Global access to key anti-malarial interventions has improved over the last year, but persistent gaps in coverage mean the burden of disease is still massive — at a time when funding to combat the parasitic disease has flatlined, according to the World Malaria Report.
Released today, the report finds that malaria control has improved for the most vulnerable in Africa, but inadequate funding and fragile health systems stand in the way of reaching global eradication targets. Authors warned against complacency and urged donors to continue prioritizing malaria interventions.
“The sense that the job has been completed and therefore we move on is a dangerous one,” Pedro Alonso, director of the Global Malaria Program at the World Health Organization, which is behind the annual report, in a conference call with reporters on Friday ahead of the launch of the report today. “The hardest is still to come.”
Released every December, the World Malaria Report examines trends for malaria control and elimination. The report draws on data from 91 countries and territories with ongoing malaria transmission and tracks progress toward targets from the Global Technical Strategy for Malaria, which include reducing malaria incidence by 90 percent from 2015 to 2030. This year, the takeaways offer those in the fight against malaria a chance take stock of what has been accomplished and what lies ahead.
Access is improving
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“When I looked at the report, I was struck by the speed at which certain interventions are gaining traction,” Martin Edlund, CEO of Malaria No More, told Devex.
According to the report, there has been an impressive scale up in malaria control. For example, between 2010 and 2015, the percentage of women receiving the recommended doses of preventive treatment in 20 African countries increased fivefold. The percentage of the population using an insecticide treated mosquito net in sub-Saharan Africa — where 92 percent of malaria deaths occur — also rose to 53 percent, up from 30 percent in 2010.
Alonso said the world also appears on track to meet one Global Technical Strategy for Malaria target: to eliminate malaria in 10 countries by 2020. Another 10 countries reported no malaria deaths in 2015, according the report. And while the report focuses on 2015, Sri Lanka and Kyrgyzstan also achieved malaria free status from WHO in 2016.
Despite the progress, malaria control is not on track to meet another target to reduce malaria incidence and mortality rates by 40 percent by 2020. Current rates of progress indicate that there will be a reduction of 21 percent in malaria incidence and 29 percent in malaria mortality.
“What really needs to happen is to accelerate progress in those countries with the largest numbers of cases and deaths because progress has been slowest there,” said Richard Cibulkis, coordinator for the strategy, evidence, and economics unit of the WHO’s Global Malaria Program.
Gaps in coverage remain
A host of new innovations are facilitating malaria control — but new thinking is still needed to reach the most vulnerable pockets of the population.
“There is no question we can eliminate malaria today from many parts of the world using the tools we have,” said Ashley Birkett, director of PATH’s Malaria Vaccine Initiative. “But very few people believe we can eliminate malaria from all countries with the tools we have.”
The proliferation of tools is visible in the labs at Seattle institutions such as PATH, the University of Washington, or Global Good at Intellectual Ventures, where scientists are at work on everything from new diagnostic tools to lasers designed to shoot mosquitoes from the sky. Those at work here must consider not just the science but also if their interventions are appropriate, affordable, and accessible.
Getting existing tools to those who need them also remains a challenge, particularly in countries where health systems are weak. “We still have significant coverage gaps,” Alonso said.
The report points to the consequences of those gaps in terms of disease burden. In 23 African countries, 36 percent of children with a fever were not taken to a health facility for care. Forty-three percent of the population across sub-Saharan Africa remains unprotected by treated nets or indoor spraying with insecticides. And worldwide, 2015 saw 212 million new cases of malaria and 429,000 deaths worldwide.
Funding is a concern
While malaria funding increased considerably between 2000 and 2010, it has flatlined in the last five years, Alonso explained.
Funding in 2015 totaled $2.9 billion, including pledges to The Global Fund to Fight AIDS, Tuberculosis and Malaria as well as commitments from governments of malaria endemic countries. That is less than half of the $6.4 billion funding milestone set by the Global Technical Strategy for Malaria for 2020. Alonso said that if this trajectory is not reversed, the goals will not be met.
Edlund emphasized the role the private sector can play in malaria funding. “The product pipeline for malaria, which I believe is genuinely the envy of much of the global health world, we wouldn’t be anywhere near that if it weren’t for the role of industry,” he added.
ExxonMobil, for example, has invested more than $145 million in organizations fighting malaria since 2000, in part because by investing in malaria control, they could save several times that in productivity for projects such as pipeline construction in endemic areas, Edlund said.
On the eve of the release of the World Malaria Report, U.S. President-elect Donald Trump looked set to select ExxonMobil CEO Rex Tillerson, whom Malaria No More has honored for his company’s contributions to the fight against malaria, to lead the U.S. Department of State.
States also have a role to play, said Alonso, noting that money was necessary but not sufficient to end the disease.
“Countries need to have the capacity to absorb those resources, and that calls for a larger strengthening of their health systems and their national control programs,” Alonso said. “So money is a requirement, but it’s not enough,”
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