The enduring menace of malaria
The Battle Plan We run the risk of thinking that the malaria problem is largely solved. It is not – and the malaria parasite takes advantage of any slackening in the efforts made to beat it.
Deaths from malaria have come down by 62 per cent over the term of the Millennium Development Goals (2000-2015), and 29 per cent between 2010 and 2015. Incidence of malaria has declined by 41 per cent and 21 per cent in the same periods. Since 2000, 17 countries have seen malaria eliminated, and it is estimated that 6.4 million deaths from malaria have been prevented.
That has been achieved because the global community and the World Health Organization (WHO) again started taking malaria seriously in the late 1990s, and have cooperated intensely since then. Funding increased from less than $100 million per annum in 2000 to $2,900 million in 2015. Of that, the UK contributed 16 per cent, second only to the US, which provided 35 per cent.
Investment in tackling malaria is a clear example of the importance of the UK’s development work, which has tangible results. It saves lives and improves the life chances of millions every year.
But there is a great deal more to do to achieve the aim of the WHO’s global strategy for malaria by 2030. And that is: to reduce the rates of malaria incidence and mortality by 90 per cent from current (2015) levels; to eliminate malaria from a further 35 countries; and to prevent malaria from becoming re-established in any country which has been declared malaria free. If the aim is achieved, it will also mean that part of target 3.3 of the Sustainable Development Goals – to end the epidemics of malaria, HIV/AIDS, TB and the Neglected Tropical Diseases – will have been met.
Analysis shows that the main tools for the reduction in malaria incidence and mortality since 2000 have been greatly increased availability and use of insecticide-treated bed nets; better and more effective anti-malarial drugs, especially the combination therapies based on artemisinin (ACTs); and more indoor spraying against mosquitoes. The development of rapid diagnostic tests (RDTs) has also been critical in ensuring that cases are diagnosed earlier and hence drugs used more effectively.
The seriousness with which most countries with endemic malaria have taken tackling the disease has also been important. They see that they now have the tools to beat malaria, and not just to try and manage it. They also see how the reduction in the malaria burden has given their health systems the chance to improve and extend the range of health services which they can offer to their people.
We are now seeing challenges to the effectiveness of the insecticides and anti-malarial drugs. Mosquitoes in certain areas are developing resistance to insecticides, while ACTs – the most effective class of drugs – are becoming less effective against the malaria parasite in the Mekong Delta region. It is from that area that resistance to previous drugs, such as chloroquine, has spread, particularly to sub-Sahara Africa, which is why the situation is taken so seriously.
So there is a considerable amount of research going on into new malaria drugs and insecticides. In addition, the first licensed malaria vaccine – GSK’s and PATH MVI’s RTS,S – has been approved by the WHO for piloting in three parts of sub-Saharan Africa. Other vaccines are also in development. We are also seeing more work being done to tackle malaria in areas which are harder to reach, such as the Sahel where seasonal malaria and conflict has prevented mass drug administration.
The UK government has proven itself to be a global leader in championing the fight against malaria. The UK Government continues to commit £500million per year across malaria research, treatment and vector control. Parliamentary groups like the All-Party Parliamentary Group on Malaria & NTDs in the UK will continue to play a key role in informing and engaging parliamentarians in debate to support Government policy discussions and sustain political will.
Thanks to UK leadership, progress made in tackling malaria since 2000 has been one of unprecedented advance. It was a deadly, or at least debilitating disease, which was feared by hundreds of millions of people around the world. It remains that in certain parts of some countries. But for many people, it has either become a thing of the past, or a disease which can be rapidly diagnosed and effectively treated. However, we run the risk of thinking that the problem is largely solved, it is not – and the malaria parasite takes advantage of any slackening in the efforts made to beat it. Even now, we need at least to double the amount spent on malaria to reach the WHO’s 2030 targets. Much of that should come from countries where malaria is endemic, but there is still a need to increase investment by wealthy countries too.