Malaria still kills thousands of people a day. That's distressing when you consider it's a disease that can not only be combated, but even eradicated. On the occasion of World Malaria Day 2011: the irritation, the expectation and the hopes of three prominent Dutch malaria fighters.

"All over the world people are making money from the research" sighs Professor Bart Knols of Malariaworld, a network for malaria professionals. "And precious little of that feeds into practice. All the knowledge generated is only good for the careers of scientists in the west".

Wedding dress from a mosquito net

Dr Ingeborg van Schayk, director of the Malaria Foundation, has her own frustrations:

"What I have most difficulty with is that many organisations give the impression that if everybody gets under a mosquito net it will be okay. I think mosquito nets - of which I am also a supporter - are very important, but I don't want to give our supporters the message of 'save your life with a mosquito net and solve the malaria problem."

Fishing nets and curtains are often used as mosquito nets. And there are certain places in Africa where people are using the free mosquito nets distributed by NGO's to make into wedding dresses.  There's also an increasing resistance to the insecticides which are soaked into mosquito nets. Dr Van Schayk wants to get the point across that malaria is very complex and there's no simple solution.

Encouraging

Professor Robert Sauerwein of the St Radboud Medical Centre in Nijmegen is well advanced with the development of a malaria vaccine. He won't speak of frustration. On the contrary, he finds it encouraging that the Millennium Development Goal of the World Health Organisation of the UN - 50% fewer malaria deaths in 2010 - appears to have been achieved in some countries.

New ways to fight malaria are commonly in the news, almost without exception presented as a breakthrough in the disease. These range from special moulds which make mosquitos ill, to producing harmless, genetically-modified mosquitos that will compete with the wild species. As Bart Knols puts it:

"The academic world has woken up and thought to itself: Yes, if we appear often enough in the press, then that's better for the recruitment of new students, the university becomes more popular in the community, and we are more in the spotlight. Unfortunately that means that when a normal scientific paper is published the press departments of the universities make a very exaggerated and positive story out of it under a headline such as 'The solution to malaria is close.'"

Comparison with HIV

Robert Sauerwein says it's true that there is no torrent of medical-technical solutions. "Compared with, for example, cancer or HIV there are very few."

Ingeborg van Schayk thinks that all the ingenious solutions are very interesting, but almost irrelevant to everyday practice: "If you take, for example, genetically modified mosquitos - mosquitos that act as competitors to the malaria-carrying mosquitos - I think that's still a very vague concept. Besides, can you really make that seem ethical? I don't see it happening in the Netherlands that a genetically modified insect is just let loose."

The future

When it comes to the direction the fight against malaria should go in the coming years, all three have their own opinion. Robert Sauwerwein finds it particularly important not to let attention slacken as things now seem to be going in the right direction:

"The number of malaria cases has fallen. But that's in no way a stable situation. The danger is - as I also point out to policy makers - that they feel: Oh, now that malaria has taken a downturn, it's a disease where the pressure is somewhat reduced. The numbers are still 2,000 children dying per day instead of 3,000, which is still unacceptably high."

Dr van Schayk calls especially for all anti-malarial methods to be integrated and used simultaneously. She sees that too often different malaria fighters seem to be competing with each other.

Paramilitary

Bart Knols still sees the most hope in one central, tightly-directed approach to control by the government. He believes it's an illusion to think that the local population itself will go into the forest, for example, to clean mosquito larvae out of pools in order to fight the disease. He sees the fight against malaria as a kind of war: "I support the idea of a paramilitary approach."

- Thijs Westerbeek van Eerten

Read Dheera's blog: Tiptoeing through the tulips on World Malaria Day here