Malaria continues to ravage the life of more than 300,000 Indians every year, affecting the wellbeing and nutrition of the victims and plundering the human capital and financial security of their families. Despite spending crores of rupees in the last 70 years, the brooding impact of Malaria on the health and development of the nation has remained inexorable since it lost its initial spell of success in the 1960s. The second opportunity to end Malaria has only arrived after six decades as the country has now reduced the annual incidence by more than 80% compared to that at the beginning of this millennium. The decline has been more pronounced since 2015 when the honorable Prime Minister made his bold pledge of making India Malaria-free by 2030. As the country enters the endgame, the task to reach zero becomes more challenging than ever, requiring an uncomplacent strive to find and treat every single infection, apparent or hidden in a population of 1.3 billion.
Reliably finding every Malaria infection is daunting, to say the least, for two reasons. First, Plasmodium, the parasite causing the disease, is notorious for persisting silently inside the human body, and second, the parasite can escape detection through conventional tests at low concentrations. The cryptic parasite species may remain undetected for many years as well if not treated radically in the beginning. Thus, the apparent burden of Malaria is only like the tip of an iceberg. If this sounds less intimidating, the more significant threat is underpinned by the profound health impact of the inapparent infections. In the absence of fever as the victim remains unsuspicious of Malaria, Plasmodium continues to destroy the red cells. It causes anemia in adults and growth failure and malnutrition in children. Recent studies have shown the co-existence of Malaria and malnutrition problems in large parts of India and that malnutrition and under-5 deaths could be primarily averted through detecting and reducing the submerged portion of the iceberg.
On top of these challenges, the overwhelming impact of Covid-19 has further reduced the treatment-seeking, and therefore the surveillance required to detect Malaria. The pandemic has an impact on Malaria surveillance and treatment on two accounts: first, the consumption of resources and time of the health workforce to deliver the services for Covid-19; and second, the disruption of routine Malaria surveillance and response system, especially in the hard-to-reach areas.
Recent advancements in technologies provide an opportunity to reach the bottom of the iceberg. The first to be named is the Rapid Diagnostic Test (RDT) for Malaria. India’s community health workers, the ASHAs, use the RDTs at the point of care, where the reach or access to microscopy is limited. Mass screening using RDTs has emerged as a promising strategy against asymptomatic Malaria in remote and high burden areas. However, the conventional RDTs can only detect the Malaria parasite when its concentration in the blood is usually higher than 100 parasites/ ul. Besides, mass screening also comes with the caveat of becoming cost-ineffective in low burden areas. Molecular techniques, like Polymerase Chain Reaction (PCR), can be a solution for detection level, as they detect parasites at a concentration as low as 2-5 per ul. But, making it accessible at the grassroots is a challenge. Ultrasensitive RDT, which has similar detection levels to PCR, yet scalable at the grassroots due to its ease of use, are also under development. The use of these technologies, however, can only be cost-effective when they are appropriately targeted.
The Indian Government has made several bold decisions in the recent past, setting the right policies to bring the required technologies and laying out tailored strategies to strengthen routine Malaria surveillance. While the Covid-19 pandemic threatens to nullify the dividend accrued through these decisions, the brighter side lies in the groundbreaking progress in health technologies, which can be translated to solve persistent problems like Malaria. Now, it is time to introduce pioneering innovations leveraging the pipeline that has become resilient to systemic challenges and red knots. Besides, during the pandemic, the availability and will of coupling these technologies to advanced data science use cases have revolutionized precisely targeting actions where they are needed the most. At the outset of fighting the toughest battle against the rolling second wave of Covid-19, India now needs to re-prioritise its focus on unrelenting enemies like Malaria and build on its strength of advanced health technologies and data science to end Malaria once and for all.
(DISCLAIMER: Dr Kaushik is a Global Health specialist, business analyst, and data engineer with leadership experience in programmes, policy, and partnerships. Dr Ranjit is Scientist G (Director Grade) at the Molecular Epidemiology Laboratory at the Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar. Dr Joshi is a renowned public Health expert of the country, who has directed many disease control programmes in the Ministry of Health and Family Welfare, Government of India. The views expressed are solely of the authors 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).