Context: Challenges of Malaria Vaccination as elimination becomes achievable

Source: The Hindu

Georgia’s recent designation by the WHO as the 45^th nation to eradicate malaria marks an important turning point. Malaria continues to kill more than 600,000 people every year and cause over 240 million cases despite decades of international efforts.

Miasma, or swampy air, was thought to be the source of malaria. This false belief lasted until 1880, when military physician Alphonse Laveran discovered the Plasmodium parasite, demonstrating that malaria was brought on by a living thing.

Later, Giovanni Grassi verified that the parasite was only borne by female Anopheles mosquitoes. The last major discovery was made in 1897 when Ronald Ross in India showed that Plasmodium finished its life cycle in mosquitoes, demonstrating that these insects were the carriers of malaria.

The parasites initially enter the liver, where they infiltrate liver cells and proliferate without the immune system noticing. Following this stage, they re-enter the bloodstream, where they infect red blood cells and produce the fever and chills that are typical of malaria.

Plasmodium is a eukaryotic parasitic protozoan organism. Human-infecting Plasmodium species P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi each have distinct traits that make developing a vaccine more difficult.

Antigenic variation is the malaria parasite’s greatest power; it often modifies its surface proteins, making it challenging for immune cells to identify and react. For 30 million years, Plasmodium has been honing this tactic, changing and adapting to ensure its survival.

After 60 years of study, the RTS, S Malaria vaccine was the first to be approved by the WHO for widespread use in endemic areas. Its effectiveness is modest; after four doses over four years in children, it reduces malaria cases by about 36%.

Research on malaria vaccines has long been underfunded. Funding for research and healthcare facilities has been scarce because malaria mostly affects low-income nations in Africa and some areas of South Asia. The immediate need for developing a vaccine has diminished due to the availability of therapies for malaria.

Model Question:

Malaria remains a significant public health challenge in India. Discuss the causes of its spread, the precautions that can be taken, and the government initiatives aimed at malaria eradication. (250 words)

 

 

Model Answer:

Malaria is a life-threatening vector-borne disease caused by the Plasmodium parasite and transmitted through the bites of infected female Anopheles mosquitoes. Despite progress, malaria remains a major public health concern in India, particularly in tribal and rural regions.

Causes of Malaria Spread:

1. Climatic Conditions: Warm and humid climates, with stagnant water, facilitate mosquito breeding.
2. Poor Sanitation: Open drains, waterlogging, and lack of proper waste disposal create mosquito breeding sites.
3. Lack of Awareness: Inadequate knowledge about preventive measures, especially in rural areas.
4. Drug Resistance: Increasing resistance of Plasmodium to anti-malarial drugs hampers treatment.
5. Deforestation & Urbanization: Human encroachment into forested areas exposes populations to new mosquito habitats.

Precautions Against Malaria:

1. Personal Protection: Use of insecticide-treated bed nets (ITNs), mosquito repellents, and wearing full-sleeve clothing.
2. Environmental Control: Elimination of stagnant water sources and improved drainage systems.
3. Early Diagnosis & Treatment: Rapid diagnostic tests (RDTs) and prompt access to artemisinin-based combination therapy (ACT).
4. Vaccination: The RTS, S/AS01 (Mosquirix) vaccine has been introduced in some African nations and may benefit India in the future.

Government Initiatives for Malaria Eradication:

1. National Framework for Malaria Elimination (NFME) 2016-2030: Targets malaria-free India by 2030 through phased eradication strategies.
2. National Vector Borne Disease Control Programme (NVBDCP): Integrated approach to control malaria, dengue, and other vector-borne diseases.
3. Malaria Elimination Research Alliance (MERA) India: Aims at developing research-based strategies to eliminate malaria.
4. Distribution of Long-Lasting Insecticidal Nets (LLINs): Supplied in high-burden areas to reduce malaria transmission.
5. Strengthening Healthcare Infrastructure: ASHAs, community health workers, and improved access to healthcare in endemic zones.

Malaria elimination in India requires a multi-pronged approach involving vector control, improved healthcare infrastructure, public awareness, and research-based interventions. Continued government commitment and community participation are crucial to achieving the goal of a malaria-free India by 2030.