needs, such as a pandemic. To put it in retrospect, while countries like Sri-Lanka, China and number of European nations had the space to dedicatedly focus on COVID during the pandemic, India also had to strive to keep in check other diseases like dengue, malaria, encephalitis etc. The diversity of issues may not have just impacted our case load and mortalities, but would’ve made it a tedious task to create ever-compassing health-response strategies. This becomes a harsh wake-up call to swiftly and efficiently deal with existing public-health priorities.
There are other malaria specific priorities as well for which India needs to remain focused. High-quality and widely encompassing case-data collection, timely and commensurate provision of life-saving supplies – such as long lasting Insecticidal bed-nets, anti-malarial drugs – in endemic regions. Working on these aspects will churn out the best outcomes for us.
As pointed out earlier, our efforts in the next ten years will be crucial in determining if the coming generations of Indians will have to brace the deadly impact of malaria and mosquito-borne diseases. The impact would wary from the astronomical economic costs – estimated yearly sum of INR 11,000 crores – to costing lives and disrupting thousands of households every-year.
It’s now more than ever in our hands, to create a future where no Indian falls sick or loses their life to malaria, thereby requiring dedicated efforts for 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 precision, personalized health approaches. He has worked closely with MNM India in on their Campaign Bite Ko Mat Lo Lite.
(DISCLAIMER: The views expressed are solely of the author and ETHealthworld.com does not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person/organisation directly or indirectly.)