By Kent Campbell, Director of the Malaria Control Program at PATH
Last week, as the world commemorated the sixth annual World Malaria Day, I was struck by the tremendous progress we have made against this disease — progress that, at the outset, many would have thought impossible. Malaria mortality rates in Africa have decreased by one-third, and more than one million lives have been saved over the last decade. Amazingly, we are now in a place few of us could have imagined: eliminating malaria in Africa is a real possibility.
To succeed, however, the global malaria community must recognize that our mission, and what it demands of us, has changed. Now we need to work together and bring every tool we have — our communities, technologies, talent, and commitment — to reach our goal. A world free of malaria is within our sights. We cannot afford to hesitate.
No treading water
In Africa, many of the countries hit hardest by malaria are calling for elimination and have included aggressive goals in their national health plans. A few countries, including Zambia, Swaziland, Senegal, and Rwanda, already are piloting successful strategies to stop transmission, creating and expanding large areas that are completely free of the disease. This expression of national aspiration poses both an enormous opportunity and challenge for the malaria community.
There are some who contend that eliminating malaria in Africa is not possible with currently available tools; however, there is no evidence to support this contention. As researchers develop additional tools, the current alternative — trying to maintain high levels of malaria control by keeping transmission at low levels indefinitely — is not sustainable. It would require us to constantly inject money and effort into keeping the disease at bay with no end in sight, all while battling the ever-present threat that the disease will resurge or become resistant to the few drugs we have to treat it. Meanwhile, funding to fight the disease has slowed over the last two years, the result of a challenging economic climate that has led to a notable decrease in support for global health programs and development assistance worldwide.
The bottom line? There is nothing sustainable about sustained malaria control. Lessons learned in our ongoing battles to eradicate polio and guinea worm have taught us that there can be no treading water when it comes to fighting malaria — we must keep pushing the envelope or risk losing the progress we have made.
Elimination is possible
Globally, more than 90 countries today are malaria-free, with an additional 26 en route to achieving that status. Still, eliminating malaria in Africa is a challenging goal. The continent is home to 90 percent of all malaria deaths, and the hard truth is that the disease has never been eliminated in a single country in malarious, contiguous sub-Saharan Africa. What also is true, however, is that we have better tools to meet this challenge than ever before. We have better diagnostics and treatments, a better understanding of how to fight the disease, new and improved technologies and strategies, interest from both the public and private sectors, and a decade of progress and experience to build on. Simply put, we shouldn’t decide something can’t be done simply because it’s never been done before.
What it takes
So, what will it take to eliminate malaria in Africa? We must continue to expand our work to control the disease in the areas with the highest burden, while working to stop transmission altogether in areas where the parasite is losing its foothold. That means developing robust surveillance and response systems to track where the disease is occurring to stop transmission. This includes identifying individuals who have acquired immunity through repeated exposure to the disease, but still carry the parasite and are vectors for transmission, despite not having any symptoms. Progress in eliminating malaria also will require optimizing targeting and uses of existing tools and strategies to fight the disease, while developing, piloting, and testing new ones.
As our goals change, we’ll need to develop new ways of measuring success: in areas with low malaria transmission, we soon may mark our progress not by a dramatic decrease in illnesses and deaths, but by the absence of disease and the economic and societal benefits of healthy, malaria-free communities and countries. Documenting progress is critical, as is advocating for sustained and diversified funding and supportive policies, and renewing our commitment to major players who support this lifesaving work, including the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Malaria Initiative.
A defining moment
The malaria landscape as we now understand it is changing. To continue to make progress in fighting the disease, we must keep pace. We cannot continue to use the same approaches to fight an evolving battle. We have good reason to be optimistic and aggressive in our approach — and must be as smart and adaptive as the malaria parasite itself to achieve our ultimate goal: a world free from malaria.
Dr. Kent Campbell is the director of PATH’s Malaria Control Program, which is focused on developing evidence-based national malaria control programs in Africa.
PATH is an international nonprofit organization that transforms global health through innovation. PATH takes an entrepreneurial approach to developing and delivering high-impact, low-cost solutions, from lifesaving vaccines, drugs, and devices to collaborative programs with communities. Through our work in more than 70 countries, PATH and our partners empower people to achieve their full potential.
GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria said today that new advances in science and implementation have given the global community the opportunity to control malaria and remove it as a threat to global health.
As people in many countries observe World Malaria Day on 25 April, the Global Fund said commitment is needed by all partners in the fight against malaria to expand and intensify efforts, so it can be transformed from a worldwide killer into a manageable and treatable disease.
“We can defeat malaria, if we work together,” said Mark Dybul, Executive Director of the Global Fund. “We have a chance to control it and sharply reduce the number of children who die from it each year. If we don’t act decisively, we will be counting the cost for generations.”
Huge progress has been made against malaria over the past decade, driven by simple scientific advances like mosquito nets treated with insecticide, quicker diagnostic tests and more effective antimalarial drugs. Better implementation, in programs supported by the Global Fund, has led to the distribution of more than 310 million nets, far broader access to rapid diagnostic tests and treatment with artemisinin-based combination therapy.
But these gains could now be in jeopardy. A resurgence of malaria may occur unless increased funding is provided to expand efforts to control the disease. Experts warn that a decline in anti-malarial efforts could quickly allow a return to pre-2000 levels of mortality, when 1.2 million people died from malaria. Today, the total is roughly half that amount.
Dr. Dybul singled out partners like the Roll Back Malaria Partnership (RBM) and the United Nations Secretary-General’s Special Envoy for Financing Health MDGs and for Malaria, Ray Chambers, for their success in raising awareness of the critical need to increase funding.
Earlier this month, the Global Fund announced a target of raising US$15 billion for the 2014-2016 period. When combined with other sources of funding, that will enable global partners to have a transformative effect on AIDS, TB and malaria.
For malaria, resources would be targeted to achieve universal coverage of insecticide-treated nets and access to effective treatment in the 18 highest-burden countries, where most malaria deaths occur. An additional 200,000 lives could be saved every year than with the funding that is currently available.
The new funding model recently launched by the Global Fund is expected to achieve greater impact by encouraging ambitious programs and by focusing interventions and financing for specific populations and catchment areas. By reaching highly vulnerable, marginalized and stigmatized groups, including women and girls, sex workers, people who inject drugs, men who have sex with men, people in prison and migrants, more programs will maximize impact while advancing human rights.
The new funding model also strives to align investments in disease programs with national health strategies while strengthening health systems and serving as a platform for promoting the health of a person rather than only combating specific diseases.
- ANDREW HURST
Head of Media and Translations, The Global Fund
Written by Dr Fatoumata Nafo-Traoré
LONDON, 25 April 2013 (Financial Times) — Thursday is World Malaria Day. Each year on April 25, local, national and global events, speeches and other advocacy actions remind the world of the suffering and loss, caused by this pernicious disease.
This year, the synchronised messages are petitioning us all to continue investing our attention, our resources and our collective will in the future, in order to defeat malaria once and for all.
In Africa, every day is malaria day. Every day our children get sick, and one is needlessly lost to the disease each minute. But, as the region that bears the brunt of malaria’s burden, with 90 per cent of global deaths, Africa has also led the charge.
Effective national policies and control interventions have saved more than 1m African children from malaria death in the past decade. In the same period, outstanding progress has been seen in malaria prevention, with nine African nations on track to achieve 75 per cent reductions in malaria cases by 2015.
African progress against malaria has been made possible by a convergence of political commitment, shared investment and technical consensus on how to tackle the disease, a process that began even before we really knew what change might be possible.
Just over 12 years ago, malaria-endemic countries in Africa committed themselves to an intensive effort to cut by half malaria deaths by 2010. Fast forward to 2013, and the undeniable change of gear towards that goal has been remarkable.
The African Union (AU) is actively promoting accountability for delivery and impact of mutual commitments made by African countries and G8 donors. African heads of state and government collaborate through the African Leaders Malaria Alliance (ALMA) to keep malaria high on the political and policy agenda, and to end malaria-related deaths in their countries.
Through the Southern African Development Community (SADC), eight southern African countries are working in close partnership towards the eventual elimination of malaria in the region, including in four countries by 2015.
Now that we know what can be done – and that our most ambitious malaria goals are achievable – our countries’ leaders and people are asking again how they can ensure that valuable malaria gains are protected and advanced: how to invest in Africa’s future.
To date, Africa governments and international partners have mobilised $4.4bn to fund vital interventions such as mosquito nets, rapid diagnostic tests and malaria medicines in Africa. Nevertheless, malaria funding reached a plateau over the past two years and the continent faces a $3.6bn gap in financing for malaria control between 2013 and 2015.
With the global financial crisis influencing the flow of development assistance for health – and with some of the world’s fastest-growing economies now to be found in Africa – a growing proportion of that gap is being filled from African domestic budgets.
Of the 53 AU Member States six have met the benchmark of 15 per cent national income to be committed to health. Average AU government allocations to health increased 9 per cent to 11 per cent over the past decade.
Such investments, when allocated to malaria control, protect African people against a possible resurgence of the disease and loss of life, as well a shield for African economies from the impact of malaria on continued growth.
African countries will also invest in homegrown malaria and related health research. A growing scientific expertise, specific focus on African health priorities and various grant-giving programmes have allowed the region’s researchers to make increasingly important contributions to global scientific collaborations.
But a dependence on funds from international research institutions and donors – and the inadequate dissemination, uptake and application of research results within African countries themselves – have created a needless separation of malaria research and policy-setting in the region.
This gap also prevents health research and capacity building from aligning with national and regional priorities. Investing in the African future will include providing support to the region’s gifted malaria researchers so they work together more closely, and contribute more to national malaria policies and technical decision-making in their own countries.
Similarly, African civil society has contributed a concerted voice to international health-related discourses, advocacy and social change over the past decade.
The South African Treatment Action Campaign, for example, has shown the tremendous impact that a movement rooted in the lived experiences of affected people and communities can have on critical decision-making.
When governments place their confidence in African civil society, malaria responses will be able fully to harness the social capital and ingenuity of our people. Regional celebrities and malaria ambassadors have also proved to be critical voices for awareness-raising and ensuring that the disease remains high on people’s attention.
Each time I hear the theme of this World Malaria Day: Invest in the Future: Defeat Malaria, I feel optimistic that African leaders – and our people – are ready to build on the tremendous malaria successes to date. Our common malaria goals are more achievable now than ever, although they need the continued commitment of all involved in order to be secured.
- Dr Fatoumata Nafo-Traoré
ABUJA –Nigeria’s President, Goodluck Jonathan, agreed to help lead the Global Fund’s efforts to raise funds this year, a critical role in the partnership to fight AIDS, tuberculosis and malaria all over the world.
President Jonathan met with Mark Dybul, Executive Director of the Global Fund, on Monday to discuss joint efforts to control these deadly infectious diseases in Africa’s most populous nation and globally.
Dr. Dybul praised President Jonathan’s effective leadership and personal commitment to expanding health services, embodied by Nigeria’s “Save One Million Lives” initiative that is aiming to dramatically increase access to basic quality health services, particularly for women and children.
President Jonathan accepted an invitation be a Co-Chair in this year’s replenishment efforts by the Global Fund. Other Co-Chairs include UN Secretary-General Ban Ki-moon and heads of state from developed countries, emerging economies and the private sector.
“Working together, we can make tremendous gains,” said Dr. Dybul. “With the existing science, our understanding of the epidemiology and our collective experience in combating the diseases, we now have an opportunity to control them. If we do not, the long-term costs will be incalculable.”
During his first visit to Nigeria as Executive Director of the Global Fund, Dr. Dybul also met with the Minister of Health, Prof. Chukwu Onyebuchi and Minister of State for Health, Dr. Muhammad Pate, and other key stakeholders, partners and implementers to discuss opportunities to further strengthen collaboration.
Mr. Aig-Imoukhuede, Chairman of Friends Africa, said: “The upcoming replenishment of the Global Fund is its most critical replenishment and ought to be given the highest levels of support for the fight against these diseases to be won.”
Dr. Dybul announced that the Global Fund is providing up to US$ 288 million in additional funding to help accelerate programs to prevent and treat HIV and malaria in Nigeria. This new funding is being made available under a new funding model, and Nigeria is one of 47 countries accessing new funding through renewals, grant extensions and redesigned programs in 2013.
The Global Fund’s latest HIV grants are targeting pregnant women and “most-at-risk” populations such as women and girls, sex workers, people who use drugs, men who have sex with men, while the TB grants support expansion of diagnosis and treatment capacity including treatment of multidrug-resistant TB.
Malaria grants are aiming to achieve nationwide coverage of mosquito nets through mass campaigns and routine distribution, while at the same time increasing availability of antimalarial medicines and diagnostic tests.
Despite promising advances in recent years, such as declining AIDS and TB mortality and a sharp increase in the use of insecticide-treated nets, Nigeria faces serious health challenges. Over the last 12 months, Nigeria and the Global Fund signed agreements in worth a total of US$ 560 million to support programs that will help significantly expand prevention, diagnosis and treatment of the three diseases.
Dr. Dybul appealed to President Jonathan to expand domestic investment in health even further.
Nigeria has the second-largest number of people living with HIV in the world after South Africa. But only 30 percent of those needing treatment are on antiretroviral therapy and only 16 percent of pregnant HIV-positive mothers are getting prophylactic treatment to prevent them from passing on the virus to their babies.
The country also has the second-highest child and maternal mortality in the world, in absolute numbers, and accounts for nearly one-third of deaths from malaria globally. While TB mortality has fallen significantly since 2003, case detection rates are still among the lowest in the world.
April 25, 2013
By the time you finish reading this article, malaria will have killed five children. Malaria kills an estimated 660,000 people every year of which some 85% are children under five years of age. That is roughly one death every minute of every day. Neatly 3.3 billion people, half of the world’s population, are at risk of acquiring malaria. In 2010, there were over 219 million cases of malaria. Eighty percent of all cases occurred in just 17 countries with forty percent occuring in only three countries- the Democratic Republic of the Congo, India, and Nigeria.
Although malaria is most common in Africa, it is endemic in many Asia-Pacific countries including Papua New Guinea. Eighteen percent of all deaths at PNG hospitals are malaria-related. With 90% of the country at risk, approximately 800 Papua New Guineans die from malaria each year.
Malaria is a preventable and curable disease. However, many countries do not have the funding or access to the prevention services, early diagnosis, or treatments that could save thousands of lives. On World Malaria Day, April 25, we reflect on the severity and cruelty of this disease but also recognize the progress we have made towards defeating one of the world’s greatest killer diseases.
Malaria is caused by parasites that are transmitted to people through the bite of an infected mosquito (specifically the Anopheles genus). Effective prevention involves the use of insecticide-treated bed nets (ITNs) which act as a barrier between an uninfected person and a malarial mosquito. ITNs have been shown to reduce all-cause mortality in children under 5 by about 20 percent and malarial illnesses among children under 5 and pregnant women by up to 50 percent. An additional preventive measure is the use of indoor residual spraying, which repels and kills mosquitoes. The Global Fund to Fight AIDS, Tuberculosis, and Malaria has provided malaria-endemic countries with some 310 million insecticide-treated bed nets and provided indoor residual spraying units to 44 million buildings.
Malaria is curable and there have been recent advances in treatment. Artemisinin-based combination therapies (ACTs), the most effective antimalarial drugs, have been increasingly available worldwide. The number of ACT treatment courses acquired by public health authorities increased from 11.2 million in 2005 to 76 million in 2006, and 181 million in 2010. The Global Fund has played a critical role in the introduction and expansion of coverage of ACTs in many countries where resistance to older malaria drugs has increased. In addition to financing treatment for 260 million cases (cumulatively) of malaria by mid-2012, the Global Fund has been piloting a pioneering financing mechanism to improve access to ACTs by making them more affordable.
With the Global Fund’s new US$15 billion replenishment target for 2014-16, announced in Brussels earlier this month, we have every hope that malaria will soon be a problem of our past. We have come a far way in treatment and prevention of malaria, but with a child dying every minute, we clearly still have a long way to go.
Global Health News
Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.