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?
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.
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.
"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.
> 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.
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
Incredible news! This should be replicated in tropics everywhere. In Singapore, the government is using Wolbachia mosquitoes to control the spread of vector mosquitoes, which looks like another effective solution.
I don’t, but there are quite a few techniques aside from nasty insecticides:
Fish. Many species of fish think that mosquito larvae are delicious and will eat them. Some of these species will also thrive even in small bodies of water with little assistance.
Sterile insects. Male mosquitos don’t bite, and females only mate once, so releasing large numbers of sterile males will reduce the population.
Wolbachia. There are bacteria that live in mosquitoes, are quite effective at infecting the next generation, will not infect humans, and prevent malaria from living in the mosquito.
Bti. There’s a species of bacteria that produces a bunch of toxins that are very specific to mosquito larvae. I have no idea why it evolved to do this, but you can buy “mosquito dunks” and commercial preparations that will effectively kill mosquito larvae in water. They’re apparently entirely nontoxic to basically anything else. I expect that they’re too expensive for country-scale control, but they’re great for a backyard puddle.
You can kill mosquito pupae in water by spraying with an oil that makes a surface film for a few days. The pupae suffocate.
It's 40 pages long. To summarize, the three pillars are universal healthcare, identifying the areas where malaria is more/less prevalent/even eradicated, and surveilling eradicated/low transmission areas for new infection.
Insecticides are a part of the "universal healthcare" aspect because vector control is a part of actually preventing malaria. But you can kill mosquitoes with things other than insecticides and mosquitoes in different regions are sometimes immune, which is why it's important to identify specific regions to target for eradication as there's no "one-size fits all" strategy. The paper goes into more detail on page 18 on the various methods of using different insecticides or parasite killing methods. All the methods have to be utilized in concert.
Once a region has eradicated malaria, surveillance is what prevents it from coming back. But it's also necessary as the number of infections go down to spend more resources on trying to find the few that are left.
Interestingly, discrimination plays a role because the last people getting malaria are generally those of very low status that don't get healthcare. If you don't expand healthcare to every single person in a society, malaria will come back.
I'm probably oversimplifying the paper a lot as a non-expert, but it seems the best way to eradicate malaria isn't a magic technological bullet but effective administration and project management using the treatment methods we already have.
I can't actually find any articles that actually describe it other than "vector control" and eliminating breeding sites, along with working with neighboring countries. I know some groups are using sterile male mosquitos to prevent breeding, as females can only mate once.
Pyrethroids are most often in bed nets, insecticide impregnated clothing, etc. How and what to apply these chemicals to is the subject of a lot of ongoing research.
Beyond this, there's just things like finding and eliminating mosquito breeding sites.
Egypt has been low-risk for malaria for some time. This declaration is from the WHO:
WHO declares a nation as a ‘malaria-free’ upon receiving valid proof that the Anopheles mosquito-borne native malaria transmission chain has been broken for at least the previous three years on a national level. A country must also demonstrate the capacity to prevent the re-establishment of transmission.
In June 2024, the WHO confirmed that there was no local transmission of malaria in Egypt, with all identified cases being imported from endemic countries. Egypt’s robust surveillance system was instrumental in early case detection, facilitated by collaboration with relevant stakeholders.
Neighbouring countries to the south have a high risk for malaria, but Egypt has had significant efforts to eliminate the disease since the '40s.
Israel Jacob Klinger quite famously rid Palestine (mandate) of malaria.
In the Galilee and around Lake Kinnereth (Sea of Galilee), malaria had decimated the Jewish settlements, with the incidence rate at 95%+ of the workers in 1919.
On the north shore of the Mediterranean sea Italy got malaria free by removing many swamps and flooded lowlands, quinine and eventually by using DDT. It was a very long effort, more that one century long. Details at https://pmc.ncbi.nlm.nih.gov/articles/PMC3340992/
How dare they? Mosquitoes are a vital part of the ecosystems. And they should restore the swamps too. Now, that DDT perversion, for that alone they deserve a second flood.
Sarcasm aside, I love swamps and I hate mosquitoes, other bugs and crocodiles because they don't let me enjoy the swamp. I also don't like cities nor agriculture for the same reason. But I like people and people being happy.
Humanism and environmentalism are at odds more often than they are not.
I understand the sentiment behind your question (lashing back in hurt), but not your reasoning. What is it? Do you believe that people can live prosperous lives in harmony with nature, and thus what you perceive as cynicism offends you? Or, do you agree with me but you think that it's something better silenced in polite company? Or something else entirely? Do you like the mosquitoes and the crocodiles, or do you believe that it's unfair people have to live near them? The mosquito is the Great Killer, the animal that kills most people, even above and beyond other people. I like swamps though, they are beautiful. And I like the happy careless shoppers and their giggles in huge malls in huge metropolis, but I know the terrible cost it has to our nature. And I resent the contradiction dearly.
In any case, I can't elaborate on the things I say without understanding what exactly you take issue with.
> Humanism and environmentalism are at odds more often than they are not.
It gets less surprising when people realize that nature is red in tooth and claw, an uncaring shithole we're evolutionary conditioned to find pretty - at least the parts we see. Beautiful meadows and happy animals and careless people are just propaganda - in reality, the people are sick and busy with back-breaking work, and animals are all on the verge of starvation, and that doesn't even touch the microbiological scale. Ecological balance is achieved by means that, when applied to balance between humans, we'd call unending war of attrition.
Humanism and environmentalism are at odds because nature doesn't care about humans anymore than it cares about anything else. Brutal death and constant suffering are hallmarks of nature.
Good news items like this in the medical, social, environmental areas is available via a weekly free email from https://fixthenews.com/. (A premium version is also available.)
_Some_ of the items from last week (each has a paragraph of details):
* India is finally becoming a clean energy superpower
* United States designates a massive new marine sanctuary
* India officially eliminates trachoma as a public health problem
* Global electric vehicle sales soared in September
* Global teen pregnancy rates have dropped by one-third since 2000
Do you know whether that capacity is regularly reinvestigated?
Because if not you could get the certification, wait a couple of years, and then dismantle all infrastructure while still reaping the, if ephemeral, benefits.
Also not all species of mosquito transmit malaria, or have a much smaller chance of transmitting it. I remember watching a BBC programme where someone was researching whether malaria mosquito had returned to Britain (they hadn't).
So even if you would somehow introduce a few busloads of Malaria-stricken people, that's not likely to re-introduce Malaria.
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...
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...
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.
I heard an urban legend that the original eradication was basically carpet bombing the south with DDT back before we knew better.
"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
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
> 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.
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
Dramatic reenactment: https://www.youtube.com/watch?v=ljmifo4Klss
(smallpox instead of malaria; close enough)
Jai's blogpost has been one of my favourites for a while now. I didn't know there was an animation like this, thank you.
You’re welcome.
it's unfortunate that the last person to have smallpox (and survived) died at 58 of malaria
Such is the indiscriminate nature of mad gods.
Incredible news! This should be replicated in tropics everywhere. In Singapore, the government is using Wolbachia mosquitoes to control the spread of vector mosquitoes, which looks like another effective solution.
I presume they used insecticides. Anyone know what they used?
I don’t, but there are quite a few techniques aside from nasty insecticides:
Fish. Many species of fish think that mosquito larvae are delicious and will eat them. Some of these species will also thrive even in small bodies of water with little assistance.
Sterile insects. Male mosquitos don’t bite, and females only mate once, so releasing large numbers of sterile males will reduce the population.
Wolbachia. There are bacteria that live in mosquitoes, are quite effective at infecting the next generation, will not infect humans, and prevent malaria from living in the mosquito.
Bti. There’s a species of bacteria that produces a bunch of toxins that are very specific to mosquito larvae. I have no idea why it evolved to do this, but you can buy “mosquito dunks” and commercial preparations that will effectively kill mosquito larvae in water. They’re apparently entirely nontoxic to basically anything else. I expect that they’re too expensive for country-scale control, but they’re great for a backyard puddle.
You can kill mosquito pupae in water by spraying with an oil that makes a surface film for a few days. The pupae suffocate.
Great overview. Add to the list the nuclear option of a “gene drive”, a genetic modification that spreads exponentially through a mosquito population.
I imagine it's more complicated than "spray insecticides everywhere" otherwise it'd be easy. Here's the WHO white paper on it:
https://www.who.int/publications/i/item/9789240031357
It's 40 pages long. To summarize, the three pillars are universal healthcare, identifying the areas where malaria is more/less prevalent/even eradicated, and surveilling eradicated/low transmission areas for new infection.
Insecticides are a part of the "universal healthcare" aspect because vector control is a part of actually preventing malaria. But you can kill mosquitoes with things other than insecticides and mosquitoes in different regions are sometimes immune, which is why it's important to identify specific regions to target for eradication as there's no "one-size fits all" strategy. The paper goes into more detail on page 18 on the various methods of using different insecticides or parasite killing methods. All the methods have to be utilized in concert.
Once a region has eradicated malaria, surveillance is what prevents it from coming back. But it's also necessary as the number of infections go down to spend more resources on trying to find the few that are left.
Interestingly, discrimination plays a role because the last people getting malaria are generally those of very low status that don't get healthcare. If you don't expand healthcare to every single person in a society, malaria will come back.
I'm probably oversimplifying the paper a lot as a non-expert, but it seems the best way to eradicate malaria isn't a magic technological bullet but effective administration and project management using the treatment methods we already have.
I can't actually find any articles that actually describe it other than "vector control" and eliminating breeding sites, along with working with neighboring countries. I know some groups are using sterile male mosquitos to prevent breeding, as females can only mate once.
There's a variety of insecticide classes:
pyrethroids (e.g., permethrin),organochlorines (e.g., DDT); carbamates (e.g., bendiocarb); and organophosphates (e.g., malathion)
Pyrethroids are most often in bed nets, insecticide impregnated clothing, etc. How and what to apply these chemicals to is the subject of a lot of ongoing research.
Beyond this, there's just things like finding and eliminating mosquito breeding sites.
From what I know about malaria prevention, insecticides are mostly used in insecticide-treated bed nets.
Do other states in the area have malaria? How and when were they resolved?
Egypt has been low-risk for malaria for some time. This declaration is from the WHO:
WHO declares a nation as a ‘malaria-free’ upon receiving valid proof that the Anopheles mosquito-borne native malaria transmission chain has been broken for at least the previous three years on a national level. A country must also demonstrate the capacity to prevent the re-establishment of transmission.
In June 2024, the WHO confirmed that there was no local transmission of malaria in Egypt, with all identified cases being imported from endemic countries. Egypt’s robust surveillance system was instrumental in early case detection, facilitated by collaboration with relevant stakeholders.
Neighbouring countries to the south have a high risk for malaria, but Egypt has had significant efforts to eliminate the disease since the '40s.
> Egypt’s robust surveillance system was instrumental in early case detection
This sounds like HN material on its own.
Ecological surveillance...
Israel Jacob Klinger quite famously rid Palestine (mandate) of malaria.
https://en.wikipedia.org/wiki/Malaria_in_Mandatory_PalestineOn the north shore of the Mediterranean sea Italy got malaria free by removing many swamps and flooded lowlands, quinine and eventually by using DDT. It was a very long effort, more that one century long. Details at https://pmc.ncbi.nlm.nih.gov/articles/PMC3340992/
How dare they? Mosquitoes are a vital part of the ecosystems. And they should restore the swamps too. Now, that DDT perversion, for that alone they deserve a second flood.
Sarcasm aside, I love swamps and I hate mosquitoes, other bugs and crocodiles because they don't let me enjoy the swamp. I also don't like cities nor agriculture for the same reason. But I like people and people being happy.
Humanism and environmentalism are at odds more often than they are not.
Did anyone besides you say these things?
I understand the sentiment behind your question (lashing back in hurt), but not your reasoning. What is it? Do you believe that people can live prosperous lives in harmony with nature, and thus what you perceive as cynicism offends you? Or, do you agree with me but you think that it's something better silenced in polite company? Or something else entirely? Do you like the mosquitoes and the crocodiles, or do you believe that it's unfair people have to live near them? The mosquito is the Great Killer, the animal that kills most people, even above and beyond other people. I like swamps though, they are beautiful. And I like the happy careless shoppers and their giggles in huge malls in huge metropolis, but I know the terrible cost it has to our nature. And I resent the contradiction dearly.
In any case, I can't elaborate on the things I say without understanding what exactly you take issue with.
Do you know of anyone who says these things? Any evidence?
Your guesses at my emotional state aren't relevant.
> Humanism and environmentalism are at odds more often than they are not.
It gets less surprising when people realize that nature is red in tooth and claw, an uncaring shithole we're evolutionary conditioned to find pretty - at least the parts we see. Beautiful meadows and happy animals and careless people are just propaganda - in reality, the people are sick and busy with back-breaking work, and animals are all on the verge of starvation, and that doesn't even touch the microbiological scale. Ecological balance is achieved by means that, when applied to balance between humans, we'd call unending war of attrition.
Humanism and environmentalism are at odds because nature doesn't care about humans anymore than it cares about anything else. Brutal death and constant suffering are hallmarks of nature.
The US and Canada used to have a big malaria problem. Over a thousand people died constructing the Rideau Canal, and majority were from malaria.[0]
[0]https://en.wikipedia.org/wiki/Rideau_Canal#Construction_deat...
Fantastic news! Now lets continue this trend!
Good news items like this in the medical, social, environmental areas is available via a weekly free email from https://fixthenews.com/. (A premium version is also available.)
_Some_ of the items from last week (each has a paragraph of details):
* India is finally becoming a clean energy superpower
* United States designates a massive new marine sanctuary
* India officially eliminates trachoma as a public health problem
* Global electric vehicle sales soared in September
* Global teen pregnancy rates have dropped by one-third since 2000
Reasons To Be Cheerful offers a similar periodical: https://reasonstobecheerful.world/
(I have no idea why the web site calls it a "self help magazine"; it's just a collection of interesting positive news.)
Another one that was pointed out on HN last week: https://www.newsminimalist.com/
Not strictly "good news" but tries to be significant news without clickbait.
Thanks for the callout! (I'm the founder)
I already have the "positivity" scores for each article, so I'll add a separate "positive and significant news" page in the coming weeks.
Cool indeed. Traditional media is so desperate with click bait and riddled with ads. And social media of course.
This is great. Thanks for sharing!
Formerly futurecrunch. It’s my only paid newsletter. I love it.
Fuck yeah! On to the rest of the continent. Let's eradicate our oldest, deadliest adversary.
Doesn't it take just one tourist with malaria to bring it back?
FTA:
> Certification is granted when a country proves that the transmission chain is interrupted for at least the previous three consecutive years.
And
> To get the WHO certification, a country must demonstrate the capacity to prevent the re-establishment of transmission.
Do you know whether that capacity is regularly reinvestigated? Because if not you could get the certification, wait a couple of years, and then dismantle all infrastructure while still reaping the, if ephemeral, benefits.
As if the main benefit of being certified malaria free is the certification instead of actually being malaria free?
It's not quite like other infectious diseases (e.g. COVID), in that transmission is dependent on mosquitos as a vector.
If they've sufficiently damaged the vector one tourist alone cannot bring it back - the disease vector would also need to come back.
I don’t think so. I don’t think malaria is contagious.
Malaria isn't contagious
That's technically correct, but an infectious person can infect another person over a vector (i.e. mosquitos).
So you get rid of mosquitos OR rid of malaria.
Also not all species of mosquito transmit malaria, or have a much smaller chance of transmitting it. I remember watching a BBC programme where someone was researching whether malaria mosquito had returned to Britain (they hadn't).
So even if you would somehow introduce a few busloads of Malaria-stricken people, that's not likely to re-introduce Malaria.
That’s true; I didn’t realize it could go human -> mosquito -> human but according to Google you’re right.
Isn’t that the only way? I’m pretty sure the human hosts are a vital step in the Plasmodium lifecycle.
I find it hard to believe this will be durable, but best of luck