Malaria and MDGs: mission accomplished?
The Battle Plan According to a joint report launched on September 17th by the WHO and UNICEF, "at the beginning of the millennium, the battle against malaria was being lost". How is the battle going now?
This opening sentence of the joint report by WHO and UNICEF, launched on Sept 17 at the UK Houses of Parliament which stated that the battle against malaria was being lost was a sobering one. The battle at the time was referring to the malaria target of the Millennium Development Goals (MDGs): Achieving the Malaria MDG Target. However, this is the prelude setting the scene for the report's very welcome news.
The headline achievement is the 60% fall in the malaria-associated death rate—from 47 per 100 000 at risk in 2000 to 19 per 100 000 in 2015. This equates to a total of 6·2 million lives saved. Clearly a great achievement. Also, the report shows that incidence of malaria is in decline. Taken together, with the addition of achievements on children younger than 5 years sleeping under bednets and receiving antimalarials, the report states that this means that the malaria-specific target of the MDGs “has been met convincingly”.
The source data in the report were published simultaneously in a research article that mapped the effect of malaria control on Plasmodium falciparum in Africa over the lifetime of the MDGs. Presented as heatmaps, this article shows the striking decline in P falciparum infection. One of the paper's authors, Peter Gething, outlined the crucial contribution of this work: he said that since 2000 “surveillance has been transformed and this has similarly had a transformative effect on policy“.
However, throughout the launch event many speakers were keen to sound a note of caution and ensure the positive news in this report did not obscure the enormous task that still lay ahead. Just in 2015, there were an estimated 214 million new cases of malaria with 438 000 deaths. And despite progress, almost half the world's population is still at risk of malaria. This acknowledgement of the work still needed prompted a reminder that despite the significant increase in funding for malaria it is still not enough. Not a message the politicians in the room really wanted to hear.
The partnership between the UK and the USA was described as a gamechanger by Bernard Nahlen, the Deputy Coordinator of the US President's Malaria Initiative. “This commitment has been crucial”, he said, “in 2000 there was evidence that interventions would work, but resources were lacking. Now these partnerships have provided those resources”. Providing additional emphasis of the importance of tackling malaria, he pointed out that the Roll Back Malaria Partnership's report Action and Investment to Defeat Malaria 2016–2030 showed that “malaria represents an impediment to economic development”. This report outlines that if coverage were to revert to 2007 levels then US$1·2 trillion of economic output would be foregone from 2016 to 2030. But Nahlen offered reassurances about the commitment of the USA to malaria because of its cross-party support in Congress.
Now that the MDGs have reached their conclusion, attention is shifting to the next set of goals: the Sustainable Development Goals (SDGs). Controversially, malaria is now one of nine targets for one of 17 goals. When asked if the SDGs would undermine progress, Pedro Alonso, Director of the WHO Global Malaria Programme, said that this would “come down to investment and political support”. However, there was a “risk that dilution will reduce impetus”.
However, Nahlen was more optimistic; despite the minor mention of malaria among the SDGs, meeting these goals would inevitably mean addressing malaria. He also offered the reminder that, before the MDGs, African ministries of health were the source of the demand for action on malaria, and this would certainly continue to be the case. But his optimism came with a warning, if we “back off now, it will be a disaster”.
Looking ahead, the WHO/UNICEF report says that “the rate or expansion of malaria programmes between 2016 and 2030 has been mapped out, and funding requirements to meet these milestones for 2020, 2025, and 2030 have been identified”. These requirements are $6·4 billion by 2020, $7·7 billion by 2025, and $8·7 billion by 2030. Although the figures will make many politicians wince, against the backdrop of the potential cost of insufficient action they might be easy to swallow.