Making the impossible, possible
The Battle Plan Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, explains how the fight against malaria can be fought – and won.
What are the greatest achievements to date in the distribution of malaria medication and treatment?
The fight against malaria is one of the biggest success stories of the 21st century. We have made progress way beyond what seemed possible not long ago. In malaria, this has been possible mostly due to the massive rollout of prevention and treatment tools. In sub-Saharan Africa, more than half of the population is now sleeping under insecticide-treated mosquito nets, compared to 2 percent in 2000. This is very important because it means that more families, particularly children under the age of five, are protected. New and smarter diagnostic tests and the availability of antimalarial drugs have allowed more people to have access to life-saving treatment. Better data has also played a big role. But there is much more to be done.
What are the key factors behind this success?
The key factor behind this success is partnership. By working together and by involving people affected by the diseases, civil society, the private sector, technical partners, donors and implementing governments, the global community has cut malaria mortality by 60 percent since 2000, saving millions of lives. We could not have done this without partnership and shared responsibility. There are also substantial cost savings and benefits to pooling resources; for example, the Global Fund’s procurement approach has achieved substantial cost savings, enabling partners to purchase more mosquito nets. Nets now cost as low as US$3 per net, a 30 percent reduction from the price of 2013.
Can you give a brief overview of the different organisations and institutions who work together to coordinate care and management?
As a broad public-private partnership, we work with many partners and organizations, including WHO, UNICEF, the World Bank, the President’s Malaria Initiative, Roll Back Malaria, Malaria No More, donor governments, foundations such as the Bill & Melinda Gates Foundation and nongovernmental organizations. More importantly, countries implementing Global Fund-supported programs are in the lead, determining their own solutions to fighting the disease.
What are the greatest challenges we’ll face in the next 5-10 years?
There are some key areas we need to concentrate on, including making prevention and treatment available to hard-to-reach communities and to the vulnerable groups. We need to build resilient and sustainable systems for health, which will improve access to treatment for people affected by malaria. Most urgent, the emergence and spread of resistance to the drug artemisinin – the most commonly used drug against malaria – threatens to undo hard-fought gains, not only in the Mekong region but worldwide. Artemisinin-resistant malaria could be globally devastating if it arises independently in other geographies or crosses more borders, especially to India, the gateway to Africa. Mosquito-borne parasites know no borders, as the Zika virus in Latin America has reminded us this year. While the impact of Zika is still being assessed, we know that malaria kills hundreds of thousands of people a year, most of them young children. Malaria is a preventable and treatable disease, and we are determined to end it. We have to looks past borders, just like infectious diseases do. To do this, we need to sustain the investments and keep the political commitment. If not, we risk a resurgence of the diseases, and undermine the last decade of investments in global health.
Do we need to change our current strategy as we seek to reach more unstable communities?
To defeat these diseases we must follow the people, wherever they are. We need to look past borders, and reach the high transmission areas, deepening cross border collaboration and regional data sharing. Our most effective weapon against these diseases is partnership and constantly adapt to changing situations on the ground. In Southeast Asia, for example, the Global Fund partnership is backing a smart regional initiative with a US$100 million grant to tackle artemisinin resistance in Myanmar, Thailand, Viet Nam, Laos and Cambodia, with a special focus on mobile populations such as farming communities and seasonal agricultural workers. The Regional Artemisinin-resistance Initiative (RAI) has galvanized strong political commitment from East Asian leaders to achieve the goal of a malaria-free Asia Pacific by 2030. Countries are now saying that to end this devastating disease, control is not enough, and that to stamp out malaria we need to work together, with deeper cross border collaboration and regional data sharing.
How do you empower communities to take ownership of their malaria response?
Country ownership is in the genetic code of the Global Fund partnership. Country ownership means that people and governments determine their own solutions to fighting these three diseases, and take full responsibility for them. At the country level, representatives from government, civil society, the private sector, advocates, health experts, technical partners, communities and people affected by the diseases form a committee that develops, oversees and guides Global Fund-supported programs in that country. This approach puts people affected by the diseases at the heart of the decision-making and response.
What role does poverty play in the perpetuation of the disease?
Malaria is a disease of poverty. The massive costs associated to lost productivity due to malaria and to treatment trap entire nations, communities and families in a cycle of poverty, suffering and injustice. A malaria-free world would enable millions of people to reach their full potential and expand schooling and opportunity.
What key factors are holding development back?
Rather than look at what’s holding us back, let’s look at what’s moving us forward. Countries around the world have made huge progress in the past 15 years on improving living conditions, fighting diseases like malaria, and other key development issues. The Millennium Development Goals have been met and even exceeded in some countries – testament to what we can do if we work together in pursuit of a common goal. We now have a new challenge, laid out in the Sustainable Development Goals passed by world leaders last year. The Sustainable Development Goals call for an integrated approach to address today’s development challenges, highlighting how the fight against diseases like malaria is interconnected with the goals of gender equality, education, universal health care, climate change and more. To get rid of malaria, we must build strong, resilient systems for health. To achieve the Sustainable Development Goals and make the world safer, more equal and more free, we need to work in partnership: governments, the private sector, communities, advocates and civil society. It requires sustained commitment, funding and innovative approaches. This is how we achieved the Millennium Development Goals, and this is how we will meet the Sustainable Development Goals.
What will it take to eradicate malaria?
Until we have a “silver bullet” we need to continue fighting malaria will all the weapons at our disposal. That means a comprehensive approach that combines the distribution of mosquito nets, indoor spraying, rapid testing, artemisinin-based combination therapies and education.
Are you optimistic about achieving a future free from malaria?
Yes. Through committed partnership and shared responsibility, the world has an opportunity to end malaria as a major public health threat by 2030.