Malaria response at ‘crossroads,’ risks backward slide – UN

The 2017 World Malaria Report presents a comprehensive state of play in global progress in the fight against malaria.
“In recent years, we have made major gains in the fight against malaria,” said Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO).

“We are now at a turning point. Without urgent action, we risk going backwards, and missing the global malaria targets for 2020 and beyond,” he added.

The WHO Global Technical Strategy for Malaria calls for reductions of at least 40 per cent in malaria case incidence and mortality rates by the year 2020. Yet, according to the new report, the world is not on track to reach these critical milestones.

A major problem is insufficient funding, resulting in major coverage gaps for insecticide-treated nets, medicines and other life-saving tools.
In 2016, a $2.7 billion investment in malaria control efforts was well below the global $6.5 billion required annually by 2020 to meet the 2030 targets of the WHO global malaria strategy. Providing $800 million, governments of endemic countries represented 31 per cent of the total funding.

Probing the numbers
The report shows that, in 2016, there were an estimated 216 million cases of malaria in 91 countries – up from 211 million cases in 2015 – with a global malaria death tally estimated at 445,000 compared to 446,000 the previous year.

While the rate of new cases of malaria has fallen overall, since 2014 the trend has levelled off and even reversed in some regions. Malaria mortality rates followed a similar pattern.
The African region continues to bear an estimated 90 per cent of all malaria cases and deaths worldwide, with 15 countries – all but one in sub-Saharan Africa – carrying 80 per cent of the global malaria burden.

“Clearly, if we are to get the global malaria response back on track, supporting the most heavily affected countries in the African region must be the primary focus,” said Tedros Adhanom Ghebreyesus.
In most malaria-affected countries, sleeping under an insecticide-treated bednet (ITN) is the most common and effective infection-prevention method. Spraying insecticide inside homes is also effective.

While the African region has seen a major increase in diagnostic testing in the public health sector – with 70 per cent of those treated having received artemisinin-based combination therapies (ACTs), the most effective antimalarial medicines – access to the public health system in many areas remains low. National-level surveys there show that only about 34 per cent of children with a fever see a public health medical provider.
The report also outlines additional challenges in the global malaria response, including the risks posed by conflict and crises in malaria endemic zones. WHO is currently supporting malaria responses in Nigeria, South Sudan, Venezuela and Yemen, where ongoing humanitarian crises pose serious health risks.

“We are at a crossroads in the response to malaria,” said Dr. Pedro Alonso, Director of the WHO Global Malaria Programme.
“We hope this report serves as a wake-up call for the global health community. Meeting the global malaria targets will only be possible through greater investment and expanded coverage of core tools that prevent, diagnose and treat malaria. Robust financing for the research and development of new tools is equally critical,” he asserted.

At the same time, Ray Chambers, the UN Secretary-General’s Special Envoy for Health in Agenda 2030 and for Malaria noted that the report sends the clear message that progress does not happen by chance.
“The gains we have achieved in the fight against malaria since 2000 – nearly seven million lives saved, and hundreds of millions of infections averted – were accomplished through the concerted actions of many champions,” he pointed out.

He said that the commitment of community health workers to endemic country governments and their external partners has “positioned the global malaria response as one of the greatest public health achievements in the world.”
“However,” he added, “the data show that our progress is stalling and we risk reversing the hard-won gains. We must double-down on our commitments, bring new technologies to bear, and increase investments to bring us back on track to end malaria for good.”

Photo: WHO S. Hollyman