Nigeria and several African countries are still grappling with a high burden of malaria, due to deficits in funding, medical personnel and safe medicines.
Coronavirus, has become a major threat to the global malaria eradication initiative in the continent and other high burden regions, according to emerging research findings.
World Health Organization (WHO) has therefore called on countries and global health partners to step up the fight against malaria, a preventable and treatable disease that continues to claim hundreds of thousands of lives each year.
‘A better targeting of interventions, new tools and increased funding are needed to change the global trajectory of the disease and reach internationally-agreed targets.’
According to WHO‘s latest World Malaria Report, progress against malaria continues to plateau, particularly in high burden countries in Africa.
The publication, which was launched on Monday, further revealed that ‘gaps in access to life-saving tools are undermining global efforts to curb the disease, and the COVID-19 pandemic is expected to set back the fight even further.’
In his submission, the agency’s Director-General Dr Tedros Adhanom Ghebreyesus said ‘it is time for leaders across Africa – and the world – to rise once again to the challenge of malaria, just as they did when they laid the foundation for the progress made since the beginning of this century.’
‘Through joint action, and a commitment to leaving no one behind, we can achieve our shared vision of a world free of malaria.’
Recall that, ‘in 2000, African leaders signed the landmark Abuja Declaration pledging to reduce malaria deaths on the continent by 50 percent over a 10-year period. Robust political commitment, together with innovations in new tools and a steep increase in funding, catalyzed an unprecedented period of success in global malaria control.’
According to the report, 1.5 billion malaria cases and 7.6 million deaths have been averted since 2000.
A plateau in progress
‘In 2019, the global tally of malaria cases was 229 million, an annual estimate that has remained virtually unchanged over the last 4 years. The disease claimed some 409 000 lives in 2019 compared to 411 000 in 2018,’ it noted.
As in past years, the African Region shouldered more than 90 percent of the overall disease burden.
Since 2000, the region has reduced its malaria death toll by 44 percent from an estimated 680 000 to 384 000 annually.
‘However, progress has slowed in recent years, particularly in countries with a high burden of the disease.’
A funding shortfall at both the international and domestic levels poses a significant threat to future gains. In 2019, total funding reached US $3 billion against a global target of $5.6 billion.
‘Funding shortages have led to critical gaps in access to proven malaria control tools.’
COVID-19 an added challenge
In 2020, COVID-19 emerged as an additional challenge to the provision of essential health services worldwide.
According to the report, most malaria prevention campaigns were able to move forward this year without major delays.
Ensuring access to malaria prevention – such as insecticide-treated nets and preventive medicines for children – has supported the COVID-19 response strategy by reducing the number of malaria infections and, in turn, easing the strain on health systems.
The lead global health organization said it ‘worked swiftly to provide countries with guidance to adapt their responses and ensure the safe delivery of malaria services during the pandemic.’
However, it expressed concern that ‘even moderate disruptions in access to treatment could lead to a considerable loss of life.’
The study revealed, for example, that a 10 percent disruption in access to effective antimalarial treatment in sub-Saharan Africa could lead to 19 000 additional deaths.’
‘Disruptions of 25 percent and 50 percent in the region could result in an additional 46 000 and 100 000 deaths, respectively.’
Dr Matshidiso Moeti, WHO Regional Director for Africa however said ‘while Africa has shown the world what can be achieved if we stand together to end malaria as a public health threat, progress has stalled.’
‘COVID-19 threatens to further derail our efforts to overcome malaria, particularly treating people with the disease.’
‘Despite the devastating impact COVID-19 has had on African economies, international partners and countries need to do more to ensure that the resources are there to expand malaria programmes which are making such a difference in people’s lives,’ she stressed.
A key strategy to reignite progress is the ‘High burden to high impact’ (HBHI) response, catalyzed in 2018 by WHO and the RBM Partnership to End Malaria. The response is led by 11 countries – including 10 in sub-Saharan Africa – that account for approximately 70 percent of the world’s malaria burden.
Over the last two years, HBHI countries have been moving away from a “one-size-fits all” approach to malaria control, by opting, instead, for tailored responses based on local data and intelligence.’
The authors said ‘a recent analysis from Nigeria, for example, found that through an optimized mix of interventions, the country could avert tens of millions of additional cases and thousands of additional deaths by the year 2023, compared to a business-as-usual approach.’
‘While it is too early to measure the impact of the HBHI approach, the report finds that deaths in the 11 countries were reduced from 263 000 to 226 000 between 2018 and 2019. India continued to make impressive gains, with reductions in cases and deaths of 18 percent and 20 percent, respectively, over the last 2 years. There was, however, a slight increase in the total number of cases among HBHI countries, from an estimated 155 million in 2018 to 156 million in 2019.
Meeting global malaria targets
This year’s report highlights key milestones and events that helped shape the global response to the disease in recent decades. Beginning in the 1990s, leaders of malaria-affected countries, scientists and other partners laid the groundwork for a renewed malaria response that contributed to one of the biggest returns on investment in global health.
According to the report, 21 countries eliminated malaria over the last two decades. Out of these, 10 countries were officially certified as malaria-free by WHO.
‘In the face of the ongoing threat of antimalarial drug resistance, the six countries of the Greater Mekong sub-region continue to make major gains towards their goal of malaria elimination by 2030.
But many countries with a high burden of malaria have been losing ground. According to WHO global projections, the 2020 target for reductions in malaria case incidence will be missed by 37 percent and the mortality reduction target will be missed by 22 percent.
WHO’s work on malaria is guided by the Global technical strategy for malaria 2016-2030 (GTS), approved by the World Health Assembly in May 2015. The strategy includes four global targets for 2030, with milestones along the way to track progress. The 2030 targets are these: Reducing malaria case incidence by at least 90 percent and reducing malaria mortality rates by at least 90 percent.
Eliminating malaria in at least 35 countries and preventing a resurgence of malaria in all countries that are malaria-free are also included in the package.
Near-term GTS milestones for 2020 include global reductions in malaria case incidence and death rates of at least 40% and the elimination of malaria in at least 10 countries. According to the report, the 2020 milestones for malaria case incidence and mortality rates will be missed: For instance on the case incidence
WHO projects that, in 2020, there were an estimated 56 malaria cases for every 1000 people at risk of the disease against a GTS target of 35 cases. The GTS milestone will be missed by an estimated 37 percent.
On the mortality rate, the estimate for globally projected malaria deaths per 100 000 population at risk was 9.8 in 2020 against a GTS target of 7.2 deaths. The milestone will be missed by an estimated 22 percent.
According to WHO African Region since 2014, the rate of progress in both cases and deaths in the region has slowed, attributed mainly to the stalling of progress in several countries with moderate or high transmission.
In 2019, six African countries accounted for 50 percent of all malaria cases globally: Nigeria 23 percent, the Democratic Republic of the Congo 11 percent, Tanzania 5 percent, with Niger, Mozambique and Burkina Faso at 4 percent each.
In view of recent trends, the African Region will miss the GTS 2020 milestones for case incidence and mortality by 37 percent and 25 percent respectively.
‘High burden to high impact’ (HBHI) was launched in November 2018, building on the principle that no one should die from a disease that is preventable and treatable.
It is led by 11 countries that, together, accounted for approximately 70 percent of the world’s malaria burden in 2017: Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania.
‘Over the last two years, all 11 HBHI countries have implemented activities across four response elements. The list includes the political will to reduce the toll of malaria, strategic information to drive impact, better guidance, policies and strategies as well as a coordinated national malaria response
Between 2000 and 2019, 10 countries received the official WHO certification of malaria elimination: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Kyrgyzstan (2016), Sri Lanka (2016), Uzbekistan (2018), Paraguay (2018), Argentina (2019) and Algeria (2019).
In 2019, China reported zero indigenous cases of malaria for the third consecutive year; the country recently applied for the official WHO certification of malaria elimination. In 2020, El Salvador became the first country in Central America to apply for the WHO malaria-free certification
In the six countries of the Greater Mekong subregion – Cambodia, China (Yunnan Province), Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam – the reported number of malaria cases fell by 90 percent from 2000 to 2019, while P. falciparum (Pf) cases fell by 97 percent in the same time period.
This accelerated decrease in Pf malaria is notable in view of the threat posed by antimalarial drug resistance in the subregion.
A call for innovation Eliminating malaria in all countries, especially those with a high disease burden, will likely require tools that are not available today.
In September 2019, the WHO Director-General issued a ‘malaria challenge,’ calling on the global health community to ramp up investment in the research and development of new malaria-fighting tools and approaches. This message was further reinforced in the April 2020 report of the WHO Strategic advisory group on malaria eradication.