Creating malaria … and drug shortages

Malaria control rests heavily on support from or activities of other development sectors besides health.  Power supply and agriculture provide two current examples.

Yewhalaw and colleagues explore the ramifications of dam construction for electricity supply in Ethiopia and see how human activity can increase mosquito breeding and the spread of malaria. Their work concludes –

This study indicates that children living in close proximity to a man-made reservoir in Ethiopia are at higher risk of malaria compared to those living farther away. It is recommended that sound prevention and control programme be designed and implemented around the reservoir to reduce the prevalence of malaria. In this respect, in localities near large dams, health impact assessment through periodic survey of potential vectors and periodic medical screening is warranted. Moreover, strategies to mitigate predicted negative health outcomes should be integral parts in the preparation, construction and operational phases of future water resource development and management projects.

At the same time Médecins Sans Frontières (MSF) has issued a warning about how agricultural market dynamics may have negative bearing on artemisinin supplies in the very near future. MSF explain that –

Current best estimates, based on available stocks and current planting efforts, demonstrate that there will be a shortfall of about 40 tons of artesiminin starting material in 2010 to produce the expected 240 million treatments needed. Taking into account that it takes about 14 months from the planting of Artemisia annua to the availability of the finished product, the availability in 2010 depends on what is being planted by farmers in the next weeks and months. We believe that market forces will not resolve the short-term artemisinin supply problem. Because it is extracted from plants, the supply of artemisinin is impacted by the highly volatile market of food crops which affect farmers’ decisions of whether or not to plant Artemisia annua.

These are two examples of how human actions exacerbate the scourge of malaria.  Such human influences are common throughout the history of malaria control. Intersectoral planning and surveillance is needed since malaria is not just a health affair.

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