Mass Drug Administration – A Kaleidoscope of New Opportunities?

05 May 2014

Malaria World Blog: George Jagoe shines the spotlight on Mass Drug Administration (MDA), a tantalizing tool that can support elimination efforts and help dramatically knock down malaria prevalence. 

The use of medicines on a mass scale to wipe out parasite reservoirs and improve individual patient health status is enormously appealing.   The annals of public health victories show how judicious mass-drug-administration (MDA) has rolled back the burden of horrific parasitic diseases (e.g. river blindness, lymphatic filariasis, trachoma). At its best, MDA marries the optimal use of effective drugs with well-coordinated delivery to improve disease outcomes radically...

Past successes also show that MDA’s effectiveness is linked to other accompanying interventions, including health education and community mobilization. To diminish the logistical burden of MDA and insure its sustainability, it should be integrated with existing healthcare delivery systems to the greatest degree possible. 

In the case of malaria, MDA’s track record has been patchy. The WHO Standard Treatment Guidelines (second revision, 2010) only dedicates ~500 words to the topic – and draws a cautious conclusion based on the published evidence over a 60-year period: in an extensive analysis of 19 MDA projects, only one contributed to a sustained drop in transmission. And that one instance occurred with a small population (<1.000 people) on an isolated island in the Pacific Ocean, with the benefit of a decade-long follow-up period of close surveillance and response. 

Yet the tantalizing allure of MDA remains. Few dispute that a large-scale MDA campaign can show very satisfactory short-term results, with dramatic drops in malaria prevalence, improved health indicators, and diminished transmission. In the aftermath of an MDA campaign, for a brief moment, one catches an exhilarating glimpse of a happier healthier future --- the way life should be… near zero transmission, near zero disease burden, no malaria deaths. Unfortunately, MDA work that is not part of a well-designed elimination effort is like a sand castle built near the high tide line: no matter how beautiful the short-term result, waves of malaria without fail will come crashing back, destroying the good work.  This setback, sadly, has been seen time and again.....

Read the full article on the Malaria World website.