Does malaria get the attention it deserves?

Abstract

The COVID-19 pandemic has changed perceptions of public health and healthcare in an unprecedented manner. Politicians, the public, and indeed even health professionals, are more aware than ever of the economic and societal threats posed by infectious diseases. The desperate search for drugs that might help us to return to some semblance of normality continues; the antiviral remdesivir, originally investigated as a treatment for Ebola, is the subject of one of this month's articles (page 31). However, for around two-fifths of the world's population, deadly infectious disease is nothing new. Malaria continues to kill hundreds of thousands of people each year, predominantly affecting the poorest in society, and is discussed on page 18. It may not be something that the majority of UK primary care clinicians will encounter, but over 1600 cases were reported in the UK in 2018, and global travel makes imported outbreaks a major risk elsewhere in the world. Mark Greener addresses the historical perspectives, the parasite's life cycle, environmental factors and drug development. Some particularly problematic issues are considered: the rise of resistance to pharmacotherapy; the fact that some new drugs cannot be used in patients with the protective G6PD enzyme deficiency; and difficulties in ensuring access to effective treatment among children and pregnant women. Greener ends with a note of optimism offered by Dr Stephan Duparc of Medicines for Malaria Venture, who highlights the raft of new antimalarials that have been introduced and millions of lives saved. Yet malaria remains a disease of the poorest, and I am left wondering how much more could be achieved if the parasite received even a modest fraction of the attention that has been given by the wealthiest developed nations to the SARS-CoV-2 virus. Of course, something that continues despite the background of coronavirus is the primary care management of long-term diseases. Emma Le Roux and Helen Frow address the primary care diagnosis and management of psoriasis this month (page 9). This condition affects up to 1 in 50 people, with substantial adverse psychosocial consequences and up to a quarter of patients experiencing significant non-skin complications. Another challenging skin problem, leg ulcer infection, is the subject of Steve Chaplin's review (page 27) of this year's NICE guidance. Finally, whether managing acute infections or chronic conditions, ensuring safety of medicines use remains a core objective for prescribers. Adrian Robertson and colleagues report their experiences of one such strategy – the delivery of a medicines helpline service (page 23) – including identifying opportunities to improve delivery of care, health literacy and adverse outcomes. The findings will be of interest to others providing (or planning) similar services to patients. Rupert Payne Consultant Editor