Kevin Baird J
Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No.69, Jakarta, 10430, Indonesia.
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
BMC Public Health. 2017 Jun 21;17(1):590. doi: 10.1186/s12889-017-4454-x.
Malaria remains a serious clinical and public health problem, the object of an ongoing technological and humanitarian struggle to abate the very substantial harm done. The manner by which humanity approached malaria control changed abruptly and profoundly after 1945 with the advent of the insecticide DDT. Malariologists in the first half of the twentieth century conceived precise modifications to natural or man-made environments aimed at making those less hospitable to specific anopheline mosquito vector species. This practical malariology achieved very significant reductions in burdens of morbidity and mortality, but the revolutionary insecticide eliminated the need for its specialized knowledge and diverse practices. By 1970 mosquito resistance to DDT and perceived environmental concerns precipitated the collapse of what had been a vigorous global campaign to eradicate malaria. Humanity did not then revitalize practical malariology but turned to another commodity as the foundation of control strategy, the war-spurred suite of synthetic antimalarial drugs developed in the 1940s and 1950s. When those drugs became lost to parasite resistance in the latter twentieth century, malaria resurged globally. Since 2005, tens of billions of dollars mobilized new commodities to control malaria: point-of-care diagnostics, effective artemisinin-based treatments, and longer-lasting insecticide treated bed nets. The know-how of practical malariology is not part of that ongoing commodities-based strategy. This article examines contemporary malaria control in the broad strokes of a strategy mitigating the consequences of infection contrasted to that of the abandoned practical malariology strategy of prevention. The inherent risks and limitations of over-reliance upon commodities in striving to control malaria may prompt consideration of a strategic posture inclusive of the proven methods of practical malariology.
疟疾仍然是一个严重的临床和公共卫生问题，是一场正在进行的技术和人道主义斗争的目标，旨在减轻其所造成的巨大危害。1945年杀虫剂滴滴涕（DDT）问世后，人类控制疟疾的方式发生了突然而深刻的变化。20世纪上半叶的疟疾学家设想对自然或人造环境进行精确改造，以使这些环境对特定的按蚊病媒物种不那么适宜生存。这种实用的疟疾学在降低发病率和死亡率负担方面取得了非常显著的成效，但这种革命性的杀虫剂使人们不再需要其专业知识和多样做法。到1970年，蚊子对滴滴涕产生抗药性以及人们对环境问题的担忧，促使一场曾经轰轰烈烈的全球根除疟疾运动走向崩溃。那时人类并没有重振实用疟疾学，而是转向另一种商品作为控制策略的基础，即20世纪40年代和50年代因战争刺激而研发的合成抗疟药物。当这些药物在20世纪后期因寄生虫产生抗药性而失效时，疟疾在全球范围内卷土重来。自2005年以来，数百亿美元用于筹集新的商品来控制疟疾：即时诊断检测、有效的以青蒿素为基础的治疗方法以及长效驱虫蚊帐。实用疟疾学的专门知识并不是当前这种基于商品的策略的一部分。本文从减轻感染后果的策略的大致情况出发，对比已被摒弃的预防实用疟疾学策略，审视当代疟疾控制情况。在努力控制疟疾过程中过度依赖商品的内在风险和局限性，可能促使人们考虑一种包括实用疟疾学已被验证的方法的战略态势。
