参 考 文 献4．今後の課題・展望・提言等 我々は，アルテミシニン耐性対する緊急対策の必要性を最近 Science 誌上で訴えた［Dhorda M, Kaneko A et al. 2024］．その戦略は，国際協力と住民主導の多角的戦略による恒久的なマラリア制圧につきる． 今般，歴史上最初のマラリアワクチン，RTS/Sおよび R21 が遂にアフリカに導入され，対象地でもそのロール・アウトが進む．いずれも媒介蚊により人体に侵入するスポロゾイトに対するワクチンだが，マラリアに対する magic bullet はない．撲滅の達成にはマラリア原虫生活環への多角的な介入の必要性を過去の経験は物語る． 我々は，見出した OlysetPlus 天井式蚊帳による新規媒介蚊対策をワクチン，治療薬などによる介入と統合し，強力な住民参加を担保したマラリア撲滅戦略を提唱する（図 5）．成功のカギは，sus-tainability, cost effectiveness, そして program owner-ship である． その戦略がエンジンとなり，マラリア流行の台風の目ともいえる汎ビクトリア湖諸国に展開されることにより，熱帯アフリカのマラリア滅撲が加速すると考える．29Attaran A, Barnes KI, Curtis C, et al. WHO, the Global Fund, and medical malpractice in malaria treatment. Lancet 2004; 363(9404): 237-40.Björkman Nyqvist, Martina, Lucia Corno, Damien de Walque, and Jakob Svensson. 2018. “Incentivizing Safer Sexual Behavior: Evidence from a Lottery Experiment on HIV Prevention.” American Economic Journal: Applied Economics 10(3): 287-314. DOI: 10.1257/app.20160469Dhorda M, Kaneko A, Komatsu R, Kc A, Mshamu S, Gesase S, Kapologwe N, Assefa A, Opigo J, Adoke Y, Ebong C, Karema C, Uwimana A, Mangara JN, Amaratunga C, Peto TJ, Tripura R, Callery JJ, Adhikari B, Mukaka M, Cheah PY, Mutesa L, Day NPJ, Barnes KI, Dondorp A, Rosenthal PJ, White NJ, von Seidlein L. Artemisinin-resistant malaria in Africa demands urgent action. Sci-ence. 2024 Jul 19; 385(6706): 252-254. doi: 10.1126/science.adp5137.Henley D. Asia-Africa development divergence: A question of intent. Zed Books: London. 2015.Idris ZM, Chan CW, Kongere J, Hall T, Logedi J, Gitaka J, Drakeley C, Kaneko A. Naturally acquired antibody response to Plasmodium falciparum describes heteroge-neity in transmission on islands in Lake Victoria. Sci Rep. 2017; 7(1): 9123.Idris ZM, Chan CW, Kongere J, Gitaka J, Logedi J, Omar A, Obonyo C, Machini BK, Isozumi R, Teramoto I, et al. High and heterogeneous prevalence of asymptomatic and sub-microscopic malaria infections on islands in Lake Victoria, Kenya. Sci Rep. 2016; 6(1): 36958.Kagaya W, Chan CW, Kongere J, Kanoi BN, Ngara M, Omondi P, Osborne A, Barbieri L, Kc A, Minakawa N, et al. Evaluation of the protective efficacy of Olyset®Plus ceiling net on reducing malaria prevalence in children in Lake Victoria Basin, Kenya: study proto-col for a cluster-randomized controlled trial. Trials. 2023; 24(1): 354.Ko YK, Kagaya W, Omondi P, Musyoka KB, Okai T, Chan CW, Kongere J, Opiyo V, Oginga J, Mungai S, et al. Evaluation of the protective efficacy of OlysetPlus ceil-ing nets for reduction of malaria incidence in children in Homa Bay County, Kenya: a cluster-randomised con-trolled study protocol. BMJ Open. 2025; 15(1): e087832.Matsumoto T, Nagashima M, Kagaya W, Kongere J, Gitaka J, Kaneko A. Evaluation of a financial incentive inter-vention on malaria prevalence among the residents in Lake Victoria basin, Kenya: study protocol for a cluster-randomized controlled trial. Trials. 2024; 25(1): 165.Minakawa N, Kongere JO, Sonye GO, Lutiali PA, Awuor B, Kawada H, Isozumi R, Futami K. Long-Lasting Insecti-cidal Nets Incorporating Piperonyl Butoxide Reduce the Risk of Malaria in Children in Western Kenya: A Cluster Randomized Controlled Trial. Am J Trop Med Hyg. 2021 Jun 14; 105(2): 461-471. doi: 10.4269/ajtmh.20-1069.Murray CJ, Rosenfeld LC, Lim SS, Andrews KG, Foreman KJ, Haring D, Fullman N, Naghavi M, Lozano R, Lopez AD. Global malaria mortality between 1980 and 2010: a systematic analysis. Lancet. 2012 Feb 4; 379(9814): 413-31. doi: 10.1016/S0140-6736(12)60034-8.Ntoumi F. What if tropical diseases had as much attention as COVID? Nature. 2020 Nov; 587(7834): 331. doi: 10.1038/d41586-020-03220-5.Sachs J, Malaney P. The economic and social burden of malaria. Nature. 2002 Feb 7; 415(6872): 680-5. doi: 10.1038/415680a. PMID: 11832956.Stokes BH, Ward KE, Fidock DA. Evidence of Artemisinin-Resistant Malaria in Africa. N Engl J Med. 2022 Apr 7; 386(14): 1385-1386. doi: 10.1056/NEJMc2117480.Symons TL, Lubinda J, McPhail M, Saddler A, van den Berg M, Baggen H, Berman Y, Hafsia S, Jayaseelen R, Amratia P, Browne A, Cameron E, Vargas-Ruiz C, Rumisha SF, Golding N, Weiss DJ, Gething PW. Estimating the poten-tial malaria morbidity and mortality avertable by the US President’s Malaria Initiative in 2025: a geospatial model-ing analysis. Lancet. 2025 Jun 21; 405(10496): 2231-2240. doi: 10.1016/S0140-6736(25)00805-0.日立感染症関連研究支援基金 研究成果報告書
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