Malaria is one of the oldest known diseases in the world - and one of the biggest killers throughout human history. It’s developed resistance to every drug designed to beat it. Believe it or not, the small nation of Paraguay has surprised scientists with its success in beating malaria. Scott Thuman finds out how.
What you are looking at is the front line of a war - an unending battle fought around the world, against a disease that kills nearly half a million people a year. Malaria is the best known and perhaps most stubborn mosquito borne disease on the planet and globally, almost 3 billion dollars a year is spent trying to eradicate it. But here, one of the poorest and smallest countries in South America stands alone. That's because Paraguay is malaria free.
Scott: Is that a remarkable feat?
Castellanos: A remarkable public health landmark in our history.
Dr. Luis Castellanos oversees anti-Malaria programs at the Pan American Health Organization based in Washington DC.
Castellanos: In South America, remember, Paraguay is very poor as compared to Brazil, Argentina. And they haven't yet done that. So it's a remarkable example for the other countries to say, how does this guy manage to do that before us?
Scott: It was that big of a deal?
Castellanos: Yes. Yes, it is.
So big, we went to Paraguay to find out, visiting the headquarters of Senepa, the organization that for the last half century has put mosquitoes in the cross hairs.
Scott: So you haven’t had a domestic case of malaria since 2011?
Aguayo: Not a single case since 2011, and that was confirmed after a visit of experts from the World Health Organization, who checked the reports and visited places where malaria had been bad. There were some regions in the country with many cases, the last case was in December, 2011.
For the last four years, Dr. Nicolas Aguayo has led an effort that began back in the 1950s, when one in every ten Paraguayans was sick with the disease.
So how exactly did they do it, how did they beat malaria? Key to their success they claim a system they call: uno, tres, siete.
Translated: A 1-3-7 strategy. Identifying potential cases within a day of someone showing symptoms, confirming an infection within three days, and within a week, treating the patient and spraying around the area where they live. It also involved flagging passengers on flights arriving from Malarial countries and looking for symptoms, an army of volunteers who helped report suspected cases, and a widespread sense of urgency. Do that consistently across the country for years on end, and you win.
Scott: A lot of people would call that a colossal breakthrough.
Aguayo: Yes, we had series of celebrations and commemorations at SENEPA. Now the “SENEPEROS” our volunteers, the people who work for SENEPA are considered national heroes because a country like Paraguay, with limited resources, nevertheless got rid of malaria. This shows with a good strategy you can achieve your goals.
Scott: Why isn’t everyone banging down your door trying to do exactly what you are doing?
Aguayo: There are many countries banging on our door for help. They want to borrow our experts to work in other countries. I don’t like that idea very much because we need them here!
Scott. And that's because they know you can't let up.
Scott: If people don't worry about it, if people don't pay attention to it as much as you believe they should. The end result is...
Castellanos: It's people getting back to getting infected with Malaria. Even in the US, the US gets 1,000, to 2,000 imported cases every year. Imagine if the US wouldn't do much to keep an eye in detecting and treating these people, you know in a good summer in this country you'll have a huge outbreak of Malaria because you the mosquito, you have people infected and the spread is easy.
And you don't have to imagine, just look at Venezuela. Once on the brink of eradication, as its economy collapsed, Malaria cases jumped 70 percent in 2017.
Puerto Rican born public health entomologist Manuel Lluberas has spent 30 years killing mosquitoes around the world. The company he works for makes spraying equipment used to contain mosquito populations. He says the world needs to wake up to the dangers of Malaria and other mosquito-borne diseases.
Lluberas: The world is sitting on a powder keg smoking a cigar and flicking the ashes on the floor. It is time, right now, that we are in between epidemics to tell the population, "Listen, we need your help." No country has the government or program that is big enough to handle a mosquito-borne disease outbreak. No country. Even the United States. Without the communities' engagement, we will have another outbreak of Zika, we will continue to have dengue, we will continue to have chikungunya, and lord knows what else is coming, okay?
Which can mean different methods in different settings. The World Health Organization says Africa has 200 million Malaria cases a year around 90 percent of the global total. In Rwanda, they're considering using drones to spray larvicide in areas where mosquitoes breed. And in Zambia, health officials in some areas have treated entire populations with anti-Malaria medication to stop the spread, even if they don't show symptoms. In Paraguay, what won the battle against Malaria, was a matter of simple communication.
Castellanos: Every time someone has fever, let us know. Let someone know, so we can check and see what's happening with this individual.
Scott:That sounds so simple, though.
Castellanos: Yeah. It is so hard to actually make it happen, is very difficult. And that's the second greatest achievement of Paraguayans: that no one with suspicious fever was left behind.
Argentina and El Salvador both hope to malaria free within the next year. And Paraguay has proven if the mindset is there among people and government, it's not that expensive. In the last 5 years, they've spent just 22 million dollars.