Johannesburg. Sub-Saharan Africa is disproportionately affected by malaria. This region accounts for 95 percent of the world’s malaria cases. The disease kills an African child every 60 seconds. These figures are frightening. But malaria is preventable and treatable.
The progress made between 2000 and 2015 is testament to what can be achieved. Support from global donors helped reduce malaria deaths among children under the age of five from 723,000 to 306,000. Most deaths were prevented in sub-Saharan Africa. Of the 106 malaria-endemic countries, 55 showed a 75 percent reduction in new malaria cases by 2015 compared to 2000.
But in 2016, the global malaria response stabilized. In some areas it even went backward. Malaria cases and deaths increased as national malaria control programs competed with other health challenges. The World Health Organization (WHO) and other partners made urgent calls to address the challenges facing national programmes. But the gap in funding and technical capability widened. Malaria control efforts in Africa have lagged badly in meeting 2030 elimination targets. And then the COVID-19 pandemic struck
At the start of the epidemic, there were dire warnings of catastrophic disruptions to routine malaria services. These were expected to double the number of malaria deaths in Africa. Disruption also came. But national malaria control programs have shown impressive progress over the past three years. The innovative actions saw only a 10 percent increase in malaria deaths between 2019 and 2020. Malaria deaths did not double, and remain stable in 2021.
Now, the fight to eliminate and eventually eradicate malaria has become even more challenging. Challenges include the impact of climate change on the spread of malaria-carrying mosquitoes; In addition, the invasion and spread of new mosquito species is increasing rapidly; Also drug-resistant malaria parasites and insecticide-resistant mosquitoes are emerging. However, there is hope on the horizon. After decades of intense research, two new malaria vaccines have come on the market. And researchers are developing new treatments and experimenting with different drug combinations. Maybe not until 2030, but malaria can be eradicated.
History In 2000, the United Nations launched the Millennium Development Goals. One of the goals was to reduce the burden of malaria by 75 percent by 2015. This catalysed significant investment, particularly in sub-Saharan Africa. Between 2000 and 2015, funding from international donors, primarily the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US government-led Presidential Malaria Initiative, fueled national malaria control programs in Africa.
As of 2015, over 150 million insecticide-treated bed nets; 17 crore 90 lakh Malaria Rapid Diagnostic Tests; and 153 million doses of a WHO-recommended malaria treatment – artemisinin-based combination therapy (ACT) – distributed across Africa. Encouraged by progress toward malaria elimination, WHO launches Global Technical Strategy for Malaria . The strategy provided a roadmap for malaria-endemic countries to reduce malaria transmission. The ultimate goal was to make the world malaria-free by 2030.
Unfortunately, with the release of this strategy came a decrease in domestic and international funding, leading to a spike in malaria cases. In 2016, there were 216 million cases – 50 million more than in 2015. Ninety percent of the new cases were in Africa, where funding for effective malaria control fell short of the continent’s 42 percent.
Failures and challenges The global malaria response now faces new challenges. Climate change experts predict that as the Earth warms, malaria will spread to areas that are currently malaria-free. Malaria mosquitoes and parasites will develop rapidly. In addition, environmental changes associated with human activities, such as deforestation, are also expected to spread to more areas of mosquitoes and to change the nature of the diseases they carry. The recent invasion and rapid spread of the Asian malaria mosquito, Anopheles stephensi, in the Horn of Africa and Nigeria may be an example.
It has been identified as a threat to malaria elimination efforts in Africa. This species of mosquito is extremely difficult to control. It thrives in urban areas, is equally invasive indoors and out, bites animals and humans, and is resistant to many insecticide classes. Fully aware of the threat this mosquito poses to malaria control in Africa, WHO issued an initiative to slow the spread of this vector to the rest of Africa.
Western Hemisphere In 2021, WHO took the bold step of approving the use of the RTS,S malaria vaccine in countries with a high burden of malaria, despite a very modest efficacy of less than 40 percent. A newer version of the RTS,S vaccine, the R21 vaccine produced by the Jenner Institute at Oxford University, has shown very high efficacy in a phase III trial. This has prompted Ghana and Nigeria to approve its use this month without prior approval from the WHO. Researchers are developing new, more effective anti-malarial vaccines. Others are trying to make them effective by using different combinations of existing drug and antibodies for effective treatment of malaria.
New, more effective insecticide-treated nets are being produced. And genomic surveillance is a new tool in the malaria elimination toolbox to aid evidence-based decision making.
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