Test. Treat. Track.
The message of the World Health Organization’s latest initiative, launched on World Malaria Day (April 25), to donors and policymakers is simple: Test every suspected malaria case, treat every confirmed case with quality anti-malarial medicine, and keep track of the disease to guide policy and operational decisions.
Malaria — coined from the Italian words “mal” and “aria,” which mean “bad air” — is one of the top three leading causes of death among children under 5, along with pneumonia and diarrhea. In 2010, 86 percent of the estimated 655,000 people who died from the disease were children under 5. WHO says a child dies every minute from malaria in Africa.
In 1955, WHO launched the Global Malaria Eradication campaign at the 8th World Health Assembly. The campaign included all malaria-endemic countries except Madagascar and countries in sub-Saharan Africa. The campaign promoted DDT indoor residual spraying, which led to the elimination of the disease in 37 countries.
Despite this success, the campaign faced several problems in different areas and was “suspended” on the 22nd World Health Assembly in 1969. The global effort then shifted to a less ambitious goal: Minimize the health damage brought on by malaria, according to the U.S. Centers for Disease Control and Prevention.
The campaign’s suspension drove malaria control away from the spotlight. During this period, the global health community focused instead on researching and developing new tools, such as insecticide-treated nets and artemisinin-based treatment therapies. Now, WHO widely recommends ACTs in the treatment of malaria caused by Plasmodium falciparum, the deadliest malaria species.
The new millennium ushered in renewed optimism and commitments in combating the disease, and led to the creation of new initiatives and programs: WHO’s Roll Back Malaria Partnership, the U.S. President’s Malaria Initiative and the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Millennium Development Goals, which include combating malaria, were also formed during this time.
Further, the World Malaria Report 2011 says malaria mortality rates have fallen 25 percent since 2000, largely because of expanded access to anti-malarial interventions. Close to 300 million insecticide-treated nets have been delivered to sub-Saharan Africa since 2008 — more than half of these were distributed via Global Fund-supported programs.
The Affordable Medicines Facility for Malaria initiative, which is managed by the Global Fund, has also made quality malaria medicines more affordable in Africa, where the disease burden is high. The initiative has allowed people to purchase anti-malarial medicines in pharmacies and stores for less than a dollar.
Despite said gains, malaria remains a public health threat. Half of the world’s population, or 3.3 billion people, are still at risk of malaria to this day. And since WHO reinitiated its certification process for malaria-free countries in 2004 — there should be no local mosquito-borne transmission for three consecutive years in the country — only five have made it to the list: the United Arab Emirates, Morocco, Turkmenistan, Armenia and Kazakhstan. Of these, the UAE was the first to have been certified malaria-free in 2007 and Kazakhstan, which WHO officially acknowledged March 20, 2012, has so far been the last.
In Africa, which accounted for 90 percent of deaths from malaria globally in 2010, the battle against the disease goes beyond health. The region loses an estimated $12 billion in GDP every year to malaria and 40 percent its public health expenditure goes to treating and eradicating the disease.
Regardless, the gains made in 2010 ushered in new goals for malaria: Reduce deaths to near zero and cases by 75 percent, and eliminate malaria in 10 new countries, including in the European region, all by 2015.
Is this possible?
In 2011, Gro Harlem Brundtland, former WHO director-general and one of the “architects” of the RBM Partnership, said they “did not consider malaria eradication possible” when the partnership was formed.
“Even today I wonder if we have the technical base to eradicate malaria. If we could save people of dying from malaria that would in itself be a formidable achievement,” Brundtland told RBM’s communications officer Katya Halil in an interview.
Read our previous DevTrivia.