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Bart Knols

Managing Director, In2Care BV

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Join now: What is really needed to have a world without malaria? Live Conversation with Bart Knols

More than 800 million people currently live in parts of the world where they used to run the risk of contracting malaria. Its disappearance in more than 70 countries shows us one thing: it can be done...

The question then arises why we fail to repeat these successes in major parts of the tropics, notably sub-Saharan Africa. Although we have seen a decline in deaths starting in 2005, we're still looking at anywhere between 0.7 - 1.2 million deaths per year.

In this debate, we have the opportunity to discuss the 'why' of this problem, but also the 'how' and 'what' regarding possible solutions. I would encourage you to come forward with innovative and creative ideas that may provide new insight.

Thank you for participating.

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    Jun 12 2012: Bart -
    Can you tell us a little more about why it's been so difficult to eradicate, and what the unintended consequences are?
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      Jun 12 2012: Eradication has been complicated by a number of factors, notably:
      - resistance of mosquitoes to insecticides
      - resistance of malaria parasites to drugs
      - lack of funding
      - insufficient support for setting up appropriate health infrastructure in developing countries
      - not enough well-trained public health specialists in many endemic countries

      A long list...showing how difficult it can be to eliminate a disease nobody needs to die of...
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      Jun 12 2012: As for unintended consequences...failure to eradicate means that evolution catches up with us. Prolonged efforts to control rather than eliminate means that you give the players in the system (notably the mosquito vector and the parasite) all the time to evolve, mutate, and become resistant.

      The result is that we have to go back to the bench once more to find new drugs and/or insecticides...
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        Jun 12 2012: (I am from the US, NYC, btw.)

        Such a difficult situation. Admittedly, I know little about this problem but want to understand it better. It's my hope others more educated than I will join the conversation - since I am only able to ask the most elementary questions. :)

        What companies are most committed to finding answers, Bart?
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          Jun 12 2012: No problem - even basic questions are good. Malaria control (note the word control as there are very few companies engaged in this commercially) is mostly funded through large NGOs (think of UNICEF, World Bank, Global Fund for HIV/AIDS, TB and malaria, and so on.

          But you raise an interesting point, as I believe there is a lot of scope to 'commercialise' malaria control (if not elimination).
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          Jun 12 2012: The US President's Malaria Initiative (PMI) is run through USAID, and they outsource activities (notably house spraying with insecticides) to a commercial firm. They have done so in at least 15 African countries to date.
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          Jun 12 2012: In terms of finding new drugs and insecticides, commercial entities are engaged (pharmaceutical companies as well as pest control companies) and there are public private partnerships to drive this endeavour (e.g. the Medicines for Malaria Venture (MMV), or the IVCC (Innovative Vector Control Consortium).
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        Jun 12 2012: This stuns me. International companies dedicated to developing eradication methods for every weed and insect under the sun are not directing a significant effort into eradicating malaria?

        I also live in Idaho - on a ranch - when not in NYC, and the money we (farmers and ranchers)receive simply to participate in weed eradication is embarrassing.
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          Jun 12 2012: The amount of money spent on pet drugs in the US far exceeds the research and control budget for malaria...
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          Jun 12 2012: As a company developing insecticides, you should know that it takes a decade on average and 1 b$ to bring a new insecticide to the market. Obviously there is much more business in agriculture than in public health, so the public health insecticides we use today have mostly come from the agricultural field...
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        Jun 12 2012: What are the health risks to house spraying? How is this handled in underdeveloped countries?

        When training, I like to tell the story about the cats in Borneo...through the song by Alan Atkisson :)
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          Jun 12 2012: Yes - the cat story from Borneo. DDT spraying and its pros and cons are still being debated in sicentific circles. Fact is that it is used on a large scale because it is cheap and persistent. But widespread resistance means that we will sooner or later stop using it anyway...
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      Jun 12 2012: Another major reason why it is hard to eradicate malaria is that in many countries it is virtually impossible to set up a campaign due to civil war or civil unrest, making it hard for programmes to be implemented...
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        Jun 12 2012: Yes, this is a real problem. Have there been any specific approaches that have been effective in the face of this unrest?
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          Jun 12 2012: If anything, then insecticide-treated bednets may find there way into communities, even when exposed to such stress. In DR Congo bednets have reached far-out corners of the country now. However, even though these will save lives, this is not about elimination which requires a lot more...

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