[lysozyme]

It’s interesting how Egypt’s efforts to monitor and test for malaria contributed to this accomplishment. It underscores how eradicating many infectious diseases will require a deep understanding not only of the disease itself, but also the cycles of transmission and the complex ecology of different hosts.

Malaria’s complex lifecycle [1] seems like it would be easy to “break” with different interventions, but we’ve seen historically malaria has been difficult to eradicate. Why is this?

1. https://en.m.wikipedia.org/wiki/Plasmodium#/media/File%3ALif...

[foxyv]

I think the greatest challenge with eradicating Malaria is that it is most prevalent in impoverished regions of the world. The USA occasionally has incursions of Malaria which is quickly quashed by the CDC National Malaria Surveillance System. If you have enough funding, Malaria is preventable. However, if most people do not have access to medical care, they cannot be diagnosed or tracked.

Essentially, a lack of access to health care results in Malaria continuing to devastate regions of the world. If you ever want to save a life, donating to the MSF is a great way to do it.

https://www.cdc.gov/malaria/cdc-malaria/index.html

https://www.doctorswithoutborders.org/what-we-do/medical-iss...

[zahlman]

>If you have enough funding, Malaria is preventable.

It requires more than funding to solve the problem. Sorry that my source is a YouTube video, but https://www.youtube.com/watch?v=CGRtyxEpoGg explains a general problem (that of trying to solve problems that are more prevalent elsewhere in the world, from within your own cultural context) and gives malaria as an example. People in malaria-afflicted countries, given free insecticide-treated nets, will often try to use them for fishing - not caring about the effect the insecticide will have on the haul. It's not due to ignorance or a lack of understanding, but due to a value judgment: people who have lived with malaria for generations don't see it as being as big of a problem, while poor people (on a global scale - not like in the US where "the poor" can afford some really impressive things) are always concerned with food supply.

[foxyv]

So, once you understand the cultural context, you know to give the people both mosquito netting and fishing nets. This would be easier if you could afford outreach and food assistance. This just shows that food assistance is a key part of medical assistance.

> people who have lived with malaria for generations don't see it as being as big of a problem

I don't accept the idea that these people want to live with malaria because it is normal. People don't like being bitten by insects. They just like starving to death much less. Appropriate funding can honestly solve this problem.

[tga_d]

>So, once you understand the cultural context, you know to give the people both mosquito netting and fishing nets.

Another example of this problem was the distribution of high efficiency stoves as a form of carbon credits. People just used both their low efficiency stove and the higher efficiency stove to increase yield.[0] If you give someone who needs more nets a fishing net and a mosquito net, guess what they're going to do. This is a fundamental methodological issue, not a simple problem of "Okay, but now we understand."

>I don't accept the idea that these people want to live with malaria because it is normal.

Of course not, but people are also capable of making their own decisions about what is affecting their lives most immediately. We just saw a massive number of educated populations in the US refuse vaccination efforts during a global pandemic because of a risk tradeoff, despite that decision statistically making no sense for the overwhelming majority of them. You think someone impoverished and facing food scarcity is going to prioritize a government or NGO effort to solve a problem that is inherently a low statistical background noise to their life experience? Why would they?

[0] https://www.nature.com/articles/s41893-023-01259-6

[jorvi]

> If you give someone who needs more nets a fishing net and a mosquito net, guess what they're going to do.

So you give them a mosquito net and two fishing nets. Or five. Put a giant mosquito label on the mosquito net and a giant fish label on the fishing nets.

> This is a fundamental methodological issue, not a simple problem of "Okay, but now we understand."

Like.. way to overcomplicate something that is indeed solved with more money.

[foxyv]

If you are giving other forms of aid, you can incentivize the use of netting. However, netting is just the beginning of such an effort. For instance, you don't see people in Louisiana sleeping with mosquito nets. This is because there are eradication efforts using pesticides and sterilized males. More money means that you can engage in that as well as helping locals avoid bites.

[Fomite]

This. That malaria is not prevalent in the Southern U.S. (there's a reason the CDC is in Atlanta) is as much an economic choice as an epidemiological success story.

[te_chris]

I heard an urban legend that the original eradication was basically carpet bombing the south with DDT back before we knew better.

[dragonwriter]

"Carpet bombing" is perhaps a hyperbolic term, but widespread application of DDT in the southeastern US was, in fact, a central component of the effort.

https://stacks.cdc.gov/view/cdc/100616/cdc_100616_DS1.pdf

[CJefferson]

It's very possible getting rid of malaria made this was a worthwhile, even given our modern knowledge, given the treatment options available at the time.

Large-scale medical treatments are always a difficult area, because almost no treatment, or course of action, is risk-free, but malaria was awful when it was more widespread.

[anitil]

I believe now they use sterile mosquito larva to achieve the same now [0], though it's from a youtube video so I'm not sure how much to trust it.

[0] https://www.youtube.com/watch?v=Olj8arvfYj4

[foxyv]

It's such a neat method because it is so inexpensive too. You take a bunch of mosquitos, irradiate them with just the right dose at the right time and then release them en-masse.

https://www.cdc.gov/mosquitoes/mosquito-control/irradiated-m....

[tomjen3]

Its not really that we know better. We known more and we know there is more of a trade of than was assumed then.

But to know better would mean we would have done anything different back then. If the choice is a silent spring (hyperpole, but okay) or dead babies from malaria in the US, no politician is going to align with the "I support dead babies party" and nobody is going to listen to those who do.

[dennis_jeeves2]

Until they banned DDT ostensibly because it was a threat to 'wild life'. I'm sure it affected people very adversely (it's rumored that DDT was one of the major causes of polio). Right now there will be chemicals which are widely used which fall in the same league.

[Fomite]

Not really an urban legend.

[zx10rse]

If I may add two links for people interested in helping people in impoverished regions.

It seems that people on the ground living there also really need basic things like mosquito nets, clean drinking water, proper nutrition, medical equipment, facilities where they can be treated, medicaments, and so on.

Malaria in Africa - https://www.youtube.com/watch?v=jQHjB6Nepog What we actually need - https://www.youtube.com/watch?v=FpnJ76EHNxU

[JumpCrisscross]

> If you have enough funding, Malaria is preventable

Malaria is also dependent on a non-human vector. That means you can target it without requiring peoples' co-operation. Contrast that with e.g. polio where you have to convince people to get vaccinated.

[foxyv]

I agree, once you detect that malaria is present, you can interrupt the cycle by treating wetlands in the area to kill mosquitos. These efforts are crazy expensive, but then again, so are the health care costs related to treating the disease. In the USA they use a ton of different methods to accomplish this, with and without pesticides. But it's really expensive.

[ffsggdvh]

Malaria has multiple dependencies but they’re all resilient like well set up k8s. You can reduce its function by attacking multiple paths but, mathematically, to destroy it one of the decencies has to go to 0 or several have to be severely degraded. Polio was comparatively easy because it had a cheap vaccine you could take by mouth and you could isolate