MANILA — The number of people affected by malaria increased slightly in 2017, a global report has shown, as progress against the disease stalled amid a scaling-down of significant investments.
There were 219 million cases of malaria in 2017, up from 217 million in 2016, according to the “World Malaria Report” released Tuesday by the World Health Organization. It added that 11 countries carry 70 percent of the global burden. Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda, Tanzania, and India will now be targeted by a WHO campaign.
“Experience from previous outbreaks of Ebola in West Africa has shown how symptoms of malaria can be very difficult to distinguish from those of Ebola, causing further problems and risks for malaria patients.”— Dr. Pedro Alonso, director of WHO’s Global Malaria Programme
The report also revealed the global community fell short of the $4.4 billion required for malaria elimination and control in 2017, and that the global fight against malaria is still reliant on external funding. Only $3.1 billion was made available for malaria programs and activities worldwide, of which $2.2 billion came from international financing. In addition, more than half of the 42 high-burden malaria countries showed a decline in funding per person at risk of malaria, some by as much as 20 percent or more. Some of these countries experienced a combination of low domestic investments and reduced external financing.
Observers say that the data reveals worrying trends in the fight against malaria, and raises several critical questions.
1. In DRC, what’s the impact of the Ebola outbreak on malaria?
Several countries registered an increase of more than half a million cases, including Ebola-hit DRC. From 2016 to 2017, estimated cases in the country jumped from 24.4 million to 25 million. This could be due to unsustained control activities, said Dr. Pedro Alonso, director of WHO’s Global Malaria Programme, such as gaps in the early distribution of insecticide net replacements, or stockouts of rapid diagnostic tests at health facilities.
The Ebola crisis could exacerbate the situation. In North Kivu’s Beni town, the epicenter of the outbreak, there has already been an eight-fold increase in malaria incidence compared to last year, Alonso said.
“Wherever Ebola emerges, it usually disrupts health services. Experience from previous outbreaks of Ebola in West Africa has shown how symptoms of malaria can be very difficult to distinguish from those of Ebola, causing further problems and risks for malaria patients,” he told Devex.
To avert the problem, WHO and its partners, including UNICEF, the Global Fund, and the U.S. President’s Malaria Initiative, have launched a mass drug administration campaign — as was done in Sierra Leone during the Ebola outbreak there — to lessen the malaria burden in Ebola-affected populations. A net distribution campaign is also “scheduled to take place shortly,” Alonso explained. The goal is to reach up to 450,000 people and “thoroughly suppress the incidence of fevers caused by malaria in the Ebola epicenter,” he said. Long-lasting insecticide-treated nets are also being distributed to the entire population, with the goal of reaching nine provinces by the end of 2018, and the rest in 2019.
2. What do declining investments in R&D mean for parasite resistance to anti-malarial drugs?
The report showed mixed results on investment in malaria research and product development. Investment in vector-control product research almost doubled to $61 million from $33 million, while investment in diagnostics R&D was at $20 million, up from $15 million.
But investments in malaria vaccine R&D declined from $133 million to $118 million. Drug development funding also reduced from $238 million to $222 million. The report pointed to a decline in philanthropic and industry investment in vaccine discovery as part of the reason.
These reduced investments come at a time of increased parasite resistance to malaria drug artemisinin, and several of its partner drugs, particularly in the Greater Mekong subregion. High treatment failure rates have been observed in Laos, Cambodia, and Vietnam, for example.
3. What happens to the global fight against malaria if the Global Fund doesn’t get fully funded?
Of total malaria funding in 2017, $1.3 billion — or 44 percent — came from the Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund is the largest source of funding for many countries’ malaria control programs, including in several of the highest burden countries such as Cameroon, DRC, Ghana, Mozambique, Niger, Nigeria, and Uganda.
Given this critical role, malaria experts from WHO and the RBM Partnership to End Malaria emphasized the importance of a fully financed Global Fund during a press conference last Wednesday. The fund is holding its sixth replenishment conference in 2019.