Little big battle

The elimination of malaria, HIV/aids, and TB before 2030 That’s one of the sustainable development goals which 195 global leaders signed in 2015.. But it isn’t an easy process. Dif Report presents a number of special forces who are working hard towards that goal.

The 4 Malaria-terminators:

1. Anti-malaria drone

The malaria-mosquito is mostly present outdoors, and breeds in stagnant water. That’s why irrigated rice fields form the perfect breeding grounds. Those who treats these breeding grounds with a biological pesticide tackle the problem at its core, but manual spraying is labor and time-intensive. With the anti-malaria drone Bart Knols (see long read), and his coworkers want to tackle this problem. They raised 20.000 euro through crowdfunding and had a drone adapted to be able to spray the pesticides. Everything is set for a pilot in the rice fields in Ahero, West-Kenya, and there will even a CNN drone which will document it all. As soon as the Kenyan army will grant permission the first flight will commence.  With large scale deployment of these anti-malaria drones, the prevention of malaria can be given a huge boost.

2. Smartphone microscope

Through a small glass ball, which can be held in front of a smartphone camera, a microscope is formed, which, together with the digital zoom function and a smart algorithm, can detect malaria in no-time. PHD-students Tope Agbana and Hai Gong, from the Technical University in Delft developed this smart and cheap solution. Agbane grew up in Nigeria and has first-hand experience with the devastating consequences of malaria. Granted that the disease is diagnosed and treated in time, a patient can be cured within a week. However, if that doesn’t happen, then the malaria can turn into a life-threatening disease. Up until now a good diagnosis required a blood sample to be sent to a laboratory for testing, something which took valuable time. With the smartphone microscope, local doctors in development countries can detect the disease and start treatment promptly. A prototype has been developed and they’re working hard to start a trial in Nigeria.

3. Irresistible sweaty feet

‘Hmmm, sweaty feet, delicious!’ mosquitos love the human smell, that’s what researchers at the university if Wageningen have found. They managed to replicate the smell with which they’ve built a trap which draws mosquitos and then traps them through the use of a fan. The mosquitos can’t escape the trap and die eventually, and the trap operates without insecticides. It does however, require electricity. When scientists ran a test-case on the Kenyian island Rusinga in the Victoria lake, they used solar panels to generate electricity. Within three years the number of malaria-mosquitos was reduced by 70%, and the number of infections by 30%. The university is now looking for money and partners to implement the SolarMal-project on a larger scale.  A trap costs around 10 dollars, and the maintenance comes down to between 1 and 3 dollars per year.

4. Turbo-gene

In 7 to 11 generations, the 650 malaria mosquitos in laboratory cages had self-eradicated. ‘I ran from the lab and immediately called my supervisors over: you have to see this,’ Drew Hammond, molecular biologist at the Imperial College in London, tells Vox.com about the recent discovery which led to the eradication. The manipulated gen that they had implanted in 50% of the descendants returned in nearly 100% of further generations. The biologists had de facto managed to hijack heredity. With this so called ‘gene-drive’, turbo-gene, the way was paved to rapidly spread this infertility gene among the mosquito population, and thus to eradicate them. However, whether this can be recreated outside of a laboratory setting still remains a question.


Everyone against the mosquito

What seemed to be only a matter time between 2000 and 2015, is an alarming phenomenon since 2017. The number of malaria infections is increasing and the struggle against TB is failing due to increasing resistances against antibiotics. We need to turn the tide.

THREE BOYS IN SCHOOL UNIFORMS are lying on brightly colored rugs in a tent. There is a plastic bag, attached to several tubes, tied around their right foot. While the boys are having fun, there feet are providing important data in the fight against malaria.

Scientists discovered that malaria mosquitos love the smell of humans, and the sweaty feet of children who were already infected are the crème de la crème. The scents that the boys in the tent, together with 53 others, provided, was used to recreate a human odor which can be used to trap mosquitos (also see the segment ‘irresistible sweaty feet’).

In 2017 there were 2 million more malaria infections as compared to the previous year, while TB claimed 1.6 million victims among the HIV-infected population

It is one of the many innovative ways (see segments) to combat malaria. And it’s sorely needed, as 2017 saw 219 million people infected with malaria, 435.000 of which died.  over 90 percent of the infections were in Sub-Saharan Africa, and 85 percent of the victims under the age of five.

Between 2000 and 2015, there were quantifiable gains in the struggle against malaria and HIV/aids, thanks to the efforts of the Global Fund (to Fight Aids, Tuberculosis and Malaria), which was established in 2002. That fund annually raises about 4 billion dollars from governments and private investors. Thanks to those efforts the number of people that die annually from malaria has decreased by 62 percent, while the number of deaths caused by aids had decreased 40 percent since 2005.

Unfortunately that has now changed. In 2017 there were 2 million more malaria infections as compared to the previous year, and the number of deaths from HIV/aids, and TB, the deadliest of the three, was 1.6 million in 2017. The biggest problem is the ever increasing resistance to insecticides (malaria), and antibiotics (TB), but what is the solution?

There is always a need for a broad, holistic approach.  Look at the current Ebola-outbreak in Congo, despite a working vaccine we can’t get it under control

‘One solution for both malaria and HIV/aids is unlikely’, says Jaap van Dissel, director of the center for combatting infectious diseases of the RIVM. ‘There is always a need for a broad, holistic approach where there is room for social-cultural factors besides medical attention. Look at the current Ebola-outbreak in Congo, we have a working vaccine and practical knowledge from recent outbreaks, but we can’t get it under control.  This is largely related to the war that’s raging in that area. Because of the war, healthcare professionals can’t safely provide care, and the public health infrastructure has collapsed. That’s how social factors can play a role in how a conventional approach is failing. A broad, multiheaded approach needs to be a spearhead with all infectious diseases’

Another example is the multi-drug-resistant TB outbreaks in Russia and other former Soviet countries. These are, among other reasons, due to bad medical care in prisons, where patients have longer times to infect others.  insufficient oversight on medication, or the lack of finishing treatment, leads to a resistance of bacteria against antibiotics.

And the fight against HIV/aids also suffers under these social-cultural factors. ‘Countries such as Russia, but also China for instance, where the existence of homosexuality is denied, don’t invest in the safeguards against infection, with all the consequences that come with those decisions.’

Yet Van Dissel is still optimistic. He says we can eradicate the big three infectious diseases before 2030. ‘Humanity has always proven resourceful and able to find solutions under pressure. There are new antibiotics available against TB. And we’re making progress with the development of a vaccine against malaria, HIV/aids, and TB. There are investments being made in innovative solutions, such as those dealing with antibiotics resistance. The European Commission is looking for ways to subsidize industries and startups to entice them to invest in new antibiotics. These would then have to be used sparsely, to keep them efficient when having to deal with resistant strains of bacteria. We can’t produce these at a marketable volume, so we need to think of a new business model for that.

That the WHO is so adamantly sticking to rules from the DDT era is because of the lobby of powerful chemical corporations

Malaria expert Bart Knols (entomologist at Radboud University) is less hopeful: ‘In the last decennium there were three new insecticides developed. The Gates Foundation has invested over 200 million in those.  And they’ll hopefully hit the market in 2022, after which they can be implemented across Africa. But after large scale usage malaria mosquitos will redevelop resistances within a few years. That’s what we call the resistance treadmill: we’re constantly running after the facts. Yet there seems to be no change in the response: more new medicines and insecticides. In this case we appear to learn nothing from history.’

That it can be done differently is proven by the agricultural sector, according to Knols. Where at the start of the eighties 90 percent of plagues in greenhouses were combatted chemically. Now that’s turned around, 10 percent chemically, 90 percent biologically. Knols himself has spent the last 20 years on the use of biological means against malaria. He discovered a fungus which kills malaria mosquitos when they get into contact with it. At a field study in a Tanzanian village where they put up pieces of cloth impregnated with the fungus, the number of infected bites decreased with 75 percent. unfortunately Knols can’t seem to get funding to put the product on the market.

At the WHO in Geneva Knols also got no for an answer, because the fungus would only last 3 months in tropical conditions, while the WHO-guideline mandates that a products needs to preferably be efficient for at least six months. ‘That rule still stems from the DDT era. That the WHO is so adamantly sticking to these rules is because of the lobby of powerful chemical concerns. They’re not willing to listen to other arguments, such as that the chance of resistance against the fungus is nearly nonexistent.

Knols and his coworkers are now working on modifying the fungus in such a way that they’re able to survive for longer periods in tropical climates. ‘If we’re able to accomplish that, we’ll be right across from the chemical industry!’

The number of alpha-males in the fight against malaria is rather high, and there is a lot of competition between the various groups and organizations

Just like Van Dissel, Knols believes that when fighting infectious diseases you need a multi-pronged approach. We could learn from history in that case. Take that of Brazil for example. when in 1930 a French navy vessel brought malaria mosquitos with it from Senegal, theyspread over 54.000km within 8 years, causing a massive epidemic in 1938. Epidemiologist Fred Soper got the assignment from the Rockefeller Foundation to stop the spread of this African mosquito, lest the epidemic would spread across the whole continent.  Eighteen months later and the mosquito (Anopheles arabiensis) was eradicated.  How? Soper trained 4000 Brazilians to find and eliminate the breeding grounds of larvae.

‘Fourteen countries, all smaller than 54.000km, are still suffering from malaria to this day’ Knols proclaims. ‘And there is plenty of manpower in Africa. In a country such as Kenya, over 70 percent of the population is out of a job. You can easily build an army of exterminators and do the same as Soper. There is no reason why it wouldn’t work over here.’

Following Soper’s example, Knols wants to use a package of measures, ranging from eradicating larvae in bodies of water to distributing mosquito nets and better medication, to clean up a region, for instance in Western-Zambia. ‘When we’ve hit zero mosquitos, then we’re going to learn what to eliminate. We constantly remove one variable, and then we’ll see if it’s still effective. That would mean the exact opposite approach then how it’s done now, where we first want to prove everything scientifically, but that takes too long, with children dying daily from malaria.

At the start of November 2017, Knols presented his plan to the Gates Foundation. ‘They thought it was amazing, but after that I heard nothing from them anymore. Why is that? I’m not exactly sure, but the number of alpha-males in the fight against malaria is rather high. There is a lot of competition between the different groups working on the problem. At some moments I think: I’ll just go to Tanzania or Kenya with my coworkers and we’ll find a village to execute our plan. If we’re successful, then the attention will come on its own. But that would mean that I would have to settle over there, and cut ties with everything I have here. And that’s a major leap. Therefore I’m still waiting for a project to pop up for now.

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