Adequate financing for malaria control and elimination is crucial

Urvashi Prasad, CNS Correspondent, India
According to the World Malaria Report 2015, malaria cases and deaths have declined over the last 15 years. However, the disease still claims 400,000 lives every year, primarily in Africa. Malaria control and elimination poses several challenges that need to be addressed in a comprehensive manner.

Firstly, climate change has contributed to a spike in the number of malaria cases in several regions of the world that were previously not as badly affected.

For instance, in sub-Saharan Africa, including Uganda, Mali and the Democratic Republic of Congo, Médecins Sans Frontières (Doctors Without Borders) teams have observed an increase in the number of malaria cases during the last few years. While several factors might be responsible for this, an increase in temperatures and rainfall caused by the El Niño has played an important role. Secondly, mosquitoes are becoming resistant to pyrethroids which is one of the most common insecticides used to treat bed nets. Access to bed nets has increased significantly over the last decade. The World Health Organisation estimates that only 2% of Africa’s population had access to bed nets in the year 2000 but by 2014, over 50% could access a net. Insecticide-treated nets, along with spraying of insecticides inside and around homes, is a crucial strategy for reducing the exposure of people to mosquito bites. However, resistance to insecticides is becoming an important concern in malaria control. In order to understand the extent of the problem, more robust data on changes in insecticide efficacy is needed. 

Thirdly, the malaria parasite is becoming resistant to artemisinin-combination therapies (ACTs) which are used to treat malaria. Resistance has especially been documented in the regions of Latin America and Southeast Asia. There are several reasons for development of resistance, including use of artemisinin mono therapy, instead of in combination with other drugs; inferior quality drugs; and patients stopping treatment in between once symptoms ease. It could be a long time before a new drug is available for treating malaria, which makes this emergence of resistance a serious public health threat. Fourthly, preventative strategies, like distributing anti-malarial drugs during the months in which transmission is high, have shown encouraging results. However, they are typically implemented over a short period of time. Their impact also lasts for only a few weeks after implementation ceases. Effective strategies such as this one therefore need to be implemented in a consistent manner in order to have a greater impact on reducing the number of malaria cases.

Fifth, developing an effective, safe and affordable vaccine against malaria remains an important goal. The efficacy of Mosquirix, the first malaria vaccine able to complete clinical development, is limited. This is especially the case for more severe forms of malaria. Moreover, administering the vaccine is quite complicated as it involves four doses and an 18-month gap is necessitated between the third and fourth doses. Tackling malaria, therefore, requires a concerted effort by all stakeholders with a special focus on the aforementioned challenges. Controlling malaria is no longer an option but a necessity, especially because of the emergence of drug-resistant forms of the disease. Malaria must be eliminated and a health system approach that addresses malaria along with conditions like HIV and TB is required, as opposed to disease specific programmes alone.

In order to achieve this, adequate financing for malaria is crucial. In a webinar, Dr Tim France, Team Leader for External Communications, Asia Pacific Leaders’ Malaria Alliance (APLMA) and Managing Director of Inis Communication, highlighted that investment in malaria in the Asia Pacific region has plateaued at approximately USD 350 million per year. Estimates from modelling exercises, however, suggest that in the first five-year phase of eliminating malaria in Asia Pacific, USD 1 billion needs to be spent every year. In subsequent phases, USD 2 billion per annum are required. Thus, it is crucial that countries, in which malaria is endemic, mobilise additional funding for malaria elimination, including through innovative financial mechanisms like sin tax and engaging the private sector.

Urvashi Prasad, Citizen News Service - CNS
17 September 2016

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