VietNamNet Bridge – Viet Nam is nearing its goal of eliminating malaria, but it’s all riding on how determined the Government is to succeed. Nguyen My Ha & Vu Thu Trang

Bringing in help: Quang Binh Province reported more than 500 malaria cases and no deaths in 2015. Most of the cases are located in border communes, where people move across the border in Tuyen Hoa and Minh Hoa to trade. In order to prevent and cure malaria cases, medical workers are based at border points and remote villages, where medical aid takes longer to get through. Pictured here is a medical doctor consulting and performing health checkups at Dan Hoa Commune, located up in the mountains. — VNA/VNS Photo Duong Ngoc

Every year at this time, Ta Thi Tinh packs her bags to take the 1,000-km train and then a bus to Binh Phuoc Province which is one of the few provinces in the whole country still grappling with malaria.

Working for the last 36 years at the National Institute of Malariology, Parasitology and Entomology (NIMPE) in Ha Noi, Tinh says every year she makes these trips to the malaria-infested hotspots to gather samples and conduct studies about the parasites that cause malaria in humans.

In 2011, Deputy Prime Minister Nguyen Thien Nhan signed The National Strategy for Malaria Prevention, Fighting and Elimination from 2011 to 2020 with a vision until 2030. This Masterplan mobilised all relevant administrative and medical authorities to provide the population with preventive methods to reduce malaria cases in the country, provide medication for confirmed cases, aiming at completely eliminating the disease by 2030.

Now, just five years after the Masterplan became effective, the results have been quite impressive and that has prompted some medical researchers to believe that the country can reach its malaria elimination goal as projected.

Medicinal benefits: Associate Professor, Doctor Ta Thi Tinh of NIMPE presents samples of extracts from the thanh hao hoa vang plant, the main ingredient that cures malaria. — VNS Photo My Ha

The authorities of Ministry of Health, Viet Nam and WHO malaria experts and of course, provincial authorities met in Ha Noi at a conference held on March 3 to review achievements in 2015 and work out the next five-year plan for 2016-2020.

World Health Organisation representative  Gawrie N.L. Galappaththy, a medical officer on malaria and other vectorborne and parasitic diseases, spoke to Viet Nam News about the 40-percent reduction of malaria cases from 2014 to 2015.

“This is a remarkable achievement, when you compare it with greater Mekong sub-region countries,” she said. “I can attribute this success to good programme management and effective use of existing interventions and tools for malaria control.”

This year marks the 25th anniversary since the largest outbreak of malaria in 1991, when more than a million confirmed cases were reported and nearly 5,000 people died of the disease.

In 1999, there was also another malaria outbreak in Gia Lai Province.

Tinh recalls, "What I remember most is this boy, about 7, who was seriously ill." The boy's father was one of the local authorities, but he would not allow doctors to take his son out of the village for tests and treatment.

According to the local custom, if the son died outside of the village, his parents would be punished with a buffalo or a cow.

"When we got there," Tinh continues, "the boy had already gone into coma and ants had already gathered on his eyes. However, the parents insisted on only praying and keeping him home."

"We spent a long time convincing the father, who finally allowed us to take his son to the community clinic. After testing positive, we gave him medicine, it was artesunate, another anal artemisinin-based medication, after which we rushed him to the provincial hospital," she said.

"We came back four days later to see him sitting up!"

Barrier to entry: Medical workers show Dao people how to soak their mosquito nets in Quang Minh Commune, Van Yen District of Yen Bai Province. — VNA/VNS Photo Hong Ky

Limited budget

In an interview with Viet Nam News, director of the National Institute of Malariology, Parasitology and Entomology, Tran Thanh Duong said that the national budget for malaria was limited to meet the actual demand. This budget allocation, approved for a five-year duration, meets less than half of the demand.

"We have mobilised assistance for malaria control from international organisations, notably from the Global Fund. Every year, the committed budget for malaria accounts for more than 50 per cent of the overall expense. In particular, in 2014, this number went to more than 80 per cent."

Well into the third month of 2016, the annual budget has been earmarked to stay the same as the year before, which is VND60 billion (US$2.7) million. But this allocation has not been approved up until the time of the interview taken on March 2, 2016.

"We do not know how much we will allocate for 2016," Head of the Preventive Medicine Department, Tran Dac Phu told Viet Nam News on telephone.

The total funds mobilised from international resources have been estimated at more than VND240 billion ($10 million) this year, according to institute Director Duong.

A veteran malaria researcher, who declined to be named, said that since the 1990s, when the annual budget stayed modest, the government of Viet Nam spared a lot of financial resources to fight malaria.

In the past 10 years, thanks to the emphasis of the Government and the Ministry of Health, the national malaria programme has received a priority status. The budget allocated for malaria-related programme rose from VND65 billion ($4 million) in 2006, when $1 was equivalent to VND16,100 to VND105 billion ($5 million) in 2011 when the rate went up to VND21,000 for one US dollar.

However since then, due to the economic crises, the national budget went down steadily, and was especially low in 2014, when it dropped by 40 per cent from the previous year.

Also, according to this Masterplan, a total amount of VND1,673 billion ($79,7 million) has been committed to fight and eliminate malaria by 2030.

The fight: To commemorate World anti-malaria Day on April 25, The Quang Ngai Malaria Control Centre start spraying anti-malaria chemicals, soak mosquito nets in medical liquid and confirming malaria cases at hotspots in the province. People get free blood testing for malaria at Son Dung Commune, Son Tay Province, where 100 per cent of the population live in a malaria hotspot. — VNA/VNS Photo Thanh Long

Ambitious goals

Despite the limited amount of the government budget for fighting malaria, Viet Nam as a country has accomplished remarkable results in lowering malaria cases as well as the mortality rate.

As outlined in the government-approved masterplan, Viet Nam is committed to keep the confirmed cases under 0.15 per 1,000 people, the number of mortalities at 0.02 per 100,000 people. This number means it tries to keep the malaria cases at 15 for every 100,000 people and 2 deaths for ten million people.

It also planned to bring 40 provinces into the prevention mode, 15 provinces on the malaria eliminating mode, and eight provinces to pre-elimination mode by the year 2020.

According to the World Health Organisation (WHO) World Malaria Report 2015, which provided the statistics, in 2014, Viet Nam reported more than 15,000 cases, and six deaths, lower than 2013.

In 2015, the number of malaria cases dropped to 9,000 and only three deaths for over 90-million population, according to NIMPE latest report.

The confirmed cases meant a blood test seen through a microscope that can detect parasites that cause malaria.

Self-reliance

"In the 1970s, we were at the institute when we heard that China had found a cure for malaria from the extract of a plant named thanh hao hoa vang," Tinh of the National Institute recalls. "But we had no clue and we had no programme or received any aid/support from China."

"After national reunification in 1975, we set out to look for this plant," she says. "Our detection of the region where this plant could be growing was incorrect. So we went south to look for it. But we could not find it."

She said that the search took a few years and they had to wait for the end of the Border War in 1979 with China to go north and look for it.

The team included Dr. Truong Van Nhu, Trinh Ngoc Hai and another herbal expert from the Traditional Medicine Plant Department under MoH.

"We finally found the medicinal plant in Lang Son, (where heavy fighting took place in 1979). When we found it, we only used it as a medicinal concoction by simmering it in water for long hours, the traditional way of extracting oriental herbal medicine. We used the concoction to treat domestic cattle with immune disease with good results."

Tinh went on to say that the institute then was working on a project to manufacture locally-made medication. The first pills made of artemisinin powder were produced in 1989 at the Viet Nam's National Academy of Sciences.

The thanh hao hoa vang, or better known in English as the Sweet sagewort or sweet wormwood can grow higher than 1 metre in height. It produces beautiful yellow blooms with a soft fragrance.

This plant, known in ancient Chinese medicine as qing-hao, provides natural arteminisinin that can help reduce fever.

According to reports in the Quy Nhon Institute of Malariology, Parasitology and Entomology, back in the 14th century, Tue Tinh, Viet Nam’s founding father of traditional medicine, had already used extracts from thanh hao hoa vang to cure fever.

Western-trained doctors, however, tread another path in treating patients. Some said they did not know about the treatment in medicinal history.

Today, Vietnamese companies produce artemisinin-based medication to provide a cure for patients.

"The standard dose lasts for three days. It takes effect very quickly and gets out of the body also quickly. In general it is very safe to use," Tinh from the Ha Noi Institute says.

But director Duong has warned against the steady decrease of national funding as the fight is not yet over.

"A decrease in government funding for the national malaria fighting programme will result in a rise in confirmed cases, deaths or disease outbreak," he says.

He then cites five reasons for this warning.

“First of all,” he says, "we have recorded parasites that are resistant to the current medication we use in five provinces, and it is in danger of spreading out across the country."

Treatment: Anti-malaria pills manufactured by domestic drug companies provide sufficient medication to treat malaria cases. The red stamp reads: “Social medication: Not for sale”. — VNS Photo Thu Trang

Secondly, he says that mosquitoes have become resistant to the chemicals that are used to kill them and as a result have lowered the prevention methods.

He further said that uncontrolled immigration for economic reasons from malaria-free regions to malaria-stricken areas will increase cases.

He also added that the habit of not using mosquito nets in thatched huts when tending to crops in the forests will expose people to infection.

A WHO representative at the conference reiterated the concerns raised by NIMPE.

“Still we have some problems: drug resistance, migrant mobility and of course, funding issues,” the representative said. Geographically, Viet Nam belongs to Southeast Asia. But WHO lists Viet Nam in the Western Pacific Region in its malaria report.

Duong's warning is ever more relevant because just last week, The Lancet warned of a malaria outbreak from the Western Pacific Region that can spread to India, the gateway to Africa, where the most people die of the disease.

"We strongly call the Government of Viet Nam to maintain the national budget to fight malaria," he says.

"The importance of keeping the budget strong for the 2016 to 2020 period will put Viet Nam on the sustainable path to continue reducing the positive cases and meet the national target of completely eliminating the disease in 2030.

Only if no more positive cases are reported for three continuous years, can the country be declared malaria-free, according to WHO standards.

At the above-mentioned conference, Director of the Quy Nhon Institute Dr. Nguyen Van Chuong, announced some bad news.

“There were two malaria-related deaths in Phu Yen Province in the two first months before this meeting,” he said. “However, one case was still disputable. We, however, need to stay alert despite the good results last year”.

 Viet Nam still has 14 years to meet its goals.

VNS