Egypt declared malaria-free after 100-year effort | Hacker News Reader

Egypt declared malaria-free after 100-year effort

bbc.com

635 pointsthunderbong69 comments

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

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....

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.

Not really an urban legend.

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.

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.

> 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.

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.

>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.

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.

>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

> 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.

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.

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

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.

I presume they used insecticides. Anyone know what they used?

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.

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.

From what I know about malaria prevention, insecticides are mostly used in insecticide-treated bed nets.

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.

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.

Do other states in the area have malaria? How and when were they resolved?

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.

https://en.wikipedia.org/wiki/Malaria_in_Mandatory_Palestine

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...

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.

> 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.

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.

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!

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.

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

Formerly futurecrunch. It’s my only paid newsletter. I love it.

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.

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.)

This is great. Thanks for sharing!

I'm super glad they did this without GM mosquitos. It shows you can treat human diseases without engineering the ecosystem.

This seems like a huge accomplishment, how was it achieved though?

> Vaccines are now being used in some places - but monitoring the disease and avoiding mosquito bites are the most effective ways to prevent malaria.

You’d think vaccines are the end-all be-all and the only reason we ever eradicated any disease, but I’m curious now : what makes certain diseases eradicated with vaccines (like polio, supposedly) and others just…go away (like malaria or even scarlet fever for example?)

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?

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.

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.

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.

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.

I find it hard to believe this will be durable, but best of luck

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