Treating everyone for malaria: does it eliminate the disease?

News article 29 Sep 2021

Some policy experts recommend giving antimalarial drugs to everyone living in a malarious area at the same time to accelerate elimination of the disease, but this is controversial. Now an independent review team from the LSTM based Cochrane Infectious Diseases Group evaluated the current effectiveness of using mass drug administration (MDA) for reducing transmission of malaria with mixed results.

Updating a Cochrane Review carried out in 2013, the review author team examined 13 studies that looked at MDA for the treatment and prevention of malaria, where all people within a population are provided medication for the disease irrespective of their infection status. The studies were carried out in different settings, with different levels of malaria transmission, and alongside other tools to prevent malaria infection. Most trials were done where the level of malaria infection was low.

Monica Shah, one of the authors, said: “Progress against malaria has stalled since 2015. To kickstart a renewed effort, countries are moving away from a one-size-fits all approach to malaria control and elimination. This review has been carried out to help inform policy makers of the relative value of MDA for malaria at a population level in the context of other malaria prevention strategies.”

The review authors found that in areas where more than 10% of the population has malaria, MDA had no impact. Contrasting with areas where malaria was less common (less than 10% of the population), malaria infections dropped immediately after everyone was provided medication, but rapidly climbed in the following months. After 4 months, malaria levels were the same as before the intervention, showing that transmission rebounded due to reinfection of the population and importation.

None of the studies achieved interruption of malaria transmission. The effect of MDA was short-lived, which may have been due, in part, to conducting only a few rounds for, at most, two years. MDA may be useful in very isolated and contained populations, in response to outbreaks or when conducted more frequently over a longer period of time, but MDA alone isn’t the answer for interrupting transmission.

Shah MP, Hwang J, Choi L, Lindblade KA, Kachur SP, Desai M. Mass drug administration for malaria. Cochrane Database of Systematic Reviews 2021, Issue 9. Art. No.: CD008846. DOI: 10.1002/14651858.CD008846.pub3

The editorial base of the Cochrane Infectious Diseases Group is funded by UK aid from the UK government for the benefit of low- and middle-income countries (project number 300342-104). The views expressed do not necessarily reflect the UK government’s official policies.