Tremendous progress against malaria seen but challenges remain

Twins Dorcas and Deborah Bendak, 7, under their mosquito net at their home in Musoma, Tanzania. Insecticide-treated bednets have become the cornerstone of malaria prevention efforts. Photo: Riccardo Gangale/VictorWorks, Courtesy of Photosphere

This was originally published on Global Health TV on April 25, 2017.

When I was a young development worker, I engaged in high risk behavior one night in a village in Mali: I slept without a mosquito net. A week or so later I contracted malaria.

Of all the diseases I have written about here, malaria is the only one with which I have personal and intimate experience. And it was not pleasant. It was so debilitating, so sapping of my energy, I remember not caring whether I lived or died.

Fortunately, I was an otherwise healthy young male and bounced back briskly after a week or so of misery. In fact, I have lived long enough to see the beginning of the end (or at least the decline) of this global killer: In December, the World Health Organization (WHO) released the World Malaria Report 2016 in which it estimated that 1.3 billion fewer malaria cases and 6.8 million fewer malaria deaths occurred between 2001 and 2015 than would have occurred had incidence and mortality remained the same. About 97% of those deaths averted were for children under five years (who are most vulnerable to the disease, along with pregnant women).

Buried on Page 50 of the report is the gist of what makes this news so exciting: In WHO’s Africa Region, these reduced malaria mortality rates have translated to a rise in life expectancy at birth of 1.2 years, accounting for 12% of the total increase in life expectancy of 9.4 years, from 50.6 years in 2000 to 60 in 2015.

This means more children — many more children — will survive the perils of childhood in Africa and go on to lead productive lives as adults. This makes malaria control one of the most exciting developments of many encouraging global health trends in recent years.

Today we mark World Malaria Day with the message “Let’s close the gap” in malaria prevention. It’s a time to celebrate the tremendous accomplishments to date, but also to remember how many challenges remain. For example, an estimated 43% of people at risk in sub-Saharan Africa are still not protected from malaria, according to WHO. And there were still 212 million cases of malaria worldwide in 2015.

Dr. Richard Cibulskis, coordinator of Evidence and Economics of the WHO Global Malaria Programme, told Global Health TV that we have good reason to be optimistic about the fight against malaria.

“We’ve had huge success in bringing down malaria incidence and mortality rates over the last fifteen years. We have effective tools to prevent, diagnose and treat the disease, and coverage of these tools has been massively scaled up in many countries. There are exciting new technologies under development, and more countries than ever are making progress towards elimination.”

“But there are also some worrying trends, especially the fact that global funding seems to be flat-lining. We can eliminate malaria, but only if we can continue to harness the financial and political will needed to accelerate progress and make new and existing tools available to all who need them.”

Insecticide-treated bed nets are one of the biggest successes in malaria control. The World Malaria Report found that 53% of the population at risk in Sub-Saharan Africa slept under a net in 2015 compared to 30% in 2010. Furthermore, WHO found that people who slept under nets had significantly lower rates of malaria infection than those who did not use a net.

And it was announced yesterday that the world’s first vaccine against malaria will be tested in Ghana, Kenya and Malawi in 2018. The vaccine has the potential to save tens of thousands of lives but it is unclear if it is feasible to get parents to bring their babies in four separate times to get the required doses.

Malaria control has had solid bipartisan support in the U.S. for 15 years. The U.S. government – the largest donor to global malaria efforts – has increased its support from $146 million in 2001 to $861 million in 2016. Funding really took off after former U.S. President George W. Bush launched the President’s Malaria Initiative in 2005.

Last month, U.S. President Donald Trump released a proposed budget that calls for close to a one-third reduction in foreign assistance. We don’t know how those cuts – which still have to be approved by a dubious Congress – would affect malaria control but it does cause concern.

What we do know is that President Trump has announced plans to meet U.S. commitments to the Global Fund for AIDS, TB and Malaria, according to this analysis by Friends of the Global Fight.

The WHO’s Global Technical Strategy for Malaria calls for malaria to be eliminated in at least 35 countries by 2030. Dr. Cibulskis call this “an ambitious but achievable target.”

“But even if this target is achieved, it could still leave us with more than 50 countries in which malaria is endemic,” he says. “A challenge will be maintaining robust funding and political commitment as we continually make progress towards this goal.”

One of the problems the malaria control community worries about is that once cases and deaths have decreased and the disease seems like less of a threat, funding for malaria could be cut.

“History has shown us that we must keep our levels of investment high, or risk a resurgence of the disease and a reversal of progress made to date,” says Dr. Cibulskis. “We cannot let up in our efforts until we get the job done.”