Eliminating malaria: how close can we get?
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Version 0 of 1. Ambition and innovation have driven progress throughout the history of humankind. Both are fundamental pillars of the strategic vision Bill Gates articulated for ending malaria on Sunday, when he addressed the annual meeting of the American Society of Tropical Medicine and Hygiene. Thanks to more than a decade of dramatic progress in reducing cases of and deaths from malaria, such an ambitious goal – to remove malaria from the whole planet – backed by investment and innovation in the tools and solutions we use to fight the world’s oldest disease, is something we can conceivably achieve in our lifetimes. At Malaria No More, we have always believed there needs to be more than a business-as-usual approach to fighting malaria. Setting ambitious goals that sometimes deviate from the norm has driven significant progress against malaria in the past decade. Child deaths from malaria have dropped by 54% since 2000 in sub-Saharan Africa, and boosting anti-malaria efforts globally has saved more than 3.3 million lives. While we are not yet able to set an exact date for this eradication ambition, the world is already advancing elimination efforts and a consensus is building around the concept of accelerating to zero – increasing investment to cut malaria cases and deaths in the most-affected countries, focusing efforts to eliminate malaria where feasible, and investing in tools that will fuel progress towards elimination in all regions for the future. This is not just another development slogan. With significant research and development breakthroughs on the horizon, and 26 countries already on track to becoming malaria-free, it’s tangible action, rather than mere rhetoric. The research pipeline is central to the accelerate to zero ambition, including early development of new drugs and vaccines that could block transmission of the malaria parasite from host humans back to the mosquito, thus breaking the age-old malaria transmission cycle. Game-changing developments on the horizon include the first vaccine against malaria, which could be approved next year; a single-dose cure for vivax malaria (the relapsing strain of the disease) by 2017; and resistance-beating insecticides by 2022. If we persevere then, as Gates outlined, the world has the potential to dramatically shrink the malaria map country by country, area by area, ultimately ending transmission in 30 to 40 countries. In the past decade, ambition and innovation have been matched by truly extraordinary leadership. This includes funding through the establishment of the Global Fund to Fight Aids, Tuberculosis and Malaria, and from donors such as the US president’s malaria initiative, the World Bank, Bill & Melinda Gates Foundation, and the UK’s Department for International Development – which tripled its funding for malaria between 2008 and 2014. While malaria may be one of the greatest causes of poverty, given the costs it imposes on poor families, it also offers some of the most cost-effective solutions. A study by Accenture estimated the present-day economic value (ie profit) of continued investment in malaria control in Africa at more than $322bn (£257bn) between now and 2035, due to the tremendous health and productivity gains that would result. Clearly, this is a wise investment of political will and funds. But this is not to say that progress isn’t fragile. The achievements of recent years could be rapidly reversed without continued public, political and financial support. History has shown us repeatedly the deadly consequences of ending anti-malaria programmes prematurely – huge resurgence has frequently occurred when funding of local projects is ended in Africa. And each time history repeats itself, the price goes up. Add into this equation the Ebola crisis in the highly malarial countries of Guinea, Liberia and Sierra Leone which are seeing malaria control efforts virtually shut down. There are real concerns that deaths from malaria may rise due to the breakdown in delivery of preventative interventions and because patients will not seek treatment as they shun clinics for fear of being infected with Ebola. With the rainy season under way – when more malaria cases occur – it is vital to help keep malaria control efforts on track at the same time as responding to Ebola. The Ebola crisis confirms that the best safeguard from many diseases is a robust health system. Strengthening health systems, supporting community responses and encouraging multi-sector action must be key components of the drive towards ending malaria if this goal is to be reached at the same time as reducing more widespread suffering. Ebola also highlights the cost of not acting strategically against major diseases. The strategic, decisive answer to malaria is to end it once and for all; if we focus only on driving down deaths then malaria will remain a threat and the cost of replenishing nets and treatment – however cheap they may be (the World Health Organisation rates malaria interventions as the second most cost-effective health interventions after childhood immunisation) – will become burdensome to donor and endemic countries. Reducing the human and financial costs of malaria to zero is the only truly strategic approach to take, and we are now in a position to envisage this. Human progress is neither automatic nor inevitable. But, to borrow from Franklin D Roosevelt, “there are many ways of going forward, but only one way of standing still”. We will continue to work on a powerful array of ways to defeat this disease because, given the resurgence risk, standing still is simply not an option. Do we have an ambitious agenda? Yes. Can we afford not to be this ambitious? With a child dying every minute from a disease that is costing Africa £8bn annually, we think not. • James Whiting is executive director of Malaria No More UK and Martin Edlund is CEO of Malaria No More US |