Vector-borne diseases like malaria, dengue, chikungunya, Japanese encephalitis and zika account for more than 17% of all infectious diseases, causing more than 700,000 deaths worldwide every year. Out of these, Malaria is responsible for more than 400,000 deaths every year globally, most of them children under 5 years of age. Yet, it is one of the few diseases that you can actually eliminate – because it has one transmitter, which is known to us – the anopheles mosquito.
When we talk about vector-borne diseases in India, the first three that come to mind are malaria, dengue and kala-azar. With malaria, the highest burden lies with India, after Africa – but through significant focus on public health, we have seen a 25% reduction in the number of cases over the last 3 years. However, this is not the same with dengue, which is much more common and is caused by the same mosquito responsible for the spread of zika (i.e. aedes). The third one on the list is kala-azar which is a neglected tropical disease caused by sandflies. Although it is not as well-known as the other two, it is quite prevalent in small pockets in India, especially Bihar.
Of course, it is not just these three but all major vector-borne diseases including chikungunya, filariasis and Japanese encephalitis that are prevalent in India. In addition to the mortality risk, these diseases impede economic development through direct medical costs and indirect costs such as loss of productivity and the impact on tourism.
The good news is that it is possible to control and perhaps even eliminate some of these diseases. If a dreaded disease like small pox could be eradicated, then there is definitely a clear opportunity for us to win this global fight against malaria. But the key issue is that if you don’t maintain very strong control, malaria resurges. In the 1960s, it was almost eliminated and then came it came back with a bang in the 70s. (From around 49,000 incidents in 1961, it rose to around 6.45 million in 1976.) After the resurgence, we were faced with new problems like resistance to insecticides. Also malaria, which at one time was classified as a rural disease, further diversified into various ecotypes like urban malaria, industrial malaria, migration malaria, etc.
India has made considerable progress with significant reduction in malaria over the last few years due to interventions for case management and vector control. Yet, there is a long road ahead for achieving complete victory. The Government of India has targeted to eliminate malaria from India by 2030 through the National Framework for Malaria Elimination. This is a critical milestone for the world to achieve the ‘ZERO-by-40’ accord that was signed last year by the International Vector Control Consortium (IVCC), the Bill and Melinda Gates Foundation and other signatories, including us at Bayer.
What can we do?
The government continues to combat mosquitoes, but given the complexity of the country, all these measures are difficult to execute effectively. Some things that could radically change the vector-borne diseases landscape in India include making surveillance and response more causal and real-time, use of integrated vector management techniques with innovative new products to counter insecticide resistance, and to drive further community awareness and participation.
Disease control or elimination is not easy, and requires collaboration among a broad group of stakeholders, including the government, non-governmental organizations, private sector companies and the general public. We expect that public-private partnerships will be very important in the context of India to eliminate malaria. National dialogues like the one conducted by ASSOCHAM and Bayer last year bring together relevant stakeholders to discuss critical topics and issues in vector-borne disease management, and accelerate time to market for innovative insecticides and treatment kits.
Public engagement is very important. In an urban context, the government undertakes larviciding or space sprays in public areas, but that is only part of the solution. In high-rise apartments, there could be unintended water collection pockets in areas inaccessible to municipal workers, resulting in continued mosquito breeding despite the best efforts of the government. We need additional engagement and activation of the public who can contribute with appropriate control measures.
From a rural perspective, many villagers and farmers struggle with a high mosquito burden with little recourse. Educating these farmers on simple protection measures to take and leveraging the network of large farmer-focused alliances can yield tremendous gains across the country. For example, we recently teamed up with Banaras Hindu University to train 40 village heads (some of whom had traveled from as far as 300 kilometers away) on malaria and other vector borne diseases. Their dedication to ensuring the well-being of people in their villages was simply astounding and at the end of the event, they all signed a commitment to do their part to control vector-borne diseases in their villages and eliminate malaria in India by 2030!
Finally, the private sector can play a large role by investing in research & development of innovative new tools for prevention and treatment. Further, directing use of Corporate Social Responsibility to focus on protecting rural communities from vector-borne diseases can also be an important catalyst to reaching our goal for elimination of malaria.
No doubt, this is an enormous task, yet it is definitely in the realm of possibility.
Sustainable Development Goals
At Bayer, we are committed to the principles of sustainable development. Together with HIV/AIDS, tuberculosis and other neglected tropical diseases, malaria control is included under Goal 3 Target 3.3 of the Sustainable Development Goals (SDGs), which aims to “end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases” by the year 2030. With respect to malaria, WHO interprets Target 3.3 as the attainment of the goals of the Global Technical Strategy.