Global malaria gains threatened by access gaps, COVID-19 and funding shortfalls
The World Health Organization (WHO) calls on countries and global health partners to step up the fight against malaria, a disease that is preventable and treatable and still claims hundreds of thousands of lives a year. A better focus on interventions, new instruments and increased funding is needed to change the global trajectory of the disease and achieve internationally agreed targets.
According to the latest World Malaria Report from the WTO, progress against malaria is still flat, especially in countries with a high burden in Africa. Gaps in access to life-saving instruments are undermining global efforts to curb the disease, and the COVID-19 pandemic is expected to put the fight back even further.
“It is time for leaders across Africa – and the world – to take up the challenge of malaria again, just as they did when they laid the groundwork for progress since the turn of the century,” said WHO Director – General Dr. Tedros Adhanom Ghebreyesus. “Through joint action and the commitment to leave no one behind, we can achieve our shared vision of a world free of malaria.”
In 2000, African leaders signed the characteristic Abuja declaration that they would reduce the deaths of malaria on the continent by 50% over a period of ten years. Robust political commitment, coupled with innovations in new instruments and a sharp increase in funding, have catalyzed an unprecedented period of success in global malaria control. According to the report, 1.5 billion malaria cases and 7.6 million deaths have been averted since 2000.
A plateau in progress
In 2019, the global count of malaria cases was 229 million, an annual estimate that has remained virtually unchanged over the past 4 years. The disease claimed approximately 409,000 lives in 2019 compared to 411,000 in 2018.
As in recent years, the African region has incurred more than 90% of the total disease burden. Since 2000, the region has reduced its malaria death rate by 44%, from about 680,000 to 384,000 per year. However, progress has slowed in recent years, especially in countries with a high burden of disease.
A shortage of funding at international and domestic level poses a significant threat to future profits. In 2019, total funding reached US $ 3 billion against a global target of $ 5.6 billion. Funding shortages have led to critical gaps in access to proven tools for malaria control.
COVID-19 is an extra challenge
In 2020, COVID-19 emerged as an additional challenge for the delivery of essential health services worldwide. According to the report, most malaria prevention campaigns this year could continue without major delays. Ensuring access to malaria prevention – such as insecticide-treated nets and preventative medicine for children – has supported the COVID-19 response strategy by reducing the number of malaria infections and in turn easing stress on health systems. WHO worked quickly to guide countries in adapting their responses and ensuring the safe delivery of malaria services during the pandemic.
However, the WHO is concerned that even moderate disruptions in access to treatment could lead to a significant loss of life. The report finds, for example, that a 10% disruption in access to effective treatment for malaria in sub-Saharan Africa could lead to 19,000 additional deaths. Disruptions of 25% and 50% in the region could result in 46,000 and 100,000 deaths, respectively.
“While Africa has shown the world what can be achieved if we stand together to end malaria as a threat to public health, progress has stalled,” he said. Matshidiso Moeti, WHO’s Regional Director for Africa, said. “COVID-19 threatens to further derail our efforts to overcome malaria, especially to treat people with the disease. Despite the devastating impact that COVID-19 has had on African economies, international partners and countries need to do more to ensure that there are resources to expand malaria programs that make such a difference in people’s lives. ”
An important strategy to revive progress is the response to High Burden to High Impact (HBHI), which was catalyzed in 2018 by the WHO and the RBM Partnership to End Malaria. The response is being led by 11 countries – including ten in sub-Saharan Africa – that make up about 70% of the world’s malaria classes.
Over the past two years, HBHI countries have deviated from a ‘one-size-fits-all’ approach to malaria control – instead opting for tailoring based on local data and intelligence. In a recent analysis from Nigeria, for example, it was found that through an optimized mix of interventions, the country can ward off tens of millions of additional cases and thousands of additional deaths by the year 2023, compared to a normal approach.
Although it is too early to measure the impact of the HBHI approach, the report finds that deaths in the 11 countries were reduced from 263 000 to 226 000 between 2018 and 2019. India has continued to make impressive profits, with declines in cases and deaths of 18% and 20% respectively over the past 2 years. However, there was a slight increase in the total number of cases among HBHI countries, from an estimated 155 million in 2018 to 156 million in 2019.
Achieving global malaria goals
This annual report highlights important milestones and events that have helped shape the global response to the disease in recent decades. Beginning in the 1990s, leaders of malaria-affected countries, scientists, and other partners laid the groundwork for a renewed malaria response that contributed to one of the largest returns on investment in global health.
According to the report, 21 countries have eliminated malaria over the past two decades; of these, ten countries have been officially certified by WHO as malaria-free. In view of the ongoing threat of drug resistance to malaria, the six countries of the Greater Mekong sub-region are still making huge profits to eliminate their goal of eliminating malaria by 2030.
But many countries with a large burden of malaria are losing ground. According to WHO’s global projections, the 2020 target for reducing the incidence of malaria cases will be missed by 37% and the target for reducing deaths by 22%.