Hero in the fight against malaria

Richard Tren | 10 Apr 2007
Business Day (South Africa)

Today in towns, villages and remote rural areas across southern Africa, young children are getting ready to attend school, mothers are preparing food and fathers are heading out to their jobs. That many of these young children and adults are not sick in hospitals or lying at home suffering the agonising fevers caused by malaria is due in large part to the work of one man: Dr Brian Sharp. Sharp headed SA's Medical Research Council's Malaria Research Lead Programme and spearheaded some of the most successful malaria control programmes in the region. His death on April 2 after a long battle with cancer leaves a significant gap in the malaria control community.

Malaria is a complex disease and although it is said to be both entirely preventable and curable, actually preventing and curing it is very difficult. To run a successful anti-malaria programme, one needs to have a good understanding of the malaria parasites, of the mosquitoes that transmit them and of the communities affected by the disease. Sharp was someone who grasped the complexities of malaria control and on the basis of good scientific evidence ran highly successful malaria control operations.

I first met Sharp during the negotiations of the Stockholm Convention on Persistent Organic Pollutants. With his thick white beard and strong smoker's voice, he was Hemingwayesque; but he was an absolute original and a man of great scientific and personal integrity.

The Stockholm Convention regulates the use of various chemicals, among them DDT, which was, and is, used in malaria control. The prospect that the convention, egged on by environmentalist groups, may completely ban DDT had the malaria community up in arms. DDT is sprayed in small quantities inside houses in indoor residual spraying (IRS) programmes, where it repels and kills malarial mosquitoes. There are only a few insecticides that can be used in this way and the prospect that insecticide resistance can develop means that limiting the choices available to malaria control programmes will hamper malaria prevention.

DDT, as Sharp knew well, is one of the best insecticides for malaria control and thanks to the solid scientific evidence that he and his colleagues presented from SA and from around the globe, DDT was not banned and was given an exemption for use in public health.

In the battle to defend DDT against attacks from "green" groups so eager to ban it entirely, many individuals and organisations became increasingly frustrated with the environmentalist movement as a whole. But Sharp was suspicious of attempts to use the malaria-DDT debate in a wider political context and preferred to stick to his task at hand; finding effective ways of protecting people from malaria and using that knowledge to save lives.

In October 1999, Sharp played a leading role in setting up the Regional Malaria Control Commission, which brought South African, Swazi and Mozambican malaria control programmes together. The joint malaria control programme is based on careful indoor residual spraying, the use of insecticide-treated nets and improved diagnosis and treatment of malaria cases. Thanks to Sharp's insistence on good operational research and rigorous monitoring of results, we know this comprehensive approach has brought malaria cases and deaths down precipitously.

In a 2004 interview, Sharp said: "As a result of this success, the project is being viewed as the model for scaling up malaria control activities in southern Africa. It has also provided an opportunity for determining the cost of treatment of malaria patients as well as vector (mosquito) control. And for the first time, the startup costs for introducing vector control into rural and peri-urban areas have been determined."

Sharp was right about his work serving as a model for other countries. He was responsible for developing similar, comprehensive malaria control programmes in Zambia, Equatorial Guinea and elsewhere. In part due to his these programmes, the US Agency for International Development started to give significant support to IRS programmes and is even purchasing DDT for those countries that want it. The World Health Organisation has also given its support for IRS and the use of DDT.

The malaria community has lost a great scientist and champion but Sharp leaves malaria control in southern Africa stronger and better able to fight the disease. The fact that children born today in some malarial areas in southern Africa have a better chance of surviving malaria stands as a fitting testament to this great man.

Tren is a director of the health advocacy group, Africa Fighting Malaria, based in Washington DC.

http://www.businessday.co.za/articles/topstories.aspx?ID=BD4A433244