Malaria is a deadly disease transmitted to people through bites of infected Anopheles mosquitoes. On World Malaria Day 2015, it is time to acknowledge the progress the international community has made in reducing malaria mortality.
The World Health Organisation (WHO) reports that within the last 15 years there has been a global decline in malaria mortality rates by 47 percent and 54 percent decline in Africa. Since 2001, it is estimated that more than 4 million malaria-related deaths have been averted, of which near to 97 percent have been children under five.
Despite the progress, there is still a $100 billion investment required to eliminate malaria by 2030. The disease, which caused 584,000 deaths in 2013 (WHO 2014), has a devastating impact on people’s health and livelihoods, especially in Africa, where more than a half a million children lose their lives to the disease each year. Nearly half of the world’s population is at risk, but infants, children under five and pregnant mothers are the most vulnerable and feature disproportionally in malaria mortality and morbidity rates.
Therefore, World Malaria Day is not just a chance to highlight the advances in malaria prevention and control but also spotlights the need to ensure continued awareness, investment and commitment to action to accelerate all efforts to prevent and contain the disease. Fittingly, the theme to mark World Malaria Day 2015 is a call to “invest in the future, defeat malaria.”
Achieving universal coverage of malaria interventions is still imperative. This includes measures such as artemisinin based combination therapy (ACT); use of Indoor Residual Spraying (IRS) and long-lasting insecticide bed nets (LLINs). Alongside this requires close, sustained and effective monitoring of vector and parasite resistance to ACTs.
It is well acknowledged that the technical means are already in our hands to make significant progress in confronting the disease, the problem however remains one of funding shortfalls, medicinal and awareness reach and access. For instance, seasonal malaria chemoprevention (SMC), which provides children with malaria drugs at monthly intervals during the rainy season, is failing to reach 97 percent of eligible children. WHO has recommended SMC since 2012. It works by maintaining enough drugs in the bloodstream to prevent the disease during its peak transmission season. SMC is a highly effective way to tackle the disease since it has the potential to reduce malaria occurrence and deaths in children under five by 75 percent. Philippe Douste-Blazy, Chair of the UNITAID Executive Board, emphasises the point: "this is a very important initiative for global child health, adding significantly to the toolkit for use against malaria.” Further investment in SMC projects will increase the supplier base, production output and maintain SMC drug supply, with the overall effect being a reduction in the cost of SMC delivery. The UNITAID has taken this burden on, and will be rolling out an estimated 15 million SMC treatments in 2015 and 20 million in 2016, targeting 7.5 million children. The programme is projected to prevent over 5 million cases of malaria and save more than 50,000 deaths over its entire duration.
Additionally, the USAID’s flagship Maternal and Child Survival Programme (MCSP) is aiming to get universal health care coverage for high-impact malaria interventions for mothers and their children. Mothers, as the primary care givers of children under five, need tailored prevention and control as part of community level case management. This means a collective of integrated approaches: dissemination of WHO global policy to countries on malaria alongside the Roll Back Malaria (RBM) Call to Action for intermittent preventive treatment during pregnancy (IPTp), promotion of folic acid for pregnant women and availability of insecticide treated nets during antenatal care (ANC). The WHO recommends that women receive four doses of preventative anti-malarial medication (sulfadoxine-pyrimethamine) as part of IPTp. Greater movement towards MCSP programmes is urgently needed given that in 2013, an estimated 15 million pregnant women and 28 million babies in sub-Saharan Africa did not receive a single dose of IPTp yet over 15 percent of maternal deaths are the result of malaria infection during pregnancy. As a consequence, many mothers lost their babies. Yet, small steps are being taken to change this: at the community level in Kenya and Ghana, MCSP have been integrated with ANC to form a comprehensive safe motherhood package that encourages early ANC attendance, increased IPTp uptake and usage of insecticide treated nets.
WHO and UNICF have partnered together to form the integrated community case management (iCCM) strategy, which is aimed at training community health workers to treat malaria as well as a number of other diseases with the end goal being the integration of the strategy into the national health system. iCCM in some cases have included addressing acute malnutrition alongside malaria treatment. Such approaches have clear benefits, such as bringing formal health care services to remote villages whilst at the same time providing locally sensitive interventions through community health workers. The success of such programmes has been recognised by the Global Fund who is now supporting iCCM approaches.
These partnerships have been essential for breaking ground in the global fight against malaria. Indeed, it recognises the importance of pooling resources and knowledge in collaborative partnerships, enabling NGOs, governments and the private sector to contribute their expertise towards eradicating the deadly disease. The private sector in particular needs to be brought more centrally into these efforts. One success story demonstrates the impact of corporate input in health interventions: Novartis has helped improve access to treatment, helping achieve better healthcare in their communities, and invested in research and development for the next generation of antimalarials.
The next generation will be making its debut later this year. GlaxoSmithKline has created the world’s first malaria vaccine, which may be cleared for use in Africa by October. Final trail data has shown that the vaccine offered partial protection for up to four years. Brian Greenwood, a professor at the London School of Hygiene & Tropical Medicine, has commented on the medical breakthrough: “Given that there were an estimated 198 million malaria cases in 2013, this level of efficacy potentially translates into millions of cases of malaria in children being prevented.” The vaccine, known as RTS,S, bolsters current malaria control interventions rather than replace them.
Research into and monitoring of all confirmed malaria case should continue to be documented and recorded to ensure that global mapping of the disease is for determining geographic location, prevalence and populations at risk. In this way, better understanding and knowledge towards targeted and tailored malaria interventions will help ensure that national health systems and international donors are able to increase universal health coverage in a more progressive and sustainable manner.
Combating poor quality medicine or falsified antimalarials must continue to be on the agenda as part of global malaria campaigns. Concerns on poor quality or falsified medicines risk serious illness or death, and can also lead to antimalarial drug resistance. Methods on how best to monitor and protect the quality of anti-malarial medicine are urgently needed in order to reduce drug resistance.
In all, the malaria intervention methods detailed above will collectively accelerate efforts to towards achieving the Millennium Development Goals 4 and 5 (maternal and child health indicators) by the end of 2015 and contribute to future efforts within the Sustainable Development Goals.
Malaria is preventable and treatable. Addressing limited access to and underutilisation of malaria interventions within high risk countries will be required to effectively prevent, treat and defeat malaria. There is a global consensus to reduce malaria mortality and incidence rates by 2030. Progress made so far is worthy of praise, indeed the proportion of people protected by at least one malaria control method has increased rapidly over the last decade. Nevertheless, further investment is needed by international donors, private sector and national governments if malaria is to be eradicated altogether. Otherwise ambitious targets will fail to save the lives of those most at risk. Serious commitment will ensure more children are able to secure a healthy life to make a meaningful contribution to the future of their country; one in a malaria-free world.
World Health Day is one of eight official global public health campaigns marked by WHO, along with World Tuberculosis Day, World Immunization Week, World Malaria Day, World No Tobacco Day, World Blood Donor Day, World Hepatitis Day, and World AIDS Day.